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In May 2016, the Centers for Disease Control and Prevention (CDC) released their report, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2015. According to the report, in 2015, the number of uninsured persons in the US (includes all 50 states and the District of Columbia) was 28.6 million, a decrease of 7.4 million from the uninsured in 2014.

The Affordable Care Act (ACA) has succeeded in expanding access to insurance. However, underinsurance remains a problem as premium cost pressures on employers have resulted in increased cost-sharing for employees. Furthermore, individuals purchasing their own healthcare coverage oftentimes choose lower cost policies that have high deductibles, larger cost-sharing, and less coverage.2 High health expenditures on premiums, deductibles, and cost-sharing are outpacing growth in many families' incomes.2

In this issue, we outline some of the patient assistance services and resources that may be available to your patients.



The poverty guidelines are issued by the Department of Health and Human Services (HHS) each year and 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. Many healthcare institutions and providers provide a discount for services to uninsured or underinsured patients using a sliding scale based on the HHS poverty guidelines.

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

The 2016 Poverty Guidelines for the
48 Contiguous States and the District of Columbia

Persons in family

Poverty guideline

















For families with more than 8 persons, add $4,160 for each additional person.

2016 Poverty Guidelines for

Persons in family

Poverty guideline

















For families with more than 8 persons, add $5,200 for each additional person.

2016 Poverty Guidelines for

Persons in family

Poverty guideline

















For families with more than 8 persons, add $4,780 for each additional person.

SOURCE: Federal Register, Vol. 81, No. 15, January 25, 2016, pp. 4036-4037


Medicare Prescription Drug Plan 4, 5

Medicare offers prescription drug coverage under the Medicare Part D program. Medicare beneficiaries may obtain prescription drug coverage through Medicare Prescription Drug Plans (PDPs) or through a Medicare Advantage Plan (MA-PDs).

Medicare beneficiaries are advised to join a Medicare drug plan when they are first eligible in order to avoid a late enrollment penalty. Beneficiaries that are subject to a late-enrollment penalty will pay their plan's monthly Medicare Part D premium as well as an additional penalty. The penalty is calculated as 1% of the national base Medicare Part D monthly premium for each month the beneficiary was without creditable prescription drug coverage. For 2016 the average monthly Medicare Part D base premium is $34.10.

Some Medicare beneficiaries with higher incomes, above $85,000 and filing individually or $170,000 if married and filing jointly, may pay more for the Part D coverage. These higher income beneficiaries will pay an extra amount in addition to their plan premium.

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. Initially, Medicare beneficiaries were responsible for 100% of the drug cost while in the coverage gap. The Patient Protection and Affordability Act of 2010 included a provision to begin closing this coverage gap, and when fully implemented in 2020, Medicare beneficiaries will have a 25% coinsurance during the coverage gap. 6

In 2016, Medicare beneficiaries entering the coverage gap will receive a 55% discount (50% paid by the drug manufacturer and 5% paid by the Medicare Part D plan) on brand-name drugs and a 42% discount on generic drugs.
Under the standard 2016 Medicare Part D plan, the Medicare beneficiary will have a yearly deductible of $360 before the drug plan begins to pay. After the deductible is met, the Medicare beneficiary and Part D plan each pay their share until the combined amount (plus the deductible) reaches $3,310. At this point, the Medicare beneficiary is in the coverage gap and responsible for 45% of the plan's cost for covered brand-name drugs and 58% of the plan's cost for covered generic drugs.

Once the Medicare beneficiary has spent $4,850 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, costs for covered drugs are reduced to $2.95 for generic or preferred multi-source drugs and $7.40 for brand name 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.

CMS Part D 2016 Standard Benefit Model Plan Details 7

Q1 Medicare.com provides the following highlights for the Centers for Medicare & Medicaid Services (CMS) defined Standard Benefit Plan changes from 2015 to 2016. The Standard Benefit Plan is the minimum allowable plan to be offered.

