Medicare

As with any information, the best place to go is the source! The Centers for Medicaid and Medicare Services(“CMS”) oversees administration of the two federally funded and supported health programs and can give you insight into how both Medicare and Medicaid work. For more information, go to http://www.cms.gov. As with any information, the best place to go is the source! The Centers for Medicaid and Medicare Services(“CMS”) oversees administration of the two federally funded and supported health programs and can give you insight into how both Medicare and Medicaid work. For more information, go to http://www.cms.gov.

Here is some more information from the American Society of Clinical Oncology that might be helpful: http://www.cancer.net/patient/All+About+Cancer/Managing+the+Cost+of+Cancer+Care/Financial+Resources In our experience medical debt crisis is a large concerns for patients who contact Patient Advocate Foundation. Many cancer patients have inadequate insurance or none at all and due to affordability, pre-existing clauses or a multitude of other reasons find themselves in this situation upon diagnosis. Some of the areas a patient can explore depending on income, asset and qualifiers are to apply for governmental programs such as Medicaid and/or Medicare, obtaining charity care and/or financial assistance through medical facilities, and obtaining necessary medications through prescription assistance programs or other state/national medication assistance programs (www.needymeds.com). Patients can explore clinical trials as a feasible option for access to care as well. It is always important to explore insurance options such as enrolling in plans offered at their own place of employment or their spouses. Children now can remain enrolled or re-enroll in their parents plan up until age 26 under healthcare reform, explore high risk pools or pre-existing health insurance plans (www.pcip.gov) now mandated by healthcare reform in each state, guarantee issues plans, individual/group insurance, and COBRA options. Georgetown University has an excellent website, http://www.healthinsuranceinfo.net that is a state by state consumer guide on how to get and keep health insurance and addresses topics I outlined here.

If the patient is insured is underinsured meaning he/she has health insurance coverage but lacks the financial resources needed to cover out-of-pocket expenses for medical care. Or underinsured when access to medical services is inhibited as the direct result of insurance benefit exclusions the patient can follow the same options as listed above. If they are insured through an employer who offers more than one plan, they should consider switching their benefit plan to a better option come open enrollment or if there has a been a qualifying event. Also there are many co-pay relief programs available such as our own Co-Pay Relief (www.copays.org)that can offer financial relief to qualified patients.

PAF is here to provide support to any patient with cancer who has difficulty accessing care regardless of their insurance status. We can be reached at 800-532-5274.

Here is some additional information from the American Society of Clinical Oncology: http://www.cancer.net/patient/All+About+Cancer/Managing+the+Cost+of+Cancer+Care/Financial+Resources The impact on Medicare Part D as a result of healthcare reform provides the following relief, while small a stepping stone to the closure of the gap as anticipated in the year 2020. For this year (2011) manufacturer’s are to offer a 50% discount on brand name prescription drugs and 7% discount on generic prescription drugs. Over the next ten years, Medicare beneficiaries will receive additional savings on brand name and generic drugs until the coverage gap is closed in 2020.

I don’t have concrete evidence based on your message if the medication you have a large out of pocket expense is a result of a grandfathered drug under Part B or more common drug covered under Part D which you must elect to enroll. Either way if you have insurance coverage for the medication I would strongly encourage exploring co-pay relief programs such as our own Co-Pay Relief (www.copays.org) they offer a 12 months look back period if approved, which is especially helpful for money you are out of pocket currently. Other copay programs are Assistance Fund, Cancer Care, Chronic Disease Fund, Inc, Healthwell Foundation, Leukemia and Lymphoma Society, National Organization for Rare Disorders, Patient Access Network Foundation, Patient Advocate Foundation Co-Pay Relief, and Patient Services Incorporated. Qualifiers all vary based on disease, drug, income levels.

Depending on the household income and asset level you should look into programs such as the Medicare Savings Program, there are programs that help millions of people with Medicare save money each year. States have programs for people with limited income and resources that pay some or all of Medicare’s premiums and may pay Medicare deductibles and coinsurance. You can learn more by visiting www.medicare.gov See publication #10126. I have listed below each of the programs. These figures do change each year and can vary per state but the following are for 2011:

QMB- Qualified Medicare Beneficiary - Covers part A and B premiums, and other cost-sharing (like deductibles, coinsurance and co-payments)
• Individual Monthly Income limit $903.50
• Married Couple Monthly Income limit $1215.00
SLMB- Specified Low-Income Medicare Beneficiary -Covers part B premiums only
• Individual Monthly Income limit $1,083.00
• Married Couple Monthly Income limit $1,457.00
QI- Qualifying Individual- Covers part B premiums only
• Individual Monthly Income limit $1219.00
• Married Couple Monthly Income limit $1,640.00
QDWI- Qualified Disabled & Working Individuals-Covers part A premiums only
• Individual Monthly Income limit $1825.00
• Married Couple Monthly Income limit $2448.33

