Financial IssuesFinancial issues often are a result of:
- Inability to afford out-of-pocket costs.
- Higher out-of pocket expenses related to out-of-network care.
- Pharmacy or medication related issues.
- Inability to afford COBRA premiums.
There are actions to consider if you are having difficulty affording your out-of-pocket responsibilities. Your goal is to find a positive resolution to your issue. These suggestions may help you achieve success.
- Make sure you are getting all the health insurance benefits you are entitled to by reading and following the specific requirements of your health insurance plan. Be sure to pay attention to what services are covered as well as excluded under the definition portion of your plan.
- Review your plan language for a complete list of participating providers and facilities to avoid additional expenses often associated with out-of-network care.
- Seek coverage options through personal or alternatively-sponsored plans for better coverage (example employer or spousal coverage).
- Apply for Medicaid programs if you meet the eligibility criteria. In the event you are determined not to be eligible for regular Medicaid, you may be able to qualify for other programs available through Medicaid such as Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiary program (SLMB), or a Medicaid Spend down (you pay a share of cost). You can obtain information on these programs and how to apply by contacting your local Medicaid office.
- Apply for county medical assistance programs when denied Medicaid. This program is not available in every county. However, when available, the program is a coordinated system for the low-income, uninsured of the county of residence to access needed medical care on a sliding scale or no cost. Contact your local Medicaid office to learn more.
- Seek financial assistance through state, national, or disease-specific co-pay assistance programs listed under the resource section of this book.
In addition to the information above, if the issues you are seeking assistance with involve co-payments, co-insurance or deductibles, you may want to try the following action step: inquire through treating hospitals, facilities, or providers about available assistance programs such as prompt-pay discounts, self-pay discounts, partial and full-charity care or reasonable payment arrangements.
Consider the following when you are approaching or have exceeded an annual, lifetime, or specific cap as outlined in your health insurance plan.
- Inquire through treating hospitals, facilities, or providers about available assistance programs such as prompt-pay discounts, self-pay discounts, partial and full-charity care or reasonable payment arrangements.
- Search for a Clinical Trial that is specific to your diagnosis. Clinical trials are a way for those to access other therapy after they have exhausted traditional or standard care. Clinical trials also provide an avenue to care for the uninsured or underinsured. Some trials absorb most or all of the treatment cost and can be a cost effective way to access care. The National Institute of Health (NIH) and National Cancer Institute (NCI) offer a broad range of clinical trials. NIH offers a broad range of trials whereas,
NCI only offers cancer related trials. In order to be prescreened for these trials you must call NCI at 1-888-624-1937 and NIH at 1-800-411-1222 to determine if you fit their criteria.
- Emergingmed offers a free online tool that helps cancer patients find appropriate clinical trials. They may be contacted at 1-877-601-8601 or on their website at www.emergingmed.com.
- Seek care through community health facilities, free clinics and your local health department.
You may find the following action steps helpful when you are seeking assistance with pharmacy or medication related issues.
- Explore discount drug options through large retailers, supermarket or pharmacy chains such as Walgreen's, Wal-Mart, CVS, or Target. Contact your closest retailer to see if a comparable program exists.
- Consider generic-equivalent medications with your doctor approval.
- Explore mail order options offered by your health insurance plan.
- Check with your provider to see if he/she can offer you samples of the medication.
- Apply for national or disease specific co-pay assistance programs. There are also free or low-cost drug programs. A complete listing is available in the resource section of this publication.
- Apply for state drug assistance programs by contacting your local state insurance commissioner's office. You can find a link to state specific programs at www.needymeds.com.
- Drug replacement programs may be available to assist you by providing medications directly to your physician’s office for your use. Discuss these programs with your treating physician.
- Medicare Part D beneficiaries can call RxAssist at 401-729-3284 or link to www.rxassist.org link for a comprehensive database of patient assistance programs.
- Medicare beneficiaries can apply for a low-income subsidy (LIS), also known as Extra Help, to help cover full or partial costs of Medicare Part D. Additional information and eligibility requirements are available on the Social Security Administration website, https://secure.ssa.gov/ or by calling 1-800-772-1213.