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Volume 13, Issue 1 Download for iPad


PATIENT ASSISTANCE RESOURCES 2018 1, 2

In the fourth quarter of 2017, the percentage of U.S. adults without health insurance rose to 12.2%, representing a 1.3% increase since the end of 2016. According to the Gallup and Sharecare Well-Being Index, the 1.3% increase represents nearly 3.2 million Americans who have entered the ranks of the uninsured. The uninsured rate is now the highest recorded since the last quarter of 2014 when it was 12.9%.

The uninsured rate is expected to continue to increase with the destabilization of the Affordable Care Act (ACA) in the individual insurance marketplace, and subsequent rising premiums across much of the country. The Henry J. Kaiser Family Foundation reports that nationally, the unsubsidized premium for the lowest-cost bronze plan increased an average of 17% between 2017 and 2018, the lowest-cost silver plan increased an average of 32%, and the lowest-cost gold plan increased an average of 18%.

The rise of high-deductible health plans, and short-term limited duration (STLD), health insurance will also likely contribute to an increase of the underinsured. While the lower price for these plans are initially attractive, many consumers find they are unable to pay the deductible under their high-deductible health plan, or the limited coverage of the STLD plan leaves them without essential benefits such as prescription drug coverage. STLD plans may offer lower premiums but this is generally offset by the much higher out-of-pocket costs and in many cases, the STLD plan imposes a monetary cap on coverage.

In the current healthcare environment of escalating costs of treatment and out-of-pocket costs, many more cancer patients will find themselves in need of assistance. In this issue, we provide a summary and contact information for some of the patient assistance services and resources that may be available to your patients.

 

FEDERAL POVERTY GUIDELINES 3

Two separate versions of the federal poverty measure are released each year: poverty thresholds and poverty guidelines. The U.S. Census Bureau updates the poverty thresholds, which are used mainly for statistical purposes, while the poverty guidelines are issued by the Department of Health and Human Services (HHS) each year and are used for determining financial eligibility for certain federal programs.

The HHS poverty guidelines are generally published in the Federal Register in late January. The HHS poverty guidelines, or percentage multiples of them, are used as an eligibility criterion by a number of federal and state programs including Head Start, the Supplemental Nutrition Assistance Program (SNAP), the Low-Income Home Energy Assistance Program (LIHEAP) and the Children's Health Insurance Program (CHIP). Additionally, many health care institutions and health care providers use the poverty guidelines to determine eligibility for a discount for services to uninsured or underinsured patients using a sliding scale based on the HHS poverty guidelines. Using the HHS poverty guidelines helps to show that the health care provider has undertaken a reasonable inquiry to determining financial need on an individualized and objective basis and that any discounts are based on good faith assessments of financial hardship.

The poverty guidelines can be found on the HHS website at https://aspe.hhs.gov/poverty-guidelines.

The 2018 Poverty Guidelines for the
48 Contiguous States and the District of Columbia
Persons in Family/Household Poverty Guideline
1 $12,140
2 $16,460
3 $20,780
4 $25,100
5 $29,420
6 $33,740
7 $38,060
8 $42,380
For families with more than 8 persons, add $4,320 for each additional person.
2018 Poverty Guidelines for
Alaska
Persons in Family/Household Poverty Guideline
1 $15,180
2 $20,580
3 $25,980
4 $31,380
5 $36,780
6 $42,180
7 $47,580
8 $52,980
For families with more than 8 persons, add $5,400 for each additional person.

2018 Poverty Guidelines for
Hawaii
Persons in Family/Household Poverty Guideline
1 $13,960
2 $18,930
3 $23,900
4 $28,870
5 $33,840
6 $38,810
7 $43,780
8 $48,750
For families with more than 8 persons, add $4,970 for each additional person.

SOURCE: Federal Register, Vol. 83, No. 12, January 18, 2018, pp. 2643

Most cancer centers employ financial advocates or counselors to verify coverage benefits, obtain pre-authorizations, provide patient treatment cost estimates and payment options, to assess patient financial needs, and to assist patients with financial assistance applications.

The Association of Community Cancer Centers' (ACCC's) Financial Advocacy Boot Camp is an online program consisting of education and resources for practices and oncology financial advocates. The Financial Advocacy Boot Camp is free to ACCC members at https://www.accc-cancer.org/home/learn/financial-advocacy/boot-camp.

2018 Medicare Costs 4, 5, 6, 7

MEDICARE PART A

Medicare Part A covers most medically necessary hospital care, skilled nursing facility care, certain nursing home care, hospice and home health services.

Most Medicare eligible individuals qualify for Part A for free through the Medicare tax (the FICA deduction) they paid while working. Individuals who do not qualify for premium-free Part A will pay up to $422 each month for Part A coverage. In most cases, individuals who choose to buy Part A must also have Part B and pay monthly premiums for both.

When an individual is first eligible for Medicare, they have a 7-month initial Enrollment Period to sign up for Part A and/or Part B. For example, if the individual is eligible for Medicare at age 65, they may sign up during the 7-month period that:

  • Begins 3-months before the month they turn 65
  • Includes the month they turn 65
  • Ends 3-months after they turn 65

Individuals who did not get automatically enrolled or sign up during the Initial Enrollment Period, will have a late penalty premium for Part A when you do sign up later on. The enrollment periods and premium penalties are the same whether you are entitled to Medicare Part A or can voluntarily buy Medicare Part A. The penalty premium is 10% of the current Part A premium. You will continue to pay the penalty premium for twice the number of years you were eligible for Part A but did not enroll.

