Tag Archive for: Diahanna Vallentine

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

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.

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).

Financial Fitness Workouts

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From PEN-Powered Activity Guide VIII: Supporting Your Support System

It seems every day we’re being bombarded with ways to stay fit. there is always a new fitness program or a new types of fitness equipment that’s supposed to give us the best bodies we can have. But with those who are dealing with a chronic illness, fitness takes on a different meaning. Not only do we need to feel our best physically, we also must be prepared in every aspect of our lives with your sight always set on your best possible treatment and your continuum of care.

I thought this would be a great time to review four of the most impactful areas you can review, reallocate, and make the changes that are most appropriate for your specific circumstance.

A good way to look at it is, in the fall we make sure we perform maintenance checkups or in our furnaces. We prepare our gardens and lawns for the upcoming spring, we check the exterior for homes for energy efficiency and we do checkups on our cars to prepare them for the winter season.

Unfortunately, few of us take the time to review the foundations of our financial lives that in fact dictate our ability to remain on treatment plans and meet all of our financial obligation. It is my hope, that everyone takes the opportunity to review at least these four areas that I’m covering in this article before the end of the year.

Medicare

First, the big one for a lot of us, Medicare. As you know the Medicare season is almost upon us. And there are changes as there are every year. If you are already a Medicare enrollee, this open enrollment period gives you the opportunity to make changes if needed. And if you have been enrolled for 12 months or less and you have a Medicare Advantage plan you even have the opportunity to replace it with a Supplemental plan perhaps with guarantee issue If you qualify. Here may be a wait period but you may not be able to get in at a later date and the coverage may be better for you.

Also, if you have an HMO plan you may be able to switch to a PPO for more plan flexibility. Review your Prescription formulary if there have been changes to your treatment. The worst thing you can do is to not review your Medicare options as there are changes every year and more plans may be available to you and the cost may be better as well. Don’t assume that the cheaper the premium the better off you are. Review your total cost. That includes the premium, co-pays, deductibles, coinsurance, and the cost of your meds as well.

Life Insurance

Secondly, review your life insurance plan. Many people aren’t aware of the benefits that insurance offers. Such as, accelerated benefit riders in the event you need access to some cash or the options of taking a loan from your policy.

Additionally, if you are still employed, on your next enrollment period with your employer see if you can add or increase your life insurance amounts. Even if you plan to retire or terminate your employment next year or at a later date the cost to take life insurance with your employer may be the only place you qualify without medical underwriting and it’s much cheaper. Also, see if your employer offer a supplemental life insurance that you can enroll in that may be portable at your termination from employment.

Review your credit to make sure there isn’t anything on it that’s incorrect. If you anticipate making a big purchase this will really affect your interest rate.

Monthly Statements

Third, as a financial advisor, I found a lot of clients would not look at their monthly statements to see how their retirement accounts such as 401k’s and investment accounts were doing. You are doing yourself a huge favor if you keep up with these no matter if the market is up or down. Speak to your financial advisor to make sure you’re taking advantage of growth, income producing, and tax efficient opportunities.

Financial Assistance

And finally, don’t assume you won’t qualify for financial assistance. The cost of treatment is expensive and probably always be. Talk to your doctor or social worker to help you uncover sources that can help you pay for co-pay, deductibles, coinsurance and other needs.

Do this before you find yourself in a financial crisis. Be proactive with understanding your illness and the anticipated change in treatments that may be available for you.

Instead of waiting for spring cleaning, take the time to do a financial review now. Go into the new year in the best possible position you can. And then, like getting a check-up on your car, do the same for your financial future every year. After all, you are worth more than a car!!

The Difference Between Wanting and Needing: Redirecting and Prioritizing Spending

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Often when I am out shopping, I find myself picking up items that I think I really need. I justify it rather quickly and find myself with buyers’ regret shortly thereafter. The most irritating habit I have is not returning it to the store and getting my money back. Last week, I was cleaning out drawers and found a few bags of clothing that I had every intention of returning but it escaped my attention. I also found dresses, jeans, shoes, several coats, and a suit that had purchased but forgot about. Some of them for my granddaughter who now had long outgrown them and for me, well I thought I needed them.   

I’ve also gone through storage and closets and found household items that “I really, really needed” at the time, but there they were never opened or rarely used some with the sales tags still attached. I thought I should add up the costs of these items and see just how much money I had wasted. It had added up to over a thousand dollars. Yes, I will donate these things to a charity such as a homeless facility, and, it makes me realize it can be a blessing to others, but is there a better way to serve than by happenstance? Am I doing a disservice to myself by spending without being mindful of where my dollars are going? I would argue that both are true.   