  • Initial Deductible:
    Increased by $40 to $360 in 2016.
  • Initial Coverage Limit:
    Increased from $2,960 in 2015 to $3,310 in 2016.
  • Out-of-Pocket Threshold:
    Increased from $4,700 to $4,850 in 2016.
  • Coverage Gap (donut hole):
    Begins once you reach your Medicare Part D plan's initial coverage limit ($3,310 in 2016) and ends when you spend a total of $4,850 in 2016.
    In 2016, Part D enrollees will continue to receive a 55% discount on the total cost of their brand-name drugs while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole; however, the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP. Enrollees will pay a maximum of 58% co-pay on generic drugs while in the coverage gap.
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit:
    Increased to greater of 5% or $2.95 for generic or preferred drug that is a multi-source drug and the greater of 5% or $7.40 for all other drugs in 2016.
  • Maximum Co-payments Below the Out-of-Pocket Threshold for Certain Low Income Full Subsidy Eligible Enrollees:
    Increased to $2.95 for generic or preferred drug that is a multi-source drug and $7.40 for all other drugs in 2016.

Source: Q1 Medicare.com 2016 Medicare Part D Outlook



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. Qualifying beneficiaries with limited resources and income may receive help to pay for monthly premiums, annual deductibles, and prescription co-payments related to their Medicare prescription drug plan.

Countable resources under the Extra Help program include:

  • Money in a checking or savings account
  • Stocks
  • Bonds
  • Property that is not your primary residence

Certain Medicare beneficiaries automatically qualify for Extra Help, 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. According to CMS, more than 2 million people with Medicare may be eligible for Extra Help, but aren't currently enrolled 10. Medicare beneficiaries must apply for Extra Help separately from enrolling in a Part D plan.

Medicare beneficiaries can apply online at www.socialsecurity.gov/extrahelp or by calling 1-800-772-1213.


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 healthcare 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 provides descriptions of the most common health plan types and how they typically operate, as well as definitions of common insurance terms.

The ACS provides tips on managing health insurance and the importance of reviewing the details and coverage of insurance plans, including the Summary of Benefits and Coverage (SBC), before choosing your health insurance plan. 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.



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 that 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. It also does not allow employers to screen out potential employees who have children with disabilities. This law is administered by the U.S. Equal Employment Opportunity Commission (EEOC). 14

COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986) gives qualified employees and their families the right to temporarily continue workplace 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. COBRA is administered by the U.S. Department of Labor. COBRA information & FAQs are available on their website. 15

Patients who are losing workplace health insurance should also review the healthcare coverage options that may be available to them in the health insurance marketplace.

Women's Health and Cancer Rights Act of 1998 16
Under the Women's Health and Cancer Rights Act (WHCRA) of 1998, health insurance plans must 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. Both of these agencies have Web pages with information about WHCRA, including a list of frequently asked questions.

Department of Health and Human Services, Centers for Medicare & Medicaid Services WHCRA
Department of Labor

Breast and Cervical Cancer Prevention and Treatment Act 17
On October 24, 2000, the Breast and Cervical Cancer Prevention and Treatment Act (BCCPT) of 2000 was signed into law. The Act, which became effective October 1, 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. States that do participate receive an enhanced matching rate for women who enroll. To date, all 50 states and the District of Columbia are participating in the BCCPT.

To be eligible for Medicaid under this option, the woman must:

  • Have been screened for and found to have breast or cervical cancer, including precancerous conditions, through the NBCCEDP
  • Be under age 65
  • Be uninsured or underinsured and otherwise not eligible for Medicaid

In 2001, Congress passed a technical amendment to the BCCPT Act. The Native American Breast and Cervical Cancer Treatment Technical Amendment Act of 2001, extends benefits of the BCCPT Act to American Indian and Alaska Native women.

National Breast and Cervical Cancer Early Detection Program

The Older Americans Act 18
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.