In 2018, the Part A inpatient hospital deductible is $1,340 (up from $1,316 in 2017.) The Part A deductible covers the beneficiary's share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries will pay a coinsurance amount of $335 per day for days 61-90 and a daily coinsurance of $670 for lifetime reserve days. For beneficiaries in skilled nursing facilities, the daily coinsurance in 2018 for days 21 though 100 of extended care services in a benefit period will be $167.50 (up from $164.50 in 2017).

MEDICARE PART B

Medicare Part B covers most medically necessary services or supplies including physician services, hospital outpatient services, laboratory tests, preventative care, durable medical equipment, mental health, and some home health and ambulance services.

Medicare beneficiaries pay a monthly premium for Part B coverage. In 2018, the standard Part B premium amount is $134, however some Medicare beneficiaries with higher incomes will pay a higher premium, and some people who get Social Security benefits will pay less than the standard premium. The 2018 Part B deductible is $183 per year.

In Figure 1, CMS illustrates the Part B premium rates for 2018 based on the Medicare beneficiary's 2016 income and tax filing status. Beneficiaries with higher incomes will pay the standard 2018 premium amount of $134 and an Income Related Monthly Adjustment Amount (IRMAA).

If your yearly income in 2016 was You pay each
month in 2018
File individual tax return File joint tax return File married &
separate tax return
 
$85,000 or less $170,000 or less $85,000 or less $134
Above $85,000 up to $107,000 Above $170,000 up to $214,000 Not applicable $187.50
Above $107,000 up to $133,500 Above $214,000 up to $267,000 Not applicable $267.90
Above $133,500 up to $160,000 Above $267,000 up to $320,000 Not applicable $348.30
Above $160,000 Above $320,000 Above $85,000 $428.60

Figure 1: 2018 Medicare Part B Estimated Prescription Drug Plan Monthly Premium Based on Income and Tax Filing Status.

With few exceptions, a late enrollment penalty will be assessed to Medicare beneficiaries who don't sign up for Part B when they are first eligible. The late enrollment penalty is 10% for each 12-month period that the beneficiary could have had Medicare Part B but did not take it. This penalty is in addition to the standard Part B premium and applies for as long as the beneficiary has Part B.

Medicare beneficiaries, who are eligible for Extra Help do not have to pay the penalty. And beneficiaries, who qualify for a Special Enrollment Period (SEP), may not have to pay the penalty.

MEDICARE PART C

Medicare Part C plans, Medicare Advantage (MA) Plans, are offered by private companies approved by Medicare. Beneficiaries in a Part C plan receive their Medicare Part A and Part B coverage from the MA plan. These plans generally offer additional benefits, such as vision, dental and hearing and many include prescription drug coverage.

The monthly Part C premiums, deductibles and services vary by plan and plans may charge different out-of-pocket costs.

MEDICARE PART D

Medicare offers prescription drug coverage under the Medicare Part D program. Medicare Part D is a voluntary outpatient prescription drug benefit (with the exception of beneficiaries who are dually eligible for Medicare and Medicaid and certain other low-income beneficiaries who are automatically enrolled in a PDP if they do not choose a plan of their own) offered through private plans approved by the federal government. Medicare beneficiaries may obtain prescription drug coverage through stand-alone Medicare Prescription Drug Plans (PDPs), as a supplement to traditional Medicare, or through a Medicare Advantage Plan (MA-PDs), Medicare Part C, which provides all Medicare-covered benefits including prescription drugs.

The Medicare open enrollment period runs from October 15 to December 7 each year and Medicare beneficiaries are advised to join a Medicare drug plan when they are first eligible in order to avoid a late enrollment penalty.

In 2018, the Part D National Base Beneficiary Premium is $35.02 (a 1.71% decrease from the 2017 base premium of $35.63). The national base premium amount can change each year and is used to estimate the Part D late-enrollment penalty (LEP) and the income-related monthly adjustment amount in addition to the base plan premium.

The Part D late-enrollment penalty is an additional monthly cost that is incurred when a Medicare beneficiary goes without Part D or creditable prescription drug coverage for any continuous period of 63 days or more after the end of his or her initial enrollment period for Part D coverage.

The late-enrollment penalty is calculated by multiplying 1% of the National Base Beneficiary Premium ($35.02 in 2018) times the number of full, uncovered months the Medicare beneficiary didn't have Part D or creditable coverage. The Medicare Modernization Act (MMA) defines creditable coverage as coverage that is expected to pay on average as much as the standard Medicare prescription drug coverage.

Medicare Part D enrollees will be notified in writing by the Medicare Part D plan if the plan determines the enrollee is subject to the LEP. Along with the written notification, the enrollee will also receive an LEP Reconsideration Notice and an LEP Reconsideration Request Form. The Reconsideration Request Form lists the circumstances under which an enrollee may obtain a review. Enrollees who disagree with the LEP determination may request a review, or reconsideration. An Independent Review Entity (IRE) conducts the LEP reconsideration and the enrollee is generally notified of the final reconsideration decision within 90 calendar days of receipt of a request for reconsideration.

