Thrive Co-Pay Assistance Program is a 501 C(3) charity with the goal of improving health outcomes, and quality of life, through provision of services that increase access to medical care for individuals who are low-income and actively enrolled in Medicare. The idea for the ur charity was formed through the collaborative efforts of professionals who work in the area of either health insurance or medical care and share a common concern for the ability of this patient group to afford the often costly out of pocket charges associated with medical visits, laboratory screenings, and medications. Through their respective forms of employment, members of the Thrive board bear witness to the struggle patient’s face when having to choose between medical care and medications or other livelihood items such as food, utilities, rent or mortgage. In a pinch, doctor’s appointments are cancelled, medications are left on the shelf and overall health, wellness and quality of life diminish. Strive aims to prevent such scenarios. If awarded funds under Cenpatico’s Community Reinvestment grant, Strive will utilize the opportunity to make healthcare more affordable for underserved populations promote wellbeing across Southern Arizona.

In 2014, Arizona expanded eligibility criteria for the state’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS). While the expansion provided a wonderful opportunity for uninsured, low-income individuals to access affordable healthcare, the expansion was not seen as incredibly beneficial for individuals who qualified for Medicare (>65 years of age or disabled). Medicare patients, unlike those supported exclusively under AHCCCS, are responsible for financial contribution towards premiums, deductible, and other out of pocket costs such as copays and cost shares. Prior to implementation of the Affordable Care Act in 2014, low-income people on Medicare could enroll in AHCCCS to assist with such costs. AHCCCS acted as a secondary payer and it is important to note that patients could only use the program in this manner; they were not able to drop the Medicare plan and rely on AHCCCS as the only carrier. Post 2014, we find that these individuals are in a particularly vulnerable situation as they often cannot work and are unable to pay for costs associated with the Medicare plan. Individuals who are on Medicare receive money from the United States Social Security Office to support their livelihood and the average monthly income for a single household hovers around $1,200.; slightly over 140% of the Federal Poverty Guidelines issued by the Department of Health and Human Services. At 138% above the Federal Poverty Guideline, just 2% less than the average income for someone on Medicare, Arizonans meet eligibility criteria for a variety of social services including AHCCCS, Food and Cash Assistance through the Department of Economic Security, and possible rental support through programs like Section 8 under Housing Management. Low-income people on Medicare might qualify for assistance with health insurance premiums; however, are at quite a disadvantage as they have limited options for financial support and monthly income from Social Security is expected to cover all of their needs. While Thrive is not able to support the full scope of individual needs, our goal is to help offset the financial burden associated with medical care and increase the quality of life for the people we serve. Without a lower level of stress and concern, we hope our clients will be able to continue to attend their medical appointments, take their medications and obtain clinical care that, in turns, supports that ability to live a more healthy and balanced life.

The Thrive Co-pay Assistance Program is a Payer of last resort. Applicants will be required to consult with a licensed insurance agent and discuss healthcare coverage options that are cost efficient and also sufficient to support the specific medical needs of the client.

Thrive Co-Pay Assistance Program, when and if funds are available, will help provide an approved applicant with up to $1,000 per year with financial support towards medical costs. If funding beyond $1,000 per year is required, clients will be provided with an opportunity to submit a request for override of funding cap. Patients will be required to submit a request for override and include an estimate, issued from the medical provider, itemizing pending service costs. The program will review the documentation and authorize financial support based on funding availability. Funding will be restricted to outpatient services and will not cover medical care associated with emergency room visits, inpatient stays and cosmetic services. Clients will be provided with a card, including contact information for Strive and instructions for confirmation of payment that can be presented to medical providers prior to the medical. Strive will be available Monday through Friday, 9am – 5pm, to receive calls, review he service request and authorize payment. Payments will be issued directly to the medical provider; Strive will not reimburse clients directly. Patients will be notified by mail and phone call when they have met the $1,000 cap for the calendar year.

Thrive Co-Pay Assistance Program Qualification Guideline’s:

Resident of Arizona
Household income falls between 110%-400% of the Federal Poverty Level
Active enrollment in Medicare Part A and Part B
Applicant attestation that they will notify Strive of income or residency changes within 30 days

We are able to help cover the following cost:
Out of pocket costs associated with outpatient medical care
Outpatient care includes services provided by a primary care physician, specialty or behavioral health provider, outpatient procedures, lab, radiology and diagnostic services
Prescription medications (LIS through social security would need to be applied for on a regular basis)
Medical equipment
We are not able to cover the cost or copayments for the following:
Emergency room, including observation
Inpatient stays
Cosmetic services
Health Plan Premiums
Elective medical procedures