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Volume 15, Issue 1 Download for iPad

PATIENT ASSISTANCE RESOURCES 2020

This issue is going to publication at the same time as the COVID-19 virus is rapidly expanding across our country and the world. Oncologists (and other specialists) are trying to determine how best to navigate the challenges associated with potentially significant disruptions in the care of patients with cancer, balancing the need for treatment with the need to protect vulnerable patients and their staff from the risk of COVID-19.

The loss of jobs and health insurance benefits associated with COVID-19 increases the numbers of individuals who are or will be uninsured or underinsured. This issue includes information that may be of help to your patients including information on laws and regulations, as well as patient assistance resources to help cancer patients.

Note: As of Sunday, March 22, 2020 the American Cancer Society has made the decision to close down all American Cancer Society Lodges in the US due to COVID-19.

 

STATES EXPANDING ENROLLMENT IN HEALTH INSURANCE EXCHANGES 1, 2

In light of the COVID-19 outbreak, on March 12, 2020, Senator Jack Reed (D-RI) and 24 other Senators wrote to urge the Trump Administration to open a special enrollment period to allow people without health insurance to purchase an Affordable Care Act (ACA) plan through the health insurance marketplaces.

CMS has not reopened HealthCare.gov, the Federal Health Insurance Exchange as of March 24, and instead encouraged people to check whether they qualify for a special enrollment period for other reasons such as a job loss that ends their health coverage. However, it is reported that CMS is considering offering a special enrollment period specifically designated for COVID-19.

As of March 20, 2020, at least nine U.S. states reopened their health insurance exchanges in order to limit the number of individuals who may get infected and avoid medical care, inadvertently spreading the virus. The states that reopened their health insurance exchanges include Colorado, Connecticut, Maryland, Massachusetts, Nevada, New York, Rhode Island, and Washington. These states have the flexibility to expand open enrollment because they run their own health exchanges. California also announced that they will continue to allow residents to enroll through June. The District of Columbia is also allowing residents to sign up for coverage for reasons unrelated to the COVID-19 outbreak.

UNINSURED AND UNDERINSURED
In a recent AMA publication, 2020 and Beyond: AMA’s Plan to Cover the Uninsured, the AMA reports that nearly 60% of nonelderly Americans have employer-sponsored health insurance coverage. It’s impossible to predict how many Americans will lose their job and their health insurance coverage due to the COVID-19 pandemic. But nearly 30 million Americans were uninsured before the outbreak of COVID-19 and millions more may lose their jobs and health care before the pandemic subsides.

Additionally, millions more may move from more expensive comprehensive health plans to less expensive and less robust plans.

High Deductible Health Insurance Plans 3
High Deductible Health Insurance Plans (HDHPs) have a higher deductible than a traditional health plan, but the monthly premium is generally lower. For 2020, the HDHP will have a deductible of at least $1,400 for an individual or $2,700 for a family. And HDHPs total yearly out-of-pocket expenses can’t be more than $6,900 for an individual or $13,800 for a family (this limit does not apply to out-of-network services and does not count premiums).

Short Term Limited Duration Insurance 4, 5
On August 1, 2018, the Departments of Health and Human Services, Labor, and Treasury (the tri-agencies) issued a final rule extending the maximum duration of Short-Term Limited Duration Insurance (STLDI) plans from three months up to 12 months and allows insurers to renew STLDI plans for up to 36 months.

Originally, short-term coverage was designed to fill a temporary (up to three months) gap in coverage such as when an individual is between jobs outside of the open enrollment period and does not qualify for a special enrollment period. Because these policies are excluded from the ACA’s definition of individual health insurance coverage, they are not subject to the ACA’s requirements.