Certain Medicare Part D enrollees will be subject to the Income-Related Monthly Adjustment Amount (IRMAA). Enrollees with incomes above $85,000 and filing individually, or $170,000 if married and filing jointly, may pay more for their Part D coverage. These higher income beneficiaries will pay an extra amount under the IRMAA, based on their yearly income and tax-filing category, in addition to their plan premium. Figure 2, lists the income thresholds for the Part D IRMAA.

If your yearly income in 2016 was: You pay
(in 2018)
File individual tax return File joint tax return File married &
separate tax return
 
$85,000 or less $170,000 or less $85,000 or less Your plan premium
Above $85,000 up to $107,000 Above $170,000 up to $214,000 Not applicable $13.00 + your plan premium
Above $107,000 up to $133,500 Above $214,000 up to $267,000 Not applicable $33.60 + your plan premium
Above $133,500 up to $160,000 Above $267,000 up to $320,000 Not applicable $54.20 + your plan premium
Above $160,000 Above $320,000 Above $85,000 $74.80 + your plan premium

Figure 2: 2018 Medicare Part D Estimated Prescription Drug Plan Monthly Premium Based on Income and Tax Filing Status.

Most Medicare Part D plans have a coverage gap (commonly called the "donut hole") during which there is a limit on what the Part D plan covers for drugs. The Affordable Care Act (ACA) of 2010 included a provision to begin closing this coverage gap, and when fully implemented, Medicare beneficiaries will have a 25% coinsurance during the coverage gap. 8

In 2018, Medicare Part D enrollees entering the coverage gap will receive a 65% discount (50% paid by the drug manufacturer and 15% paid by the Medicare Part D plan) on brand-name drugs and a 56% discount on generic drugs.
Under the standard 2018 Medicare Part D plan, the Medicare beneficiary will have a yearly deductible of $405 (up from $400 in 2017) and a 25% coinsurance. After the deductible is met, the Medicare beneficiary and Part D plan each pay their share until the combined amount (plus the deductible) reaches the Initial Coverage Limit (ICL) of $3,750 (up from $3,700 in 2017). At this point, the Medicare beneficiary is in the coverage gap and responsible for 35% of the plan's cost for covered brand-name drugs and 44% of the plan's cost for covered generic drugs.

Once the Medicare beneficiary has spent $5,000 in true out-of-pocket (TrOOP) costs (expenses that count toward the drug plan out-of-pocket threshold) for the year, the coverage gap ends and Catastrophic Coverage begins. While in the Catastrophic Coverage stage, Medicare pays 80% of their drug costs, Part D plans pay 15% and enrollees pay $3.35 for generic or preferred multi-source drugs and $8.35 for all other drugs—or 5% of the drug cost—whichever is greater.

The TrOOP includes the amount of the Medicare beneficiary's initial deductible, co-payments or coinsurance during the initial coverage stage, the co-payments or coinsurance paid by the beneficiary while in the donut hole, and the 50% donut hole discount paid by the manufacturer on brand-name drugs.

Part D plans must offer either the standard benefit or an alternative equal in value, and they can also provide enhanced benefits. Part D plans vary in their benefit design, cost-sharing amounts, and utilization management tools such as prior authorization, quantity limits, formularies and step therapy requirements. However, all Part D plans are required to cover all drugs in six protected classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics.

The Henry J. Kaiser Family Foundation reports the following statistics for PDPs in 2018 9:

  • 46% of plans will offer basic Part D benefits while 54% will offer enhanced benefits;
  • 63% of PDPs will charge a deductible, with 52% charging the full amount ($405);
  • The majority of PDPs have shifted to charging tiered copayment amounts or varying coinsurance amounts for covered drugs rather than a uniform 25% coinsurance rate;
  • The vast majority of PDPs are using specialty tiers for high-cost medications;
  • 65% of PDPs will not offer additional gap coverage in 2018 beyond what is required under the standard benefit.

Beneficiaries with low incomes (less than 150% of poverty, or $18,090 for individuals/$24,360 for married couples in 2017) and modest assets (less than $13,820 for individuals/$27,600 for couples in 2017) may be eligible for assistance with Part D plan premiums and cost sharing through the Part D Low-Income Subsidy (LIS) program.

Beneficiaries who are dually eligible for both Medicare and Medicaid, the Qualified Medicare Beneficiary  (QMB) program, Specified Low-Income Medicare Beneficiary (SLMB) program, Qualifying Individual (QI) program, or are already entitled to Supplemental Social Security (SSI), automatically qualify for the additional assistance, and Medicare automatically enrolls them into PDPs with premiums at or below the regional average (the Low-Income Subsidy benchmark) if they do not choose a plan on their own.

MEDICARE EXTRA HELP 10

Medicare beneficiaries who meet certain income and resource limits, and reside in one of the 50 states or the District of Columbia, may qualify for Medicare's Extra Help program. This program helps qualifying Medicare beneficiaries pay for the costs of prescription drug coverage. Depending on their income and resources, some Medicare beneficiaries may qualify for a full or partial Medicare Part D subsidy.

Certain Medicare beneficiaries automatically qualify for Extra Help to pay for their monthly premiums, annual deductibles, and prescription co-payments, including those who have full Medicaid coverage, those who receive help paying their Part B premiums from their state Medicaid program, and those who receive Supplemental Security Income (SSI) benefits.

