Changes to Medicare Part D in 2024 and 2025

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The Inflation Reduction Act of 2022 put into play some major changes to Medicare Part D enrollees. The purpose of the changes was to reduce out-of-pocket costs for prescription drugs.

I always recommend Medicare enrollees review their current plan and current and anticipated medications to make sure they have the best plan for optimal coverage. Always remember that there is a separate co-pay, deductible, premium, and max out-of-pocket from your Medicare health insurance plan. 

Let’s review these upcoming changes to the current plan. In 2023, there are 4 distinct Phases to Medicare Part D, where the cost-sharing drug costs paid by Part D enrollees, Part D plans, drug manufacturers, and Medicare varies. 

Comparisons 2023-2025: 

  1. Deductible phase

    Enrollees pay 100% of their drug costs, up to $505. Note: not all Part D plans charge a deductible, however in the stand-alone Part D plans, many enrolled are responsible for a standard deductible.

  2. Initial Coverage phase

    Part D enrollees pay 25% of total drug costs and Part D plans pay 75%, up to total costs of $4660. Most Part D plans charge a mix of copayments and coinsurance rather than a standard 25% coinsurance rate.

    2025 changes     – Drug manufacturers will be required to provide a 10% discount on brand-name drugs. This will replace the 70% price discount in the coverage gap phase under the current benefit design. Part D plans will pay 60% of brand-name drug costs.

  3. Coverage Gap phase

    Part D enrollees pay 25% of the total drug costs for both brand-name and generic drugs. Part D plans pay the remainder 75% of generic drug costs and 5% of brand costs.  Drug manufacturers provide 70% price discounts on brands. Note there is no manufacturer price discount on any generic drug.

    2025 changes include    : A new $2,000 out-of-pocket cap. (This cap does not apply to out-of-pocket spending on Part B drugs), elimination of the coverage gap phase, a higher share of drug costs paid by Part D plans in the catastrophic phase, along with a new manufacturer price discount and reduced liability for Medicare in this phase, and changes to plan costs and the manufacturer price discount in the initial coverage phase.

  4. Catastrophic phase

    Medicare pays 80% of total drug cost, part D plans pay 15% and Part D enrollees pay 5%. Part D enrollees qualify for catastrophic coverage when the amount that they pay out of pocket plus the value of the manufacturer discount on the price of brand-name drugs in the coverage gap phase exceeds a certain threshold amount set at $7,400,  of which enrollees pay $3100 out of pocket before reaching catastrophic phase. This is based on the cost of brand-name drugs only.

2024 Changes – 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plan will pay 20% of total drug costs instead of 15%. For Part D Enrollees without low-income subsidies, once drug spending is high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, meaning out-of-pocket is capped. 

2024 Changes – the catastrophic threshold is capped at $8,000. This includes what Part D enrollees spend out of pocket plus the value of the manufacturer price discount on brands in the coverage gap phase. Meaning, in 2024 Part D enrollees who take only brand-named drugs will have spent about $3300.00 out of pocket and then will have no more additional cost for these drugs.

2025 Changes – Medicare’s share of total cost in the catastrophic phase (reinsurance, ) will decrease from 80% to 20% for brand-name drugs and from 80% to 40% for generics. Medicare Part D plans’ share of the costs will increase from 15% to 60% for both brands and generics above the cap, and drug manufacturers will be required to provide a 20% price discount on brand-name drugs. 

This is very important for those who are taking high-cost cancer drugs such as Revlimid, Pomalyst, Imbruvia, Jakafi, and Ibrance. These drugs have the highest per capita Part D expenditures in 2021. The annual out-of-pocket costs for these cancer drugs range from $11,000 to almost $15,000, and in the catastrophic phase, out-of-pocket costs per drug in 2021 ranged from around $8,000 to nearly $12,000. So eliminating the 5% coinsurance requirement in the catastrophic phase in 2024 means that Part D enrollees without low-income subsidies who use these and/or other high-cost cancer drugs covered by Part D will realize thousands of dollars in savings. You can see the savings especially if you use more than one of these medications.

Additional Changes to Medicare Part D

2024 Changes

  • People with Medicare who have incomes up to 150% of federal poverty level and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under Part D Low-Income Subsidy (LIS) Program. The partial LIS benefit currently in place for individuals with incomes between 135% and 150% of Federal Poverty Levels.will be eliminated.
  • The calculation of the base benficiary premium will be adjusted, as needed, to limit the increases in the base premium to no more than 6% from prior year values. Note: Premiums for individual Part D premiums and annual plan-level premium increases will continue to vary.

2025 Changes

  • Part D enrollees will have the option of spreading out their out of pocket costs over the year rather than face high out of pocket costs in any given month. 

So how do you decide how to choose Medicare Drug coverage?