While far less expensive than ACA compliant coverage, STLDI plans to not have to comply with many of the ACA’s most important protections, for example:

  • They may exclude people with pre-existing conditions or exclude coverage of pre-existing conditions.
  • They can charge more based on an individual’s age, gender or health.
  • They generally provide far fewer benefits and can choose not to cover essential health benefits such as prescription drugs or substance use or mental health treatment.
  • They can impose annual and/or lifetime limits on coverage.
  • They can rescind coverage at will.
  • They can require higher out-of-pocket cost-sharing than allowed under the ACA.

Several states have taken action to restrict the sales or limit the duration of STLDI plans and prohibit renewals. And other states have enacted legislation that expands access and allows STLDI plan durations to match the maximum durations in line with federal rules.

Health Care Sharing Ministries 6

Health Care Sharing Ministries (HCSMs) are not insurance policies, they are programs under which groups of people (who generally share a common faith) make monthly payments that is pooled into a general fund to cover health care expenses of other members. Members can submit medical bills to the fund, however, HCSMs are not subject to the consumer protections of the ACA, are largely unregulated, and do not guarantee payment of claims.

Because these programs are not health insurance, in most states the insurance laws and regulations don’t apply to HCSMs, and thus the state insurance department will not be able to intervene on a member’s behalf.

Although some individuals may find value in HCSMs it is important to remember the following:

  • HCSMs are not health insurance. However, HCSMs are generally 501(c)(3) charities, so they are regulated by the Internal Revenue Service (IRS) and state attorneys general.
  • HCSMs do not have to follow ACA regulations such as covering essential health benefits.
  • Medical benefits are far more limited than in ACA compliant plans, and payment for covered services are never guaranteed.
  • They do not have to cover pre-existing conditions.
  • They can impose annual and lifetime benefit caps.

 

ONCOLOGY FINANCIAL NAVIGATORS AND ADVOCATES

The majority of oncology clinics have found that employing dedicated Financial Navigators (also called Financial Advocates or Financial Counselors) is vital. These team members can help decrease financial toxicity for patients, the attendant financial risk to the practice, and increase patient satisfaction and adherence to treatment.

Ideally, Financial Navigators meet with patients at the time of diagnosis and before the start of any new treatment to verify coverage benefits, obtain pre-authorizations, provide patient treatment cost estimates and payment options, assess patient financial needs, assist patients with financial assistance applications, and facilitate the enrollment of eligible patients in manufacturer and/or foundation patient assistance programs, among other related tasks.

Financial Navigators must stay updated on private and public insurance plans and programs, covered benefits including prescription benefits, have an in-depth knowledge of available resources and program requirements of patient assistance programs including the many pharmaceutical manufacturers that offer patient assistance programs based on the patient’s coverage and financial need, as well as the laws that protect patients.

This is no small feat, as payer medical and prescription policies are subject to change monthly and patient assistance programs open and close new assistance applications at varying times (usually based on funds availability) and often have differing eligibility criteria.

This has largely been a manual process, and among the challenges has been the constant monitoring necessary to keep up with fluctuating open enrollment periods in the various patient assistance programs as third-party patient assistance programs (PAPs) tend to run out of money soon after opening enrollment.

However, cancer clinics have been reporting greatly improved efficiencies with software platforms that can help streamline and improve the financial navigation process including:

Services provided will vary between software platforms. But an example of important features includes Vivor’s Fund Re-open Alerts, which will automatically notify you when patient assistant funds that your patients are eligible for re-open.

FEDERAL POVERTY GUIDELINES 7

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, state and charitable programs.

The 2020 HHS poverty guidelines are effective as of January 14, 2020 and were published in the Federal Register on January 17, 2020. The HHS poverty guidelines, or percentage multiples of them, are used as an eligibility criterion by a number of federal and state programs.