Medicare beneficiaries with limited incomes who are not automatically qualified for Extra Help are urged to apply for the program. Medicare beneficiaries must apply for Extra Help separately from enrolling in a Part D plan.

Medicare beneficiaries can apply online at https://www.ssa.gov/benefits/medicare/prescriptionhelp/ or by calling 1-800-772-1213.

RESOURCES: UNDERSTANDING & MANAGING HEALTH INSURANCE

ASCO'S Cancer Net 11

The American Society of Clinical Oncology's (ASCO's) website Cancer.Net contains clinical and practical information and resources for people living with cancer. Cancer.Net provides detailed information on the medical costs and hidden costs of cancer care, questions patients should ask their health care team, a list of national organizations that provide financial assistance to people with cancer, information on the different types of private and government-sponsored health insurance options, tips for organizing financial information, and a glossary of cost-related terms. Cancer.Net also has links to ASCO's free booklet, Managing the Cost of Cancer Care, available as a printable PDF in English and Spanish.

American Cancer Society's Resources on Health Insurance 12

The American Cancer Society (ACS) website includes resources to help cancer patients and their families understand health insurance issues within private and government plans. The ACS also provides guidance on health insurance options for people affected by cancer. Cancer patients, cancer survivors, and those calling on their behalf can reach the ACS Health Insurance Assistance Service (HIAS) at 1-800-227-2345 and ask to speak to someone from HIAS.

 

LAWS PROTECTING MEDICAL INSURANCE COVERAGE & CANCER PATIENTS

The Family and Medical Leave Act of 1993 (FMLA) requires employers (with at least 50 employees) to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for certain family and medical reasons, including to care for an immediate family member (spouse, child, or parent) with a serious health condition. Employees are eligible if they have worked for a covered employer for at least 1250 hours in the previous 12 months. For the time period of the FMLA leave, the employer must maintain the employee's medical insurance coverage under any company group health plan. This act is regulated by the U.S. Department of Labor's Wage and Hour Division. Some states have family and medical leave laws with broader rights than the FMLA and in some states they apply to smaller employees who are not covered by the FMLA. 13

The Americans with Disabilities Act of 1990 (ADA) offers protection against discrimination in the workplace to anyone who has, or has had, certain disabilities, including any diagnosis of cancer. Parents of dependent children with cancer are also protected under this law. It requires private employers who employ 15 or more people, labor unions, employment agencies, and government agencies to treat employees equally, including the benefits offered them, without regard to their disabling condition or medical history. The ADA also requires eligible employees to make "reasonable accommodations," which may include modifying work schedules or reassigning an employee to a less physically taxing position, to allow employees to function properly on the job. The U.S. Equal Employment Opportunity Commission (EEOC) administers this law. 14

COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986) gives qualified employees and their families the right to temporarily continue workplace group health insurance coverage when coverage is lost due to certain specific events or qualifying events. Patients should be advised that the cost of the COBRA premium is usually far less than the cost of treatment should they let their health policy lapse. Patients should also review the health care coverage options that may be available to them through other group coverage (such as a spouse's plan), the Health Insurance Marketplace, or Medicaid. COBRA is administered by the U.S. Department of Labor. COBRA information & FAQs are available on their website. 15

Women's Health and Cancer Rights Act (WHCRA) of 1998, mandates that health insurance plans cover breast reconstruction in connection with a mastectomy if the patient decides to have reconstruction and received insurance benefits from her plan for the mastectomy. WHCRA does not require health plans or issuers to pay for mastectomies in general. However, if a group health plan or health insurance issuer does cover mastectomies, the plan or issuer is generally subject to WHCRA requirements. WHCRA does not apply to Medicare and Medicaid, as they are public health plans, not issuers of health insurance. The WHCRA is administered by the U.S. Department of Labor and the U.S. Department of Health and Human Services. 16

The Breast and Cervical Cancer Prevention and Treatment Act (BCCPT) of 2000 gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and found to have breast or cervical cancer, including pre-cancerous conditions. Under the BCCPT law, women whose cancers were found through the CDC's NBCCEDP may be eligible for Medicaid benefits for the duration of their cancer treatment. Participation in the BCCPT is optional for states. Currently, the NBCCEDP funds all 50 states, the District of Columbia, 6 U.S. territories, and 13 American Indian/Alaska Native tribes or tribal organizations to provide screening services for breast and cervical cancer. 17

The Older Americans Act provides federal funds for state and local social service programs that help frail and disabled people age 60 and older remain independent in their community. This funding covers home care aides, personal care, meal delivery, and escort and shopping services. The U.S. Administration on Aging maintains the Eldercare Locator, which provides information about assistance for older people. 18

 

