Published on June 11, 2020
Patients feeling overwhelmed by cancer-related costs may be eligible for financial support, even with a higher income. Financial navigators Dan Sherman and Aimee Hoch discuss Medicare and Medicaid programs and how to qualify for co-pay assistance.
Watch as Dan and Aimee explain what the state-by-state Medicaid expansion means for patients and what help is available if you’ve suffered a job loss or decrease in income due to the coronavirus pandemic.
This program is sponsored by Incyte, Janssen and Pharmacyclics. These organizations have no editorial control, and Patient Power is solely responsible for program content.
Transcript | Financial Assistance for Cancer Patients
Recorded on June 4, 2020
People are aware that there's a program, a federal program, but I guess administered by the states, Medicaid. So what is Medicaid? And do you have to be impoverished basically to get Medicaid assistance? Where does that come in?
So it depends on the state that you're in. Medicaid is available in all states. However, some states are part of the what's called the Medicaid Expansion Program. So those individuals would benefit from having a higher income limit criteria to them. So it's 138 percent of the federal poverty level versus traditionally 100 percent. So it gives people more access to Medicaid living in those particular states.
Okay. And if I'm a Medicaid patient, can I still get quality care?
And Andrew, I'm going to jump in too, and say that one of the benefits of the Medicaid Expansion Program is that they do not look at assets. So when you mentioned do I have to bring in all of my bank records and stuff like that? The answer would be no to that. So they purely look at income. You could have a $100,000 in the bank in IRA, and still get the Medicaid.
So, okay, if I've lost my job, my income's plummeted, or I'm some kind of freelancer, I was thinking of the example, my son is in the music business, he knows people who would go do concerts. There are no concerts now, so they have no income. So that would be somebody who could apply for Medicaid. And you mentioned states, but not every state has expanded Medicaid. How do you know? Is that what the financial navigator locally can help you know?
Correct. Odds are that your state did expand Medicaid, 37 states have expanded Medicaid so far. So that leaves what, 13 states that have not. But if you speak to your social worker or financial navigator in your cancer program, they should know if they have expanded Medicaid or not.
So, Aimee, let's understand Medicare. So right now I get a salary from Patient Power. And so I'm responsible for certain co-pays, like particularly Medicare Part D, and I do take an expensive oral medicine, but that could change. So how does that change relate to the co-pays? There are programs that can come into play there too.
So maybe you could explain that.
Yeah, there are a couple of things that we could look at if your income decreased from loss of a job. So you may become eligible for programs that help out with the premiums, your Medicare premiums Part B and Part D. So that's Medicare savings program, and also the extra help program through Social Security. So that is one thing that I would evaluate right away to help with that. We also, as far as treatment, we could look at what Dan had briefly mentioned the co-pay assistance programs, not on only based on income, but it's also based on diagnosis. So that would be another thing that I would automatically be thinking about to coincide with the Medicare and using the co-pay assistance from those programs.
So, Dan, some of these co-pay assistance programs come from foundations, but we've seen it over some years where for a specific diagnosis like Aimee was just mentioning, they run out of money. I know a couple of years ago for our friends with multiple myeloma, they were in a panic because The Leukemia & Lymphoma Society's program was running dry with myeloma money, or some of the other organizations. So let's talk about to what extent can you count on these funds to help you? And does it have to be renewed every year? How does that work?
Yeah, they do need to be renewed every year. So they generally last for one year, and most of the co-pay assistance foundations will be from the date of enrollment for an entire year. There's one that does it per calendar year. And you're correct, these funds are running out. And one of the reasons why they're running out is because there are more and more financial navigators out there that are using these programs for their patients. So they're being used more and more, which is a good thing. If you are an individual patient who is wanting co-pay assistance, but you've been told that the fund is not open, it will be critical that either you or your financial navigator is following that specific disease state, and then you can receive notification when that fund becomes available. And that is critical information, because sometimes these funds are open for one hour or two hours. And so the faster you become aware that these funds are available, the better the odds are that you can get enrolled into that program.