I’m learning to be mindful of all of my spendings. It’s making me prioritize my needs and wants. This is especially important when you have ongoing medical bills and prescriptions to manage and pay for. They can seem to be overwhelming at times. Though, I don’t have high medical bills currently, I do recognize that may not always be the case. So, diverting some money into an HSA or a regular savings account for the sole purpose of this future need could help me in the future. You can look at it as investing in yourself or, ” paying yourself first.”  

We all have bills to pay but rarely do we see ourselves as important as one of those bills. Consider setting aside $15 to $25 every pay period for medical expenses. Or, if you have bills that are already outstanding, call the service provider and request to pay a little toward those bills every month. You may be surprised how little they may be willing to take. They are in the business of service and you are their customer. Trust me, they don’t want you to leave. By putting a little each month towards the bills can help you stay in good standing with the medical provider and can help keep the bill from going to a collector and from hitting your credit report.   

Also, do what I did. Look around your house for things you no longer need or don’t want. Consider selling them. Not only will you be freeing up space at home, but you can also make some cash. There are online selling apps like OfferUp, BookScouter, eBay, and more. Terminate subscriptions you no longer need. Pay especially close attention to online subscriptions you may have forgotten about.   

Another creative way of finding more cash is to always make change when buying something at the store. Everything in coin change put in a jar. Deliberately seek out change-making opportunities. You may be surprised at how much you save. I did and saved almost $800.00 in a year.   

Consider online banks that may offer more interest than perhaps your neighborhood bank. Buy only what you’re going to eat. A study published in the American Journal of Agriculture Economics found that the average household wasted 31.9% of its food. The US total annual cost of wasted food was estimated to be $240 billion or $1,866 per household.  In fact, wasted food is the largest component taking up space in US landfills. And the United States discards more food waste than any other country.  That adds up to 30-40% of the entire US food supply. So, don’t waste and keep that money in your pocket.   

Spending comes down to desiring to satisfy oneself, however temporarily, and often supersedes logic. It’s impulse buying. Even when we know we should be directing our money to important things such as; managing the costs of healthcare, utilities, etc., it’s often difficult to stop wasteful spending. And the temporary feelings of satisfaction quickly wear off when bills start coming in.   

Getting control of this habit is achievable and not really complicated. Create a reasonable budget. Start by keeping a record of EVERYTHING you spend for a month. This may take a bit of work but is well worth the effort. Make a list of all your bills, including anticipated medical bills. Are you spending more than you make? I’ve found that when putting this down in writing, when you see it, it becomes real and important.  Putting together a budget is actually very freeing. It will allow you to reduce impulsive discretionary spending and allow you to focus on getting a firm grasp on your financial life. And, the payday of reduced financial stress is like icing on the cake.  

Financial Corner: Health Care Coverage Special Enrollment

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One of the first things President Biden accomplished since taking office was by signing executive orders that will begin to restore and strengthen Americans’ access to affordable and quality health care. Let’s review what he has done and what that can mean for you, your family, and/or your friends. While you read this article, think of other people who you think could benefit and let them know. Just because most of you understand the need for quality insurance as a result of your cancer, others may not need it now but what if something happens in the future and they don’t have it? No one expects cancer to happen to them, it happens to other people, Right?    

The first executive order he signed in regards to health care was to reopen the enrollment period to sign up in the Health Insurance Marketplace (healthcare.gov). Many states that operate their own websites to enroll residents in the healthcare exchange have followed suit and have also opened. This special enrollment lasts from February 15th through May 15th, 2021. After a horrible year of the pandemic and the needs that have arisen as a result, this should be a huge step in bringing affordable healthcare to those who have lost their jobs and find themselves uninsured. The process is very simple and can be done via a phone call or online. And for those who have an illness, this is very comforting because the previous threat to limit access to quality and affordable care because of a preexisting condition is no longer on the table.    

In addition, President Biden is directing federal agencies to reconsider rules and other policies that currently limit Americans’ access to health care as well as consider rules and actions that will protect and strengthen that access.   

Agencies will be directed to review:    

  • Policies that undermine protections for people with pre-existing conditions, including complications related to COVID-19; (Critical since some of these complications can be long-term or lifelong). 
  • Demonstrations and waivers under Medicaid and the ACA that may reduce coverage or undermine the programs, including work requirements;
  • Policies that undermine the Health Insurance Marketplace or other markets that sell health insurance;
  • Policies that make it more difficult to enroll in Medicaid and the Affordable Health care Act; and  
  • Policies that reduce the affordability of coverage or financial assistance, including for dependents. This is important because many people think of children and college-age adults only as dependents but this could be an adult child that is permanently disabled that you take care of.  