Helpful Resources

  The Air Care Alliance
Website www.aircarealliance.org
Phone 888-260-9707
Email mail@aircarealliance.org
The Air Care Alliance website provides a comprehensive list of free air transportation services for qualified patients and their families to specialized medical treatment facilities.
  Air Charity Network
Website http://aircharitynetwork.org/
Phone 877-621-7177
Air Charity Network is comprised of nine independent member organizations identified by specific geographical service areas. Airlift Hope NC-TN, Angel Flight Central, Angel Flight Mid-Atlantic, Angel Flight Northeast, Angel Flight South Central, Angel Flight Southeast, Angel Flight West, Mercy Flight Southeast and Mercy Medical Airlift coordinate volunteer pilot missions in the continental United States as well as Alaska and Hawaii.
  American Breast Cancer Foundation
Website www.abcf.org
Phone 410-730-5105
Email info@abcf.org
The American Breast Cancer Foundation (ABCF) mission is to provide education, access and financial assistance to aid in the early detection, treatment, and survival of breast cancer for underserved and uninsured individuals, regardless of age or gender.
  American Cancer Society
Website www.cancer.org
Phone 800-227-2345
The American Cancer Society (ACS) operates offices throughout the nation. The ACS can help patients locate various types of support and financial assistance.
  Andre Sobel River of Life Foundation
Website www.andreriveroflife.org/
Phone 310-276-7111
Email Info@AndreRiverOfLife.org
The Andre Sobel River of Life Foundation (ASRL) is a tax-exempt non-profit organization that provides financial assistance to single parents so that they can remain by their child's side throughout a life-threatening illness. ASRL meets urgent financial needs of single-parent families of children with catastrophic or life-threatening illnesses who are in financial crisis.
  The Assistance Fund
Website www.theassistancefund.org
Phone 855-845-3663
Email Direct from website
The Assistance Fund provides access to medications through financial support for patients who are critically or chronically ill. The Assistance Fund may be able to help with co-pays, deductibles, and health insurance premiums.
  Association of Community Cancer Centers
Website www.accc-cancer.org
Association of Community Cancer Centers (ACCC) maintains a comprehensive list of reimbursement assistance programs including industry sponsored financial assistance programs for oncology-related drugs and services.
  Benefits.Gov
Website www.benefits.gov
Phone 1-800-333-4636
Email Direct from website
Benefits.gov is a partnership of 17 federal agencies providing improved, personalized access to government assistance programs. The online screening tool is free, easy to use and confidential. The user answers a series of questions, then the website generates a list of government benefit programs that the user may be eligible to receive, along with information about how the user can apply.
  BenefitsCheckUp®
Website www.benefitscheckup.org
Email Direct from website
BenefitsCheckUp is a free service of the National Council on Aging (NCOA), a nonprofit service and advocacy organization. Through the online tool the user completes an online survey to determine what state, federal, or private benefit programs they may qualify for. Assistance is available for prescription drugs, healthcare, utilities, and other basic needs.
  The Bone Marrow Foundation
Website www.bonemarrow.org
Phone 800-365-1336
Email thebmf@bonemarrow.org
The Bone Marrow Foundation offers financial assistance and support services to bone marrow/stem cell transplant patients and their families.
  Cancer and Careers
Website www.cancerandcareers.org/
Phone 646-929-8032
Email cancerandcareers@cew.org
Cancer and Careers provides essential tools and information for employees with cancer, including general information on insurance issues, legal rights in the workplace, and filing for disability due to cancer.
  CancerCare
Website www.cancercare.org
Phone 800-813-4673
Email info@cancercare.org
CancerCare is a national non-profit organization. They provide free professional support services for people affected by cancer. They also provide financial assistance for certain expenses related to cancer treatment.
  CancerCare® Co-Payment Assistance Foundation
Website www.cancercarecopay.org
Phone 866-552-6729
Email information@cancercarecopay.org
CancerCare® Co-Payment Assistance Foundation (CCAF) is a nonprofit organization that provides financial support for co-pays for certain drugs and diagnoses.
  Cancer Financial Assistance Coalition
Website www.cancerfac.org
The Cancer Financial Assistance Coalition (CFAC) is a coalition of 14 financial assistance organizations joining forces to help cancer patients experience better health and well-being by limiting financial challenges. Links are provided to each of the 14 member organizations.
  Cancer Legal Resource Center
Website https://disabilityrightslegalcenter.org/cancer-legal-resource-center
Phone 866-843-2572
Email CLRC@drlcenter.org
The Cancer Legal Resource Center (CLRC) provides free and confidential information and resources on cancer-related legal issues to people with cancer, their families, friends, employers, healthcare professionals, and others coping with cancer. Callers can receive information about relevant laws and resources for their particular situation.
  Cancer Resource Foundation, Inc.
Website http://cancer1source.org/
Phone 508-630-2242
Email Direct from website
The Cancer Resource Foundation, Inc. has a national cancer genetic testing copay assistance program offering up to $520 toward the applicant's out-of-pocket costs for genetic testing. They also offer limited financial assistance for cancer-related costs.
  Catholic Charities USA
Website www.catholiccharitiesusa.org
Phone 703-549-1390
Email info@catholiccharitiesusa.org
Catholic Charities offers financial assistance for practical needs including rent, utilities, food, or transportation.
  Centers for Disease Control & Prevention
Website http://www.cdc.gov/cancer/nbccedp/
Phone 800-232-4636
Email cdcinfo@cdc.gov
The Centers for Disease Control & Prevention (CDC) provides low-income, uninsured, and underserved women access to screening and diagnostic services, to detect breast and cervical cancer, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Breast and Cervical Cancer Prevention and Treatment Act of 2000 gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the CDC's NBCCEDP.
  Center for Medicare Advocacy, Inc.
Website www.medicareadvocacy.org
Phone 202-293-5760
Email Direct from website
The Center for Medicare Advocacy is a national nonprofit advocacy group that provides education, advocacy, and legal assistance to help elders and people with disabilities obtain Medicare and necessary healthcare. The Center focuses on Medicare patients with chronic conditions and those in need of long-term care.