Take an inventory of your needs, now and in the near future. Look at your priorities. Here are a few things to consider when planning:

  1. What are the drugs you are taking or anticipate taking? Make sure the drug plan you are considering are on that plans formulary. Then, compare the costs.
  2. If you need protection forn high prescription costs, as is very common for a lot of cancer drugs, look for drug plans offering coverage in the coverage gap, if applicable, and check with these plans to make sure they cover your drugs in the gap.
  3. If you need to make sure your drug costs share is balanced throughout the year, refer to drug plans with no or low deductibles, or with additional coverage in the coverage gap.
  4. If you take a lot of generic medications, look at a Medicare drug plan with tiers that charge you nothing or low copayments for generics.
  5. If you don’t have many drug cost now but want to make sure you have coverage “just in case” to avoid future penalties and for peace of mind, consider Medicare drug plans with low monthly premiums. If you need prescription drugs in the future, all plans must cover most drugs used by Medicare enrollees.
  6. If you prefer the extra benefits and lower cost available by getting your healthcare and prescription drug coverage from one plan, and, you don’t mind possible restrictions on the doctors, hospitals and other heathcare providers you can use, then consider a Medicare Advantage Plan which has this all bundled into one. Again if you have multiple specialist and complex healthcare needs consider your options carefully.

Again, I encourage everyone to review their options and make the beat choice for you and your family. And most importantly, review yearly.  Don’t just look at the cost of premiums when making a decision. When you have expensive medications especially for cancer, it’s important that you stay on treatment. Knowing your options ahead of time and planing for associated cost will help prevent you from beoming financially stressed. Talk with your healthcare provider’s. Ask about generic medication options. Work with the social workers or patient advocates at your healthcare center to search out co-pay, deductible, premium assistance programs available from pharma as well as non-profits that can help you meet your financial obligations for out of pocket expenses.

Resources:

Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit

Medicare.gov

Negotiating Debt, Managing Your Finances and Gaining Financial Security

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Debt can be crushing. It can cause people to delay marriages, purchasing of a home and even decline or delay needed medical treatment. In fact, one of the leading causes of bankruptcy is medical debt. Many people are unaware that they can negotiate their debt with many creditors, It pays to be aware of the options you may have. I’m going to review some of these negotiation options with you. This list is not exhaustive. If you have bills that you’re having a hard time managing, don’t be afraid to ask your creditor. Understand how debt default can affect your credit and can lead to legal action including the seizure of property. Don’t let this happen to you.

Tax Debt

If you have outstanding debt with the IRS, talk to them. It’s important to understand that interest and penalties will continue to accrue on any outstanding balances. The sooner you speak to them the better off you’ll be. You may not be able to completely eliminate your debt, but you may be able to get it reduced or set up payment arrangements that will make it more manageable. Most creditors, from the mortgage company to hospitals to loan companies are willing to discuss your situation. For many people who delayed or did not file a 2021 tax return, penalties can accrue at a 5% rate of the unpaid taxes for every month until reaching a 25% cap. Additionally, interest will compound daily at a current rate of 7%. This interest rate may go higher if the Federal Reserve raises rates. There is also a late filing payment penalty of .05% of the unpaid taxes, an amount that accrues monthly. You can see how your outstanding debt can increase significantly. Unpaid taxes can lead to garnishment of wages, money can be taken from checking and savings accounts and the IRS can seize real estate and vehicles.  

If you owe delinquent taxes, contact the IRS and set up a payment plan. If you don’t have the income or resources to pay taxes, taxpayers can apply for an “offer in compromise,” which can reduce the overall tax liability. Another option is to ask the IRS to report the debt as currently not collectable. This will temporarily suspend certain collection actions such as seizure of property. This action does not erase debt and it will also continue to accrue interest. I would caution taxpayers to be aware of scammers that say they offer assistance with the IRS. Do your due diligence 

The collection process and penalties assessed vary greatly depending on circumstances. Many people are unaware that if you live in a federally declared disaster area or are a member of the military serving in a combat zone, exceptions can be made. 

Mortgage Debt

Many people remember the many homeowners that found themselves upside down on their mortgages in 2008-2009. Consequently, many lost their homes, 

According to the New York Federal Reserve Board, in the last quarter, 0.57% of all mortgages were seriously delinquent. There is a concern that with the rising interest rates along with the higher house payments, delinquency levels may rise in the coming years. Homeowners who are significantly behind in their mortgage payments should contact their mortgage servicer immediately. Describe your situation and how you plan to repay what is owed. Missing mortgage payments will hurt your credit score, so consider asking your loan services for a loan forbearance, which will pause or reduce your mortgage payments. The missed payments which are due at the end of the term will include interest during the forbearance period. You can also ask for a payment plan arrangement. Also, some portage servicers will offer a payment deferment in which the missed payments are added to the end of the home loan. The homeowner must be aware that if the mortgage debt continues to accrue, the loan servicer may push the homeowner to sell the property. 

Credit-card Debt

In an environment where interest rates are rising, credit card holders can find themselves in trouble when their purchases and interest charges snowball to the point where they can’t make the minimum payments. It may pay to seek help from the National Foundation for Credit Counseling. It is a collection of non-profit member agencies that help consumers develop a plan to both reduce their living expenses and pay outstanding debts. The counselors work with your credit card company to make the payments more affordable. The payments are made to the agency which disperses the money to the creditors. The credit card companies may vary in their assistance. Consumers will need to provide documentation of the extenuating circumstances that led to the debt. You can also reach the credit card company yourself and save money on fees and negotiate with them directly.