These timely steps could provide additional coverage for millions of uninsured Americans. Some of whom may qualify for free or subsidized health insurance.     

As a cancer patient, you realize the cost of healthcare. Having quality care and affordable care can be what allows you to be proactive in your healthcare with your healthcare team to stay on your treatment plan as well as to mitigate and prevent financial toxicity.  

While thinking about these opportunities, don’t forget to consider your current insurance plan if you are enrolled in a Medicare Supplement, Medicare Advantage, or employer plan. Review with your healthcare providers to find out if your treatment may change. Then inquire if the costs are going to change as a result of medication changes or treatment facilities? Or perhaps you anticipate retiring before Medicare age or going on disability. Perhaps you are already on disability and will be completing the 2-year mark and can go on Medicare. Now is the time to review your options before the enrollment period expires.   

Make sure you have the best possible insurance for your needs that you can afford. Don’t let an opportunity pass you by without investigating its benefits. Take a step to strengthen your health insurance program and possibly lighten your financial load.   

Additional information can be found at:  

Read the Full PEN-Powered Activity Guide VI

Is It Possible to Achieve Health Equity in Multiple Myeloma?

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Is It Possible to Achieve Health Equity in Multiple Myeloma? from Patient Empowerment Network on Vimeo.

How can health equity be achieved for underserved communities in multiple myeloma patient care? Watch as a panel of myeloma experts explains.

See More From the Diverse Partners in Your Myeloma Care Program

Transcript:

Rebecca Law:

I want to ask each of you to answer a question. So how can we achieve health equity in the care of multiple myeloma patients sooner rather than later?

Diahanna Vallentine:

I think we all appreciate the fact that the African American or underserved communities do not have enough people that are either willing or know that we need to go into those communities the way they are, meet the people the way they are, so that we can provide them with education, with resources, that are available. I think that is one of the first steps. And fortunately, or unfortunately, with the racial problems we’re having in our country right now, a lot of governors and mayors are opening up opportunities that we got to get into the communities. And I think this might be a great opportunity for the myeloma community to perhaps step up and say we would like to be presented or represented in the community when there are funds and when the interest is really high. I think that if we could establish a foothold that way, then we can just go on and work toward lessening that gap and disparities in the undeserved communities.

Dr. Sikander Ailawadhi:

Diahanna, that was really nicely put. I think what I can add to that is that we basically are already seeing a lot more discussion, a lot more focus coming up to this topic of racial disparity in multiple myeloma at different levels. So, what we need to do is continue to build upon that momentum, continue to build the relationships so that there is actually a combined force from various aspects. I would love to do telehealth going forward, but like Dr. Usmani brought up, if there is not enough reimbursement or leadership or legislation to support all of that, then our wants and needs may not be served fully. So I think developing those relationships, developing those partnerships and moving forward as we’re gaining momentum to address this particular question, this particular issue is extremely important. And I feel it is more hopeful and exciting in the future as compared to where we’ve come from.

Jenny Ahlstrom:

I would just reiterate what Diahanna said. I think it’s in building the programs that are simple enough for everybody to understand and utilize that makes just the usability of them as available as possible, and then building that relationship in those communities where the needs are. I totally agree with what Diahanna’s saying, you need to take the programs to the people where they are and not to expect them to come to your programs.

Dr. Saad Usmani:

I agree with everything that has been said on this topic. And I have to say that this is going to be a two-way dialogue, a two-way partnership. That’s the only way that this can succeed moving forward. Racial disparities are an inherent part of our everyday life, whether it’s in healthcare, whether it’s in other interactions we have with each other, and there’s a lot of historic perspective and context to that. This is not going to be a quick fix, this is going to be a long-term process. But it will have to be a partnership. And I’m talking on a broader level with myeloma care and better survival outcomes for all myeloma patients as the goal. But then looking at the overall societal goals as well, and trying to see how we can remove the inherent biases that everyone has and develop more fruitful productive relationships going forward in our respective geographic regions, but overall in our country as well. I think that’s the overarching theme and tone of the conversations we’re having in the country right now, and it certainly makes sense to do that for myeloma care as well.

Rebecca Law:

I want to take the time to thank each and every one of you for joining me today. On behalf of the Patient Empowerment Network and Diverse Health Hub, I am Rebecca Law. Thank you.