  Children's Leukemia Research Association, Inc.
Website childrensleukemia.org
Phone 516-222-1944
Email info@childrensleukemia.org
The Children's Leukemia Research Association's Co-Pay Assistance programs are open to adults and children with leukemia. The programs are open for enrollment every January 1st on a first-come/first-serve basis and provide help with leukemia related medical bills.
  Colorectal CareLine
Website www.colorectalcareline.org
Phone 866-657-8634
Email CCL@patientadvocate.org
The Colorectal CareLine helps identify and facilitate financial assistance to colorectal cancer patients. As part of the Patient Advocate Foundation (PAF) the organization also supplies various patient resources and direct appeal assistance.
  Colon Cancer Alliance
Website www.ccalliance.org
Phone 877-422-2030
Colon Cancer Alliance's Blue Note Fund provides one-time grants of $300 to qualifying patients to help cover screening and treatment-related expenses, and a $200 stipend to cover treatment-related expenses for those currently in treatment.
  Co-Pay Relief
Website www.copays.org
Phone 866-512-3861
Email Direct from website
Part of PAF, the Co-Pay Relief (CPR) program provides direct financial support for pharmaceutical co-payments to insured patients, including Medicare Part D beneficiaries, who financially and medically qualify. CPR can provide co-pay assistance for patients with certain diagnoses. Physicians and patients can initiate a request for assistance.
  Corporate Angel Network
Website www.corpangelnetwork.org
Phone 866-328-1313
Email info@corpangelnetwork.org
Corporate Angel Network provides free flights transporting qualified cancer patients and their families to treatment facilities. Eligibility is open to all cancer patients, bone marrow donors, and bone marrow recipients who are not in need of medical support while traveling.
  Good Days from CDF
Website www.mygooddays.org
Phone 877-968-7233
Email info@cdfund.org
Good Days from CDF (formerly known as Chronic Disease Fund) works through progressive assistance programs to provide financial support for patients who cannot afford the medications they need.
  Healthwell Foundation
Website www.healthwellfoundation.org
Phone 800-675-8416
Email grants@healthwellfoundation.org
Healthwell Foundation is a nonprofit, charitable organization that helps individuals afford prescription medications they are taking for specific illnesses. The Foundation provides financial assistance to eligible patients to cover certain out-of-pocket healthcare costs, including prescription drug coinsurance, co-payments & deductibles, and health insurance premiums. Lists of disease states and medications covered are available on their website. An online application is also available.
  Hope Lodge
Website www.cancer.org/treatment/supportprogramsservices/hopelodge/index
Phone 800-227-2345
Hope Lodge and the American Cancer Society offers cancer patients and their families a free, temporary place to stay when their best hope for effective treatment may be in another city. Currently, there are more than 30 Hope Lodge locations throughout the United States. Accommodations and eligibility requirements may vary by location. Find local lodging resources at www.cancer.org's Find Local Resources page by selecting the category Housing.
  HRSA Bureau of Primary Health Care
Website bphc.hrsa.gov
Phone 877-464-4772
The Health Resources and Services Administration (HRSA) helps patients find federally funded health centers to care for them, even if they have no health insurance. Patients pay what they can afford, based on income. An online health services locator is available on the HRSA website to identify local health centers.
  IRS
Website www.irs.gov/
Phone 800-829-1040
The Internal Revenue Service (IRS) can provide information about tax deductions for medical costs that are not covered by insurance policies. For example, tax-deductible expenses might include mileage for trips to and from medical appointments; out-of-pocket costs for treatment, prescription drugs, or equipment; and the cost of meals during lengthy medical visits.
  Joe's House
Website www.joeshouse.org
Phone 877-563-7468
Email info@joeshouse.org
Joe's House website lists accommodations that cater to cancer patients, their families, and caregivers, and provides a centralized list of appropriate housing.
  The Leukemia & Lymphoma Society Copay Assistance Program
Website www.lls.org/support/financial-support/co-pay-assistance-program
Phone 877-557-2672
Email copay@lls.org
The Leukemia & Lymphoma Society (LLS) Co-Pay Assistance Program provides financial assistance (for certain diagnoses) for cancer treatment-related co-pays, private health insurance premiums and co-pay obligations, Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, and Medicare Advantage premium or co-pay obligations.
  The Lymphoma Research Foundation
Website www.lymphoma.org
Phone 800-500-9976
Fax 212-349-2886
Email Helpline@lymphoma.org
The Lymphoma Research Fund (LRF) offers financial assistance programs for people currently undergoing treatment for lymphoma. Through their program, LRF may be able to pay a portion of a patient's medical bills or assist with quality-of-life-expenses.
  Medicare Rights Center
Website www.medicarerights.org
Phone 800-333-4114
Email info@medicarerights.org
The Medicare Rights Center helps people with Medicare understand their rights and benefits, navigate the Medicare system, and secure the quality healthcare they deserve.
  Myriad Financial Assistance Program
Website www.myriadpro.com/for-your-patients/financial-assistance-programs
Phone 844-697-4239
Email billing@myriad.com
Myriad offers testing at no charge to uninsured patients who meet specific financial and medical criteria. Patients who are insured may qualify for financial assistance that limits out-of-pocket expenses. Qualification requirements and application forms are available on their website.
  National Association of Hospital Hospitality Houses
Website www.nahhh.org/
Phone 800-542-9730
Email bquinn@hhnetwork.org
The National Association of Hospital Hospitality Houses (NAHHH), Inc. is an association of nearly 200 nonprofit organizations located throughout the US that provide family-centered lodging and support services to patients and their families who are receiving medical treatment far from home. The NAHHH website features an online lodging locator.
  National Children's Cancer Society
Website www.thenccs.org/
Phone 314-241-1600
Email programs@thenccs.org
The National Children's Cancer Society provides direct financial assistance for families during treatment.
  National Foundation for Transplants
Website www.transplants.org/
Phone 800-489-3863
Email info@transplants.org
The National Foundation for Transplants (NFT) provides fundraising assistance to bone marrow and solid organ transplant patients in all 50 states and US territories. Through their fundraising program, the NFT endeavors to help patients with their transplant, pre-transplant treatment, follow-up care, and medications.