Student-Loan Debt

Many older people are finding that they’re holding student debt for adult children. Also, student loan holders find themselves in limbo waiting for the supreme court to rule on the legality of President Biden’s plan to forgive up to $10,000 per person in federal loans and up to $20,000 in federal loans to borrowers who also received Pell Grants. Borrowers can assess whether their monthly payments are still manageable once the pause ends. If not, contact the loan services and inquire about deferment and/or forbearance options, as well as other repayment plans. 

Medical Debt

Almost a quarter of all US adults say they have past due medical bills including bills they cannot afford to pay, according to the Kaiser Family Foundation. There are options to help manage the burden of medical debt. One of the first things a person can do is prepare for the cost of a procedure. Ask about the cost as soon as possible. Also make sure you understand your insurance and what it will and will not pay. Thirdly, make sure your medical bills are accurate. Upwards of 80% of medical bills are incorrect. Don’t pay a bill unless you have verified the itemized expenses with the Evidence of Benefit statement. If there are errors you can file an appeal. Many hospitals have charitable programs to help patients cover medical bills. They can also help you establish a payment plan to pay your outstanding bills. You can ask if the bill can be reduced to an amount you can pay. It doesn’t hurt to ask. Be prepared to provide documentation, such as proof of income, insurance, disability and even your proximity to the facility if travel expenses are significant.  

Patients can apply for grants through the Patient Advocate Foundation and other non-profit organizations. Funding comes mostly from private donations and health-related nonprofits devoted to specific ailments, such as the Leukemia and Lymphoma Foundation. 

Some healthcare providers offer medical credit cards to their clients. They come with no or low interest introductory rates that will later reset to a high rate. Consumers should be aware that these rates may be higher than that of regular credit card rates. It pays to take this into consideration before signing on the dotted line.  

 

Don’t be afraid to ask for help with any of your creditors. Getting control of your finances will reduce financial stress and allow you to focus on more important things in life.  

Hospital Charity Programs: What You Need to Know

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Understanding Hospital Charity Programs

Many of you may be aware that some laws have changed regarding reporting of medical debt to credit agencies. Those new laws are most favorable to individuals. Particularly for those patients who have frequent doctor visits and accrue numerous bills. However, it is most surprising to me that many patients are not aware of the many programs that can help them pay for medical care that they have amassed. Here is the low-down on what you need to know in order to access these charitable funds if you are going to a non-profit or a for-profit hospital for your care. 

What is a Hospital Charitable Program and How can you access it?

According to the IRS, Non-Profit hospitals or NFP’s are those hospitals that are not required to pay property-tax, state or federal income tax, or sales tax. Non-profit hospitals account for nearly 58% or three fifths of community hospitals and provide charity programs. Parameters are set by federal regulation in addition to charity-care policies that are set up by individual hospitals. The policies set up by individual hospitals can vary in terms of eligibility criteria, application procedures, and the level of charity provided. Hospitals bear the direct costs of providing charity care, support from donors and federal, state, and local governments may cover some or even all of these expenses.  

In exchange for tax-free status, nonprofit hospitals are expected and required to distribute any additional capital back into their surrounding communities. Because of this, non-profit hospitals face additional scrutiny by healthcare policymakers concerned as to whether and how the facilities are following through and contributing to their communities in a meaningful way to justify the tax exemptions that they are receiving. They question how the funds in the communities are being spent. 

You should know the type of  facility you are visiting. Don’t be afraid to ask. Find out about their charity and community programs. Many states have required that this information be readily available to patients. Unfortunately this isn’t always the case. Ask for a copy of their charity plans and how to access it. Get names and the phone number of people who manage it.  

For-profit hospitals are investor-owned. These facilities aim to make profits for their shareholders. Some of the largest for-profit hospital chains in the U.S. include Hospital Corporation of America,And HealthSouth. Not surprisingly, for-profit hospitals are generally among the highest-billing hospitals in the country.  

How do they compare?

Day to day functions look very much the same between the two types of organizations One very distinct difference however, is that for-profit hospitals typically use considerable portions of their available budget for marketing and advertising initiatives, as compared to non-profit facilities. For-profit hospitals tend to serve lower income populations while nonprofit hospitals are generally found in communities with higher average incomes and fewer under and uninsured patients.  

Consequently, nonprofit hospitals maintain higher bad-debt to net patient revenue ratios than for profits, although for profits with the highest bad debt to net patient revenue ratios tend to maintain higher ratios than nonprofit facilities. 

A study done in 2020 found that nonprofit and for-profit hospitals provide similar levels of charity care-another type of uncompensated care-when examined as a percentage of total debt. 

The Internal Revenue Service defines charity care or financial assistance, as “free or discounted health services provided to persons who meet the organization’s eligibility criteria for financial assistance and are unable to pay for all or a portion of the services provided”. In some cases depending on their criteria hospitals may provide charity care to both uninsured and insured patients.  