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

The 2020 Poverty Guidelines for
the 48 Contiguous States and the District of Columbia
Persons in Family/Household Poverty Guideline
1 $12,760
2 $17,240
3 $21,720
4 $26,200
5 $30,680
6 $35,160
7 $39,640
8 $44,120
For families with more than 8 persons, add $4,480 for each additional person.
The 2020 Poverty Guidelines for
Alaska
Persons in Family/Household Poverty Guideline
1 $15,950
2 $21,550
3 $27,150
4 $32,750
5 $38,350
6 $43,950
7 $49,950
8 $55,150
For families with more than 8 persons, add $5,600 for each additional person.
2020 Poverty Guidelines for
Hawaii
Persons in Family/Household Poverty Guideline
1 $14,680
2 $19,830
3 $24,980
4 $30,130
5 $35,280
6 $40,430
7 $45,580
8 $50,730
For families with more than 8 persons, add $5,150 for each additional person.

SOURCE: Federal Register, Vol. 85, No. 12, Friday, January 17, 2020

The majority of health care institutions and health care providers that offer discounts on services to uninsured and/or underinsured patients, do so on a case-by-case basis using the poverty guidelines to determine eligibility. Using a sliding scale based on the HHS poverty guidelines illustrates 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. 

2020 Medicare Costs 8, 9, 10

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 $458 each month for Part A coverage, this is up from $437 in 2019. 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, with few exceptions, will have a late penalty premium for Part A when they do sign up later on. The penalty premium is 10% of the current Part A premium and will be assessed for twice the number of years the individual was eligible for Part A but did not enroll.

Hospital Inpatient Stay Costs - 2020

  • Deductible, per benefit period*: $1,408
  • Coinsurance, Days 1-60 per benefit period: $0
  • Coinsurance per day for days 61–90: $352/day
  • Coinsurance per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime): $704/day
  • Beyond lifetime reserve days: All costs

*A benefit period begins the day the patient enters a hospital or skilled nursing facility (SNF) and ends when they have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.

Original Medicare covers up to 90 days of inpatient hospital care each benefit period. Beneficiaries also have 60 additional days of coverage called lifetime reserve days. Lifetime reserve days can only be used once, and they do not have to be applied to the same hospital stay. With few exceptions, Medicare beneficiaries who are in the hospital for more than 90 days in a benefit period may elect not to use their lifetime reserve days. More information on these reserve days can be found in the Centers for Medicare & Medicaid Services (CMS) online manual: Medicare Benefit Policy Manual Chapter 5 - Lifetime Reserve Days.

Skilled Nursing Facility Stay Costs – 2020

  • Coinsurance for the first 20 days of each benefit period: $0
  • Coinsurance per day for days 21–100 of each benefit period: $176
  • All costs for each day after day 100 of the benefit period

MEDICARE PART B – Original Medicare Fee-For-Service
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 2020, the standard Part B premium amount is $144.60, an increase of $9.10 from $135.50 in 2019. However, some beneficiaries will pay more. Since 2007, a beneficiary’s Part B monthly premium is based on his or her income. According to CMS, these income-related monthly adjustment amounts (IRMAA) affect roughly 7% of people with Medicare Part B. Part B premium rates for 2020 are based on the Medicare beneficiary’s 2018 income and tax filing status.

The 2020 Part B deductible for all beneficiaries is $198 per year, up from $185 in 2019. After the deductible is met Part B beneficiaries typically pay 20% for most physician services, outpatient therapy and durable medical equipment (DME).

CMS states that the rise in Part B premiums and deductible is largely due to rising spending on physician-administered drugs.11

2020 MEDICARE PART B PREMIUM RATES

If your yearly income in 2018 was

You pay each month in 2020

File individual tax return

File joint tax return

File married & separate tax return

 

$87,000 or less

$174,000 or less

$87,000 or less

$144.60

Above $87,000 up to $109,000

Above $174,000 up to $218,000

Not applicable

$202.40

Above $109,000 up to $136,000

Above $218,000 up to $272,000

Not applicable

$289.20

Above $136,000 up to $163,000

Above $272,000 up to $326,000

Not applicable

$376.00

Above $163,000 and less than $500,000

Above $326,000 and less than $750,000

Above $87,000 and less than $413,000

$462.70

$500,000 or above

$750,000 or above

$413,000 and above

$491.60

Source: Medicare.gov Medicare Costs at a Glance

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 full 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.