  National Organization for Rare Disorders
Website www.rarediseases.org
Phone 800-999-6673
Email Direct from website
The National Organization for Rare Disorders (NORD) is a nonprofit organization, comprised of a federation of voluntary health organizations, dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. NORD provides premium and co-pay assistance as well as working with other organizations to provide travel and lodging assistance for study participants enrolled in specific rare disease clinical trials.
  National Patient Travel Helpline
Website www.patienttravel.org/
Phone 800-296-1217
Email Direct from website
The National Patient Travel Center (NPTC) provides a single point of contact to facilitate patient access to appropriate charitable or discounted airline tickets for patients and patient escorts. The NPTC serves in association with numerous national and state-level charitable medical air transportation programs providing maximum efficiency and minimum costs.
  NeedyMeds
Website www.needymeds.org
Phone 800-503-6897
Email info@needymeds.org
NeedyMeds does not supply medications or financial assistance. They provide a comprehensive listing of drugs and dosages that are available through patient assistance programs as well as contact information, application forms, eligibility guidelines, and the application process and requirements. Patients may download the NeedyMeds Drug Discount Card, which offers savings of 0-80% on prescription drugs.
  Partnership for Prescription Assistance
Website www.pparx.org
Phone 888-477-2669
Email Directly from website
The Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including nearly 200 programs offered by pharmaceutical companies.
  Patient Access Network Foundation
Website www.panfoundation.org
Phone 866-316-7263
Email contact@panfoundation.org
The Patient Access Network Foundation is an independent, national organization dedicated to assisting underinsured patients with co-payment assistance. Applicants must meet certain financial, medical, and insurance criteria. A list of covered disease states is available on their website.
  Patient Advocate Foundation
Website www.patientadvocate.org
Phone 800-532-5274
Email Direct from website
Patient Advocate Foundation (PAF) provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their chronic/debilitating or life-threatening illness. The PAF website contains links to many helpful resources for patients and caregivers, including a National Financial Resources Guidebook providing an interactive state-by-state database of available financial assistance and resources.
  Patient Services Incorporated
Website www.patientservicesinc.org
Phone 800-366-7741
Email uneedpsi@uneedpsi.org
Patient Services Inc. provides premium and co-pay assistance programs for qualified patients with certain diseases.
  PatientAssistance.com
Website www.patientassistance.com
Phone 888-788-7921
Email Direct from website
PatientAssistance is a nonprofit organization providing a patient assistance program database and online enrollment forms (when available through the manufacturer).
  Road to Recovery
Website www.cancer.org/treatment/supportprogramsservices/Road-to-Recovery
Phone 800-227-2345
Email Direct from website
Road to Recovery is an American Cancer Society service program that provides transportation for cancer patients to their treatments and back home after treatment. Transportation is provided according to the needs and available resources in the community.
  RxAssist
Website www.rxassist.org
Email info@rxassist.org
RxAssist is a national nonprofit resource center containing a comprehensive database of patient assistance programs.
  RXHope
Website www.RxHope.com
Phone 877-267-0517
Email CustomerService@RXHope.com
RxHope contracts directly with pharmaceutical companies to provide an electronic application process for their patient assistance programs. RxHope provides this service to physicians and patients free of charge. Physicians or their staff members can go online to complete the application. Some applications can be transmitted electronically through the site and others must be printed and mailed or faxed.
  Rx Outreach
Website www.rxoutreach.org
Phone 800-769-3880
Email questions@rxoutreach.org
Rx Outreach is an independent, nonprofit pharmacy that offers prescription medicines to individuals and families, as well as those who have limited prescription drug coverage. Financial qualifications and applications are available on the website.
  The SAMFund
Website www.thesamfund.org
Phone 617-938-3484
Email info@thesamfund.org
The Samfund for young adult survivors of cancer provides direct financial assistance to help young adult cancer survivors recover from the financial impact of cancer treatment.
  Sarcoma Alliance
Website www.sarcomaalliance.org
Phone 415-381-7236
Email info@sarcomaalliance.org
The Sarcoma Alliance Assistance Fund reimburses expenses directly associated with getting a second opinion from a sarcoma specialist.
  State Health Insurance Assistance Programs
Website www.shiptalk.org
The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Patients can be referred to their state's SHIP by contacting 1-800-Medicare and asking for health insurance counseling. Patients and others can get state-specific information through the SHIP website.
  Supplemental Security Income
Website www.socialsecurity.gov
Phone 800-772-1213
Email Direct from website
Supplemental Security Income (SSI) is administered by the Social Security Administration (SSA) and supplements Social Security payments for aged, blind, and disabled people with little or no income. It provides cash to meet basic needs for food, clothing, and shelter. Information on eligibility, coverage, and how to file a claim is available from the SSA. The Benefit Eligibility Screening Tool is available on the website. Individuals who are disabled for 6 months or longer may qualify for benefits. Certain cancer diagnoses qualify.
  Taking Charge of Money Matters
Website https://www.cancer.org/treatment/finding-and-paying-for-treatment.html
Phone 800-227-2345
Email Direct from website
The American Cancer Society provides interactive tools dealing with financial and insurance issues that may come up during or after a person's cancer treatment.
  The United Way
Website www.unitedway.org
Phone 703-836-7112
Email worldwide@unitedway.org
The United Way is an international organization that can help patients locate various types of assistance.
  UnitedHealthcare Children's Foundation
Website www.uhccf.org
Phone 855-698-4223
Email customerservice@uhccf.org
The UnitedHealthcare Children's Foundation is a nonprofit charity providing financial assistance in the form of medical grants to be used for medical services for children (16 years and younger) with cancer who are not covered or not completely covered by commercial health benefit plans.