Who is eligible for hospital charity care?

Hospitals have a lot of flexibility to establish their own criteria for charity care. For instance, one analysis of a large sample of nonprofit hospitals that used the Federal Poverty Level to determine eligibility for free care in 2018, found that about one in three (32%) of the hospitals required patients to have incomes at or below 200%  the FPL or imposed more restrictive eligibility criteria, while the remaining sample (68%) relied on higher income caps. For discounted care, (62%) of nonprofit hospitals in the study limited eligibility to patients with incomes at or below 400% FPL or used lower income levels. The remaining (38%) rely on higher income caps. 

The conditions that hospitals put on the free or discounted care can vary. Patients may need to have few assets or must live in hospital service areas. Other criteria may also become  determining factors for free or reduced care.   

Unfortunately, from my experience, all patients are not getting access to this free reduced care because the information is not readily available or they don’t know that they may be eligible. For example, non-profit hospitals have estimated that  of the bad debt they reported in 019 reflecting 2017 expenses or earlier, about $2.7 billion came from patients who were likely eligible for charity care but did not receive it. Now it would be interesting to see how this picture has changed post COVID. These numbers are rough estimates coming from unaudited hospital reports and do not account for all facilities or for patients who qualified for charity care but still paid their bills.  

Patients have a right to know the cost of care and where they can get help if they qualify. Don’t hesitate to ask what’s available at your care facility. Ask prior to services and after services are provided. Fill out your required documentation and do so in a timely manner. Be empowered to better your physical and financial health. 

Medical Bills Collections, and Your Credit Score and Upcoming Changes

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Many people don’t realize that their credit report may contain medical bills in collection that can seriously affect their credit score. Even if you’ve been paying your credit cards, mortgage, rent, and other reportable lines, you may be surprised that medical bills carry their own weight when reported. Fortunately, you have more leeway when addressing these bills than other regular credit lines. In addition, they can be more easily removed from your credit report after they’re paid off. You should however monitor your credit report to make sure they are removed. Don’t forget to check all 3 major Credit Reporting Agencies, Equifax, Experian, and TransUnion. 

According to the Consumer Financial Protection Bureau, approximately 31.6% of adults in the US have collection accounts on their credit reports. That’s an astounding 1 out of every 3 Americans. And, medical bills account for over half of all collections with an identifiable creditor. So, it stands to reason, that you may have a medical bill in collections. Even more probable if you’ve moved and aren’t receiving your bills. After a period of time, they are reported to a collection agency. After attempts to contact you via mail and or phone without arrangements being made by you, they will be reported to the credit agencies.  

This can be really damaging to your credit history as it can affect your borrowing interest rates, your ability to secure financing, and secure employment as many employers pull your credit report.  

Areas that you need to be aware of:

  1. Just because you have insurance and possibly good insurance, it doesn’t mean you will not owe anything. I would suggest you review your Evidence of Benefits (EOB) to get an idea of your responsibility. If in doubt about a bill, contact the medical provider as well as the insurance provider in the event of incorrect billing. 
  2. It is possible to pay a medical bill and it is still sent to collections. This can be extremely frustrating. If you’re making small payments or paying even a few days late, the bill can be sent to collections. Fortunately, you can call the collection agency and make payment arrangements with them. You are given a grace period. They give you typically 180 days before they report to the credit agencies. If you pay it off and are on time you can generally avoid it hitting your credit report. 
  3. Protections under the ACA give patients at a non-profit hospital time to apply for assistance before any extraordinary measures are taken. But remember, any unpaid balances can be and probably will be reported. I’ve seen bills hit a credit report with only a few dollars outstanding. The hit to your credit score is the same regardless of the amount! 
  4. Be sure to make payment arrangements with the medical provider and get a copy of it in writing. Then pay off the bill according to the agreement. I will say over and over again, that keeping a copy of agreements/arrangements that you have with your insurance company and provider makes good business sense in the event you find a discrepancy and need documentation at a later date.  

Managing Collection Calls

Whenever you’re contacted by a collection agency on behalf of a medical provider, have them send you a written confirmation of and a detailed itemized list of the debt as well as the right to dispute it. You have this right but you must do it in a timely manner. Again, make sure the bill is accurate. Compare it to the EOB. You should not be responsible for paying more than your responsible amount referenced on the EOB. After you’ve paid, keep a copy of the payment confirmations for a few weeks in the event you need to reference the transaction. It isn’t unheard of for things to cross in the mail, get lost, or even have payments applied to the incorrect patient account.  

If you’re concerned about your credit and or bills, get a free credit report one time a year for free through credit.com. Credit.com will also provide an easily understandable breakdown of the information on your credit report. Additionally, credit agencies can give you pointers as to how to establish and repair your credit history. Credit is a very integral part of our financial lives. Keeping a good credit history can present options such as cheaper car insurance, and better interest rates on personal loans.  