MEDIGAP POLICIES IN 2020 12
Medigap policies are health insurance policies that are sold by private insurance companies. Medigap policies offer standardized benefits and helps supplement original Medicare, paying part or all of certain costs remaining after original Medicare pays. These policies may cover outstanding deductibles, copayments and coinsurance as well as other health care costs that Medicare does not cover. Medicare beneficiaries who have a Medicare Advantage Plan (Medicare Part C) cannot buy a Medigap plan.
As of 2020, Medigap policies can no longer cover the Part B deductible for enrollees. Plan C and Plan F currently cover the Part B deductible, but these plans are being phased out and people eligible for Medicare on or after January 1, 2020 cannot purchase these plans. Medicare beneficiaries who already have these two plans will generally be able to keep their plan.

Medicare Supplement Insurance
(Medigap) Plans

Benefits

A

B

C

D

F*

G*

K

L

M

N

Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Medicare Part B coinsurance or copayment

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%***

Blood (first 3 pints)

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Part A hospice care coinsurance or copayment

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Skilled nursing facility care coinsurance

   

100%

100%

100%

100%

50%

75%

100%

100%

Part A deductible

 

100%

100%

100%

100%

100%

50%

75%

50%

100%

Part B deductible

   

100%

 

100%

         

Part B excess charges

       

100%

100%

       

Foreign travel emergency (up to plan limits)

   

80%

80%

80%

80%

   

80%

80%

Out-of-pocket limit in 2020**

           

$5,880

$2,940

   

* Plans F and G also offer a high‐deductible plan in some states. With this option, you must pay for Medicare‐covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 before your policy pays anything. (Plans C and F won’t be available to people who are newly eligible for Medicare on or after January 1, 2020.)

**For Plans K and L, after you meet your out‐of‐pocket yearly limit and your yearly Part B deductible ($198 in 2020), the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Source: CMS 2020 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

Medicare beneficiaries who want to buy a Medigap policy should do so during the Medigap Open Enrollment Period which lasts for 6 months and begins on the first day of the month in which the beneficiary is both 65 or older and enrolled in Medicare Part B. During this period the insurance company cannot:

  • Refuse to sell the beneficiary any Medigap policy it offers
  • Charge the beneficiary more for a Medigap policy than they charge someone with no health problems
  • Make the beneficiary wait for coverage to start (with some exceptions for pre-existing conditions, in some cases the insurance company can refuse to cover out-of-pocket costs for pre-existing health problems for up to 6 months).

The CMS publication 2020 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare provides helpful information for Medicare beneficiaries on Medicare Supplement Insurance (Medigap) policies, what they cover, the beneficiary’s rights to buy a Medigap policy and step-by-step instructions on choosing and buying a Medigap policy.

MEDICARE PART C
Medicare Part C plans, Medicare Advantage (MA) Plans, are offered by private companies approved by Medicare, to provide the Medicare beneficiary all Part A and Part B benefits. These plans generally offer additional benefits, such as vision, dental and hearing and many include prescription drug coverage.

The average monthly premium for MA plans has been declining in recent years as enrollment continues to increase. According to CMS, the average MA premium for 2020 is $23 a month, and Kaiser Family Foundation reports for Medicare Advantage plans with integrated Part D prescription coverage (MA-PDs), the average premium in 2020 is $36 a month.

MA plan premiums, deductibles, copays, and services vary by plan, and plans may charge different out-of-pocket costs. However, MA Plans cannot charge higher copays than Original Medicare for certain care, including chemotherapy, dialysis, and skilled nursing facility (SNF) care.