1 News.gallup.com. U.S. Uninsured Rate Steady at 12.2% in Fourth Quarter of 2017. Gallup-Sharecare Well-Being Index. http://news.gallup.com/poll/225383/uninsured-rate-steady-fourth-quarter-2017.aspx. Accessed February 4, 2018.

2 Henry J Kaiser Family Foundation. How Premiums Are Changing in 2018. https://www.kff.org/health-reform/issue-brief/how-premiums-are-changing-in-2018/. Accessed February 4, 2018.

3 Federal Register. Annual Update of the HHS Poverty Guidelines. https://www.gpo.gov/fdsys/pkg/FR-2018-01-18/pdf/2018-00814.pdf. Published January 18, 2018. Accessed February 20, 2018.

4 Medicare.gov. 2018 Medicare Costs. https://www.medicare.gov/Pubs/pdf/11579-Medicare-Costs.pdf. Accessed February 01, 2018.


6 Medicare.gov. Medicare 2018 Costs at a Glance. https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4809. Accessed February 3, 2018.


8 HHS.gov. The Affordable Care Act. http://www.hhs.gov/healthcare/about-the-law/read-the-law/. Accessed February 12, 2018

9 Henry J. Kaiser Family Foundation. The Medicare Part D Prescription Drug Benefit. https://www.kff.org/medicare/fact-sheet/the-medicare-prescription-drug-benefit-fact-sheet/. Accessed February 12, 2018.

10 www.ssa.gov Extra Help with Medicare Prescription Drug Plan Costs. https://www.ssa.gov/benefits/medicare/prescriptionhelp/. Accessed February 14, 2018.

11 American Society of Clinical Oncology. Cancer.Net. http://www.cancer.net. Accessed February 14, 2018.

12 The American Cancer Society. Understanding Health Insurance. http://www.cancer.org/treatment/findingandpayingfortreatment/understandinghealthinsurance/index. Accessed February 14, 2018.


13 United States Department of Labor, Wage and Hour Division. The Family and Medical Leave Act of 1993, as amended. https://www.dol.gov/whd/fmla/fmlaAmended.htm. Accessed February 14, 2018.


14 ADA.gov. United States Department of Justice, Civil Rights Division. Information and Technical Assistance on the American with Disabilities Act. https://www.ada.gov/ada_intro.htm. Accessed February 14, 2018.

15 United States Department of Labor, Employee Benefits Security Administration. COBRA Continuation Coverage. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/cobra. Accessed February 14, 2018.

16 Centers for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight. Women's Health and Cancer Rights Act (WHCRA). https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet.html. Accessed February 14, 2018.

17 Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program (NBCCEDP). http://www.cdc.gov/cancer/nbccedp/about.htm. Accessed February 14, 2018.

18 U.S. Department of Health and Human Services. Administration for Community Living. Administration on Aging. http://www.aoa.gov/AoA_Programs/OAA/Index.aspx. Accessed February 14, 2018.

Published by Rise Marie Cleland.Sponsored by Lilly Oncology

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ABOUT THE EDITOR
Risë Marie Cleland is the Founder and CEO of Oplinc, Inc., a national organization of oncology professionals. Through Oplinc, Inc., Ms. Cleland publishes the weekly Oplinc Fast Facts focusing on the timely dissemination of information pertaining to billing, reimbursement and practice management in the oncology office and Oplinc’s Best Practices Review, which provides a more in-depth look at the issues and challenges facing oncology practices. Ms. Cleland also works as a consultant and advisor for physician practices, pharmaceutical companies and distributors.

IMPORTANT NOTICES
Please note that this newsletter is presented for informational purposes only. It is not intended to provide coding, billing or legal advice. Regulations and policies concerning Medicare reimbursement are a rapidly changing area of the law. While we have made every effort to be current as of the issue date, the information may not be as current or comprehensive when you review it. Please consult with your legal counsel for any specific reimbursement information. For Medicare regulations visit: www.cms.gov.

CPT® is a Trademark of the American Medical Association Current Procedural Terminology (CPT) is copyright 2018 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

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