A government program is also available to discount the amount a beneficiary pays for their medications. Eligibility is based on income and assets.
Also referred to as the “Extra Help Program.” The 2011 Guidelines are listed below and help Medicare recipients with premiums, deductibles and co-pays/coinsurance.
• If your yearly earnings and resources are:
• $21,855 married w/resources <$25,010
• $16,245 single w/resources <12,510
• If you qualify, you can enroll into a Medicare part D plan at any time.
o Online at www.socialsecurity.gov
o See publication #11318-AA


Additionally, explore your state to see if they offer a prescription drug program (pays for premiums or discounts.) http://www.rxassist.org/patients/res-state-programs.cfm

You should always review your current Part D or Advantage plan coverage annual during open enrollment to see if you are enrolled in the best cost effective plan as well. PAF case managers are available to provide support as well. I hope this information was helpful.

Medicare offers a hospice benefit and many employer or private health insurance plans also include hospice benefits, although coverage for services varies.

For more about hospice, see our article: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue3.cfm
Medicare offers a hospice benefit and many employer or private health insurance plans also include hospice benefits, although coverage for services varies.

For more about hospice, see our article: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue3.cfm

There are multiple strategies that may be employed to help with unpaid medical bills. You may want to discuss options with your treatment facilities on ways to reduce or eliminate your out of pocket expenses:

For assistance with Part A or B cost, apply for financial assistance through the billing office at your provider’s office or medical facility.

You may first need to apply and be denied for Medicaid or one its programs, such as Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiaries (SLMB) Program to qualify for financial assistance from the hospital. To apply contact your State Department of Social Services in the State where you reside.

Co-pay relief programs may be able to cover some of your pharmaceutical co-payments. Check with each program to see what is covered. You can also contact Patient Advocate Foundation’s Co-Pay Relief Program at 1-866-512-3861 to see if you qualify for assistance with your co-payments or explore websites such as www.pparx.org for a list of programs by disease.

Negotiate discounts or payment plans with the hospital or medical provider. Some providers will offer a discount for prompt payment of your balance.

Drug replacement programs may be available to assist you by providing medications to your physician’s office specifically for your use. Discuss these programs with your physician.

Contact a disease specific organization to see if there are any financial grants available to assist you. These programs vary widely and may pay for transportation or other related expenses. Patient Advocate Foundation’s National Underinsured Resource Directory can lead you to the best resources for you needs. Visit http://www.patientadvocate.org/help4u.php

For assistance with Part D cost, apply for Extra Help through www.ssa.gov that offers qualified individuals with extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug Program.

Some states offer a State Prescription Assistance Plan. Explore the site http://www.needymeds.org/state_programs.taf to learn more about the your state.

Discuss generic alternatives with your physician if brand named drugs are too costly.

We encourage the review of our publication, A New Approach: A Simple Dialogue between the Patient and Provider about the Cost of Medical Care available at http://www.patientadvocate.org/pdf/pubs/a_new_approach.pdf.
There are multiple strategies that may be employed to help with unpaid medical bills. You may want to discuss options with your treatment facilities on ways to reduce or eliminate your out of pocket expenses:

For assistance with Part A or B cost, apply for financial assistance through the billing office at your provider’s office or medical facility.

You may first need to apply and be denied for Medicaid or one its programs, such as Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiaries (SLMB) Program to qualify for financial assistance from the hospital. To apply contact your State Department of Social Services in the State where you reside.

Co-pay relief programs may be able to cover some of your pharmaceutical co-payments. Check with each program to see what is covered. You can also contact Patient Advocate Foundation’s Co-Pay Relief Program at 1-866-512-3861 to see if you qualify for assistance with your co-payments or explore websites such as www.pparx.org for a list of programs by disease.

Negotiate discounts or payment plans with the hospital or medical provider. Some providers will offer a discount for prompt payment of your balance.

Drug replacement programs may be available to assist you by providing medications to your physician’s office specifically for your use. Discuss these programs with your physician.

Contact a disease specific organization to see if there are any financial grants available to assist you. These programs vary widely and may pay for transportation or other related expenses. Patient Advocate Foundation’s National Underinsured Resource Directory can lead you to the best resources for you needs. Visit http://www.patientadvocate.org/help4u.php

For assistance with Part D cost, apply for Extra Help through www.ssa.gov that offers qualified individuals with extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug Program.

Some states offer a State Prescription Assistance Plan. Explore the site http://www.needymeds.org/state_programs.taf to learn more about the your state.

Discuss generic alternatives with your physician if brand named drugs are too costly.

We encourage the review of our publication, A New Approach: A Simple Dialogue between the Patient and Provider about the Cost of Medical Care available at http://www.patientadvocate.org/pdf/pubs/a_new_approach.pdf.