Upcoming Changes to Medical Bill Reporting

Make it a habit to review your credit reports regularly, Don’t assume you owe anything for medical visits. Ask for payment arrangements early and stick to them. Be proactive and free up time to do the things you’d rather be doing and not worry about collections and your credit report.  

The good thing about medical bills and credit is the changes that go into effect in 2023. But before I get into that, for those who currently have medical bills on their credit reports, very few of those existing bills will change. The credit reporting system has long been used as a threatening tool to try to coerce people to pay bills they may not even owe.  

Past research by the CFPB, suggests that medical collections are less predictive of future repayment risk than other collections or payment history on loans. Yet many creditors rely on older credit scoring models that penalize individuals with medical bill collections on their credit reports.  

Fortunately, as a result of the changes, two-thirds of medical collections on credit reports will no longer be reported. Starting in 2023, medical collections tradelines with less than $500 will no longer be reported to credit bureaus. For those who have relatively small outstanding bills, the $500 watermark could mean a large reduction in coercive reporting. Therefore bettering their credit scores.  

Not surprisingly there is a disparity in the beneficial impact of the proposed changes. Both geographically and racially. It is estimated that patients and families living in the northern and eastern states have a higher concentration of medical debt that is paid or they have lower medical debt balances. Consequently, these families are more likely to benefit from the changes.  

Conversely, residents of lower-income those being the majority of Black or Hispanic will realize less of a benefit from the proposed changes. This is because they may have higher bills reporting to credit because they are less likely to be able to pay down or off their medical bills due to the lack of income. Therefore it is particularly prudent that these groups pay particular attention to programs that may help them reduce their medical debt burden prior to it being reported to the credit bureaus.  

Knowing your financial responsibility ahead of treatment as well as working with your healthcare team to locate and secure payment options and arrangements can prevent the fall into financial stress. 

Self-Education Is the Basis of Better Health Outcomes, Physically, Mentally, and Financially

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We have all heard the phrase, “Hindsight is 20/20”. Yes, it can be, if we know to look and be retrospective and heed the lessons learned. However, too many of us don’t take the time to take advantage of hindsight and find ourselves caught over and over in the same tidal pool.

When my husband was diagnosed in 2002 with MGUS, the driving force for me to use as a guide to be proactive in his health as his advocate was the illness and subsequent death of my 5-year-old brother David, who was very rarely spoken of in my family. I always wondered why it was sort of secretive. I remember finding his death certificate in a chest and wondered about him for years until as a teen I asked my mother about him and his illness. You see, I was only 1-year-old when he died, I have no memory of him. What I know was told to me by my mother, many years after his death. He had leukemia, diagnosed when he was 4. At that time, it was a death sentence. He was in “treatment” but it was all experimental at the time. I asked my mother what kind of leukemia he had. She wasn’t sure. She knew she had to give him over 50 pills a day. I asked what they were, but she didn’t know. I couldn’t believe how little she knew about his illness or what was being done to him. I always felt that when hearing her tell me about David that she was guarding herself somehow. He was eventually sent home to die. Hearing the bits and pieces always struck a weird chord with me.

It was only as an adult accompanying my husband on his cancer journey with Myeloma that I began to understand the horrible cost to David and subsequently my parents and older siblings. I was always trying to investigate his illness from afar. So, now the seeds of questions that always remained with me and the illness and death of my husband has led me to where I am now. Those two experiences, especially the journey with my husband made me acutely aware on a daily basis of the urgent need for all patients to be educated in their illness, so they can openly and actively participate in their treatment not only of cancer but their overall health, mentally, physically and financially.

Overcoming barriers of bias both conscious and unconscious are still huge barriers that many patients face. Educating oneself seems to be a huge equalizer. Knowledge gives you the confidence to question, make better decisions, and to benefit from those decisions. It gives you relative peace of mind that the decisions you make are in your best interest and your family.

You may be asking how all of this comes together when in treatment for Myeloma, AML, or quite honestly, any illness. Simply, the more you know about your treatment the better equipped you are to ask the right questions about the cost of treatment, its side effects if you are going to have to take time off from work if there are other anticipated upcoming treatments that you need to prepare for. And, If your treatment is available in town or if you need to find treatment elsewhere. You can ask if there are other treatments available with perhaps less associated costs. You can prepare your personal finances and make sure your insurance coverage is the best it can be. Knowing your full treatment plan can help you gather the financial assistance you will need to help you get and stay on treatment.

There are many resources that you can easily access to educate you on your illness as well as give you information about financial resources for which you may qualify. They include help with travel for medical treatment, co-pay, deductible and premium help, utilities, lodging, and urgent financial help.

Many of the resources available today were not around to help my husband or I had no knowledge they existed and no one to inform us during his cancer journey and certainly not available to my parents with the cancer journey of my young brother in the early ’60s. Education can even be the playing field for many patients.

Becoming knowledgeable about available resources can help you control your stress levels which can benefit your overall health outcomes. And knowing that there are financial resources available to you can help alleviate some of the financial stress that comes with having a very expensive illness.