The maximum out-of-pocket spending limit for in-network services is consistent for all plans and in 2020 it is $6,700, but MA plans may set lower out-of-pocket limits. MA plans that include prescription drug coverage have a separate out-of-pocket maximum for prescription drugs costs.

Medicare beneficiaries can view and compare MA plans or Medicare Prescription Drug Plans (Part D) at www.medicare.gov/find-a-plan/questions/home.aspx.

Signing up for a Medicare Advantage plan:

  • During the Initial Enrollment Period – when you are first eligible for Medicare
  • Annual Election Period (AEP) – from October 15 – December 7 (for coverage effective in 2021)
  • Open Enrollment Period (OEP) – from January 1 – March 31, 2020

MEDICARE PART D 13
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.

Medicare Part D premiums will vary by Part D plan, in 2020, the national average for the Part D premium is $32.74. Medicare Part D deductibles also vary by drug plan, but in 2020, no Medicare drug plan may have a deductible more than $435. Beneficiaries who qualify for full Extra Help will have an annual deductible of $0, those you qualify for partial Extra Help will have a deductible of $89 or their plan’s standard deductible, whichever is lower.

In 2020, the Part D National Base Beneficiary Premium is $32.74 (down from $33.19 in 2019). 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 (IRMAA) in addition to the base plan premium.

Enrollees with incomes above $87,000 and filing individually, or above $174,000 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.

2020 Part D Premiums by Income

If your file status and yearly income in 2018 was:

You pay each month in 2020

File individual tax return

File joint tax return

File married & separate tax return

 

$87,000 or less

$174,000 or less

$87,000 or less

Your plan premium

Above $87,000 up to $109,000

Above $174,000 up to $218,000

Not applicable

$12.20 + your plan premium

Above $109,000 up to $136,000

Above $218,000 up to $272,000

Not applicable

$31.50 + your plan premium

Above $136,000 up to $163,000

Above $272,000 up to $326,000

Not applicable

$50.70 + your plan premium

Above $163,000 and less than $500,00

Above $326,000 and less than $750,000

Above $87,000 and less than $413,000

$70.00 + your plan premium

$500,000 or above

$750,000 and above

$413,000 and above

$76.40 + your plan premium

Source: Medicare.gov Medicare Costs at a Glance

Initially, most Medicare beneficiaries were responsible for paying 100% of their drug costs in the coverage gap phase. The Affordable Care Act (ACA) of 2010 included a provision to begin to close the coverage gap. In 2020, the ACA provision to close the coverage gap is complete, which means that Medicare beneficiaries will pay no more than 25% of the cost of covered generic and brand-name drugs while in the coverage gap in 2020. Medicare beneficiaries who get Extra Help paying for Part D costs won’t enter the coverage gap.

In 2020, the coverage gap begins once the beneficiary and their drug plan have spent $4,020 on covered drugs and ends once the beneficiary’s Total Out-of-Pocket (TrOOP) threshold reaches $6,350. This represents a 25% increase from the 2019 TrOOP of $5,100.

Catastrophic coverage in Part D begins when beneficiaries leave the coverage gap. In the 2020 catastrophic coverage phase, beneficiaries will pay a minimum of $8.35 for brand drugs or $3.35 for generics (or 5% whichever is higher).

The Henry J. Kaiser Family Foundation (KFF) provides a comprehensive overview of the Medicare Part D prescription drug benefit at https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/. Figure 1 from KFF shows the increases in the Part D enrollees’ out-of-pocket drug costs since 2006.


Figure 1 KFF

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 6 protected classes: immunosuppresants for treatment of transplant rejection, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics; except in limited circumstances. Part D sponsors are only permitted to impose prior authorization and step therapy requirements for beneficiaries initiating therapy (i.e., new starts) for 5 of the 6 protected classes, with no prior authorization or step therapy allowed for antiretrovirals.

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.

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 ($32.74 in 2020) times the number of full, uncovered months the Medicare beneficiary didn’