Eldercare Locator

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 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
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 copays, deductibles and health insurance premiums.
  Association of Community Cancer Centers
Website www.accc-cancer.org
ACCC maintains a comprehensive list of reimbursement assistance programs for oncology-related drugs and services.
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.
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/
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.
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 www.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.
  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.
  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.
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.
  Kristy Lasch Miracle Foundation
Website www.kristylasch.org
Phone 412-872-4125
Email kristylaschmiraclefoundation@comcast.net
The Kristy Lasch Miracle Foundation offers financial assistance for medical-related expenses to women under 30 living with breast cancer.
  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 two financial assistance programs for people currently undergoing treatment for lymphoma. Through these programs, 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 and must be filled out by both the patient and provider.
  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 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.
  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.
Website www.needymeds.org
Email Direct from website
NeedyMeds does not supply medications or financial assistance. They provide a comprehensive listing of drugs and dosages that are available through patient assistance programs. They provide detailed information about the patient assistance program, including the program name, contact information, application forms, eligibility guidelines, and the application process and requirements.
  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 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.
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.
Website www.rxassist.org
Email info@rxassist.org
RxAssist is a national nonprofit resource center containing a comprehensive database of patient assistance programs.
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 charitable organization that offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage. Individuals can use Rx Outreach regardless of their age or if they use another discount medicine program or patient assistance program. 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 www.cancer.org/Treatment/FindingandPayingforTreatment
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.
  We Believe Foundation
Website www.wbfinc.org
Phone 240-232-7795
Email Direct from website
The We Believe Foundation provides financial assistance for those who are 15-29 years old and have cancer. Grants include Financial Hardship awards (up to $3,500 per applicant per year), to help cover expenses due to any form of cancer, lost part-time wage grants, and financial assistance for expenses for breast cancer patients.


1 Centers for Disease Control. National Health Interview Survey Early Release Program. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201605.pdf. Accessed May 26, 2016.

2 The Commonwealth Fund. The Problem of Underinsurance and How Rising Deductibles Will Make It Worse. http://www.commonwealthfund.org/publications/issue-briefs/2015/may/problem-of-underinsurance. Accessed May 26, 2016.

3 Federal Register. Annual Update of the HHS Poverty Guidelines. https://www.federalregister.gov/articles/2016/01/25/2016-01450/annual-update-of-the-hhs-poverty-guidelines. Published January 25, 2016. Accessed May 26, 2016.

4 Department of Health & Human Services. Medicare & You 2016. https://www.medicare.gov/Pubs/pdf/10050.pdf. Accessed May 26, 2016.

5 Q1Medicare.com. What Is TrOOP or True Out-of-Pocket Costs. https://q1medicare.com/PartD-WhatIs-TheTrueOutOfPocketExpense.php. Accessed May 26, 2016.

63 HHS.gov. The Affordable Care Act. http://www.hhs.gov/healthcare/about-the-law/read-the-law/. Accessed May 26, 2016.

7 Q1Medicare.com. 2016 Medicare Part D Outlook. https://q1medicare.com/PartD-The-2016-Medicare-Part-D-Outlook.php Accessed May 26, 2016.

9 Social Security Administration. Extra Help With Medicare Prescription Drug Plan Costs. https://www.ssa.gov/medicare/prescriptionhelp/. Accessed May 26, 2016.

10 U.S. Department of Health & Human Services. Medicare Open Enrollment Notice. https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/2016-extra-help-drop-in.pdf. Accessed May 26, 2016.

11 American Society of Clinical Oncology. Cancer.Net. http://www.cancer.net. Accessed May 26, 2016.

12 The American Cancer Society. Understanding Health Insurance. http://www.cancer.org/treatment/findingandpayingfortreatment/understandinghealthinsurance/index. Accessed May 28, 2016.

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 May 26, 2016.

14 ADA.gov. United States Department of Justice, Civil Rights Division. Information and Technical Assistance on the American with Disabilities Act. http://www.ada.gov. Accessed May 26, 2016.

15 United States Department of Labor, Employee Benefits Security Administration. COBRA Continuation Coverage. https://www.dol.gov/ebsa/COBRA.html. Accessed May 26, 2016.

16 Centers for Medicare & Medicaid Services. The Center for Consumer Information & Insurance Oversight. Women's Health and Cancer Rights Act (WHCRA) Fact Sheet. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet.html. Accessed May 26, 2016.

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 May 26, 2016.

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 May 26, 2016.


Published by Rise Marie Cleland. Sponsored by Lilly Oncology

Risë Marie Cleland Rise@Oplinc.com

Oplinc, Inc.
1325 Officers Row
Suite A
Vancouver, WA 98661
360.695.1608 office

Comments and suggestions for future issues are welcome, please forward correspondence to Risë Marie Cleland by email at: Rise@Oplinc.com

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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.

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 2016 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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