In one of the few conversations, I had with my mother, I asked how they found out about my brother’s cancer. She said they were told over the phone. The doctor said,” Your son has cancer and is dying”. I can’t imagine living that experience. My mother said she felt hurt and angry for it being so impersonal. She said this was a hurt for which she never forgave herself. This was a time in 1961 when the disparity in healthcare was even more glaring than it is today. My parents didn’t know how or were even encouraged to ask questions to participate in David’s care. David and our family suffered as a result.

I encourage everyone to take advantage of the learning opportunities available to them. Doing so will provide you with the peace of mind that you are getting the best care while managing the cost of your treatment and reducing overall stress to allow you to live your best life.

How Medical Financial Hardship Can Affect Your Health

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How Does Your Finances Affect Your Health?

In 2002, my husband was diagnosed with MGUS, a precursor to Multiple Myeloma. As many of you have also experienced, your life changes. At diagnosis, you probably felt you couldn’t breathe or process. All you could think of for days was cancer, cancer. And if you have been unfortunate enough to witness someone else in your family or close circle of friends with cancer you could only relate to their experience or what you thought their experience was. Good or bad..

I’ve witnessed too many people in my family battle cancer. My brother with leukemia, my father with lung cancer, my great grandfather with prostate cancer and my husband with multiple myeloma. I watched my parents struggle with the cost of his care. My mother was the caregiver to my father and stopped working to care for him. That was difficult for her because her sustainable income became almost non-existent. Fortunately, it came at a time when all but one of my seven siblings were independent and on our own. This at least was less responsibility for my mom and dad to worry about. However, because he was in the hospital a lot, and she no longer had income coming in, we all covered her daily expenses, food, mortgage, gas, water, purchased her a more reliable car, home repairs etc. We became her failsafe. Many people are not so fortunate.

My mother never spoke of the emotional or financial stress of everything to any of us, but we knew it had to be difficult. We saw the strain on her health. Her weight changed. She had trouble sleeping. Her blood pressure soared and her arthritis was always troubling her. More so than usual. My siblings who lived near would spend time helping her care for dad, and within a week of his death she had to take care of her mother who was an amputee and had Alzheimer’s.

So, it’s really not at all surprising to learn that medical financial toxicity or stress could be linked to worst cancer survival. The effects are many. Unfortunately for those who live in rural areas, have low incomes, those who are minorities, the underinsured or uninsured you already have financial stress. An expensive illness like cancer makes it all the more difficult.

My husband had great insurance from his employer. I thought at first we wouldn’t have to worry about medical bills. That is until he was at first approved for coverage for a stem cell harvesting and transplant in another hospital out of network, because there wasn’t a specialist in KY. Right after the transplant we were told treatment wasn’t going to be covered by his insurance.. After 5 weeks in the hospital!!! He became very despondent and depressed could not eat or sleep. He began to suffer with other emotional and physical issues unrelated to the illness itself. Additionally healing from the transplant was difficult. Lesson learned, having good insurance does not shield you from financial stress.

An analysis of 25,000 cancer survivors showed that financial hardship had a significant association with premature death among cancer survivors, no matter their insurance coverage. And according to K. Robin Yabroff, PhD, MBA, of the American Cancer Society in Kennesaw, GA and colleagues, almost 30% of patients ages 18-64 reported financial toxicity, which is associated with a 17% excess mortality risk compared with same-aged patients who did not report medical hardship.

In older patients, they found that financial hardship was less common with a 14% excess mortality risk. Having insurance did reduce the risk but not by much and certainly didn’t eliminate it.

An earlier study in the Journal of the National Cancer Institute found an increased mortality risk in cancer survivors who filed for bankruptcy. Though the number filing was low, medical financial hardship covers a range of economic stressors.

Some of the financial hardships associated with financial stress included; patients not adhering to or even forgoing treatment. Having problems paying for expensive prescriptions could lead to not taking medicine as prescribed to make it last longer or not getting it filled at all, In addition mental health counseling and other health issues are neglected.

How to mitigate a lot of the financial stressors that can lead to higher mortality?

Understand your illness and all aspects of your treatment. Ask your doctor to refer you to someone in the facility who can help you find financial assistance to help you manage the costs of your care and help you manage your everyday expenses. A quick google search can help you locate local, state and federal resources that may be available to you. Seek out help from organizations such as American Cancer Society, Leukemia and Lymphoma Society. There are many others. Get help with finances and budgeting CoPatient is a great organization that can determine of medical bills over $500 are accurate and fight that battle for you. Triage Cancer is a great resource to help you understand legal, and insurance information based on your state of residence.

The main takeaway is, you need to focus on healing and staying healthy. Seek out help regarding your finances so that you won’t find yourself in a financial crisis. Support groups are great sources of information.

Don’t be afraid to ask. Your health depends on it!

Is Inflation Adding to Your Financial Burden?

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The stock market was doing well, until it wasn’t. For those of you who are invested in the market, things have been going splendidly for quite a while. Then comes the virus and job closures, people leaving their jobs for better pay. Home prices went through the roof. Many people made money selling their homes at a premium but then couldn’t find a home to replace it with. Rent is exploding. The cost of food is skyrocketing. You can’t find a decently priced used or new car anywhere. Sure, you can trade that used car you currently drive for a great return, but then spend the equity you made plus more into another car.  

How do you keep right-side up with all of the changes the world is enduring right now? 

Oh Yeah! Now we have a war to contend with and the fallout of it! How about gas prices soaring, way before the usual hikes around spring break and early summer 

Can you get a break? If you’re reading this you probably have already been struggling with the high costs of one of the biggest booms… Healthcare. This economic shift is a hard one. The gears are grinding and the brakes are shrieking.  

What are steps you can take to help mitigate, the best you can in your situation, the financial stress that comes from all of this uncertainty? 

Take a deep breath and I will give you some strategic steps you can take to help alleviate your financial stress and help you make the best of a difficult situation. 

First understand you cannot control what happens economically or politically, but you do need to be aware that there are risks that we can anticipate and be ready for.  

Here are some basic questions that you can ask yourself to help identify problem areas and then where to address these concerns so you can avoid financial toxicity.  

  1. What is your main area of concern?  
  2. Is it your ability to pay for healthcare?  
  3. Are you concerned that you may not have the insurance coverage you need? 
  4. Do you need help meeting your healthcare expenses? 
  5. Are you concerned about having to leave employment early due to illness? 
  6. Are you unsure of how to keep health insurance if you need to stop working? 
  7. Are you swimming in debt and need outside help managing it? 
  8. Do you need information about SSDI, or SSI 
  9. Are you having difficulty working due to your illness? 
  10. Do you need information about ADA and FMLA? 
  11. What resources do you have that you can use strategically to help you manage your overall expenses? 

I know this seems like a lot, but unless you identify your concerns it will be impossible to address your concerns effectively. Take a bit of time to ask these questions, write everything down and prioritize. Pull out your employer benefits booklet and get to know what options you have available to you through your employer. 

Get to know your insurance plan and what they are responsible for and what you are responsible for.  

Know what treatments you are on and their associated costs. Ask your treatment team if anything is expected to change so you can anticipate and prepare financially for the changes. 

If you haven’t done so already, ask your social worker about financial resources that you may be eligible for to help pharmaceutical drug costs as well as financial assistance programs through nonprofits and charitable organizations.  

There is help out there for food, utilities, medical bills, rent, insurance premiums, drug costs, travel for medical care and a host of other state and local resources. Now is a good time to take advantage of the resources. If you have a low income, you can even seek help through Legal Aid Society at no cost to you for legal help.  

Don’t let financial stress keep you from staying on your medical treatment or from keeping your lights on and food in your refrigerator. Ask for help. Seek out resources that can help you and your family.

Medicare Doesn’t Cover Free At-Home Covid Tests, But You Still Have Other Options to Attain Free Ones

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The Biden Administration’s new mandate that insurers cover the cost of at-home test did not include beneficiaries of Medicare. This is very unfortunate because Medicare recipients are the largest at-risk population.  

The new mandates that private insurers cover the cost of at-home-test – up to eight per enrollee per month. And, because Medicare enrollees are not participant of this mandate, this leaves many afraid of the consequences.   There are about 63.3 million people enrolled in Medicare and the majority of these beneficiaries, 55.1 million, are age 65 or older, and the rest, though younger, are generally people with disabilities. Many of which may have illnesses that leave them very vulnerable to COVID. 

The mandate which took place on January 15th, means that most consumers with private health coverage can buy at-home test at a store or online and either get it paid for upfront by their insurance company by submitting their insurance card or get reimbursed by submitting a claim to their insurer.  

Fortunately, there are still options for Medicare beneficiaries to get access to free COVID test. 

Here are your options:

  1. You can order four free tests through Covidtest.gov, a new government website that officially launched on January 15th. This site is available to all households not just Medicare beneficiaries. This is for 4 free at-home test per month/per household. Therefore, you may have to reorder every month.  
  2. You can also pick up at-home COVID test for free at Medicare-certified health clinics. 
  3. Community health centers. Be aware that currently demand for the test are outpacing supply, so plan accordingly. 
  4. For Medicare beneficiaries that are enrolled in a Medicare Advantage plan, reach out to your insurer as they may cover the cost of the at-home Covid test. It’s worth a try. The tests may be covered under a supplemental benefit through the insurer, not a required benefit.  
  5. Don’t forget the many testing sites that are offering free Covid testing. Beneficiaries can get the lab-based PCR test, (can take a few days to get back the test results) rapid PCR test, and the rapid antigen test. These sites were really stacked during the Holiday’s, they may be less busy now. A bonus is that many of these sites are drive through, providing you with less exposure to people. 
  6. Additionally, if a doctor or other authorized health-care provider orders the test, there is no cost-sharing. 
  7. Medicare beneficiaries are allowed to get one lab test for free per year without a doctor’s order. 

It hardly seems fair that Medicare beneficiaries have to jump through more hoops to get access to the free tests. However, this is due to the specific legal authority used to implement the directive. 

It seems that for now, this is how it will continue unless there’s another strong push for Medicare recipients to be included in the mandate. At which point It would require congressional action. For now, Don’t Hold Your Breath!! 

What Role Can Care Partners Play in Advocacy?

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What Role Can Care Partners Play in Advocacy? from Patient Empowerment Network on Vimeo.

Care partners can play many roles in advocacy. Diahanna, Sherea, and Patricia discuss that as a care partner you have to stay knowledgeable and up to date about various treatments and discussions happening in your loved one’s disease area. Diahanna shares a time where she had to advocate for her late husband by speaking up to the nurse and nearly saving her husband’s life. She also expresses that as care partners, you cannot be afraid to ask questions on behalf of your loved one.

Care Partner Tips for Communicating with Healthcare Teams

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Care Partner Tips for Communicating with Healthcare Teams from Patient Empowerment Network on Vimeo.

Ensure that you are in a position to ask the right questions of your healthcare team. Diahanna suggests familiarizing yourself with various online resources so you are aware of the potential needs of your loved ones. Watch as care partners, Diahanna, Sherea and Patricia share more crucial tips to help others communicate with one’s healthcare team.

Resources for New Care Partners

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Resources for New Care Partners from Patient Empowerment Network on Vimeo.

Sherea explains that you cannot move forward, unless you are able to acknowledge all the feelings that may come with the initial diagnosis of your loved one. Watch as care partners Diahanna, Sherea, and Patricia also share their tips and go-to online resources for new care partners.

Is There a Difference Between Care Partner vs Caregiver?

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Is There a Difference Between Care Partner vs Caregiver? from Patient Empowerment Network on Vimeo.

The term caregiver is generally more recognized around the world. Care partners Diahanna, Sherea, and Patricia share that being a care partner is generally more intimate than being a caregiver. Care partners are those who are taking care of family members and loved ones whom they’ve known before any initial diagnosis.

How to Seek Help as a Care Partner

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How to Seek Help as a Care Partner from Patient Empowerment Network on Vimeo.

When in need of help care partners Diahanna, Sherea, and Patricia share that you should not be shy. There is a tendency for care partners to deny help, but if you are burned out while caring for a loved one you are no good for them or yourself. Diahanna explains caregiving to be a very humbling and rewarding experience.

What Should Healthcare Providers Know About Care Partner Burnout?

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What Should Healthcare Providers Know About Care Partner Burnout? from Patient Empowerment Network on Vimeo.

Care partners are often able to fill in any gaps at appointments with their loved ones. Sometimes information at a visit can go in one ear and out the other for a patient as it can be a traumatic experience. Care partners Diahanna, Sherea, and Patricia discuss that providers should know that burnout is real and it is important to not only discuss the needs of your loved one, but discuss your needs as well.  

Understanding the Oncology Care Model

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Some of you may have received a letter from your oncologist notifying you that your oncologist is participating in a program called the Oncology Care Model. It was sent out to Medicare patients who are currently being treated by this provider. This letter informs you that you still have all the Medicare rights and protections including which health care provider you see. However, if you do not want to participate in this program, your opting out will require you to find a new provider. This can be very daunting for a patient that has been getting care and have a relationship established. Therefore, I want to give a brief overview of the Oncology Care Model, (OCM).

This program was developed by the Center for Medicare and Medicaid Innovation (Innovation Center) which was established by the Social Security Act and added to the Affordable Care Act. Its purpose was to test innovative payment and service delivery models to reduce program expenditures and improve quality for Medicare, Medicaid, and Children’s Insurance Program beneficiaries. The practices participating in this program have committed to providing enhanced services to Medicare beneficiaries, which includes care coordination and navigation, and to using national treatment guidelines for care.

Because cancer is such a devastating disease and because a significant proportion of those diagnosed with cancer are over 65 years of age and Medicare beneficiaries, this provided the OCM, CMS, in partnership with oncologists, other providers and commercial health insurance plans, the opportunity to support better quality care, better health, and lower cost for this patient population. It is intended to improve our nation’s health by providing clear measurable goals and a timeline to move Medicare and the US healthcare system toward paying providers on the quality of care rather than the quantity of care that they give their patients.

OCM focuses on Medicare Fee for Services beneficiaries receiving Chemotherapy treatment and includes the spectrum of care provided to a patient during a six-month episode that begins with chemotherapy.

The benefit to the patient would include enhanced services, including

  • The core functions of patient navigation to find other patient-focused resources.
  • A care plan that that meets your needs
  • Patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to the practice’s medical records: and
  • Treatment with therapies consistent with nationally recognized clinical guidelines.

There is no additional cost to patients to participate in this program. Medicare will pay for the full amount of the services. There is however a survey that patients would need to participate in to provide feedback to help improve care for all people with Medicare.

To get a good understanding of this program so that you can make the best decision regarding your care, don’t hesitate to share with your treatment team any questions or concerns you may have. Visit online at www.innovation.cms.gov/initiatives/oncology-care or call 1-800-MEDICARE (1-800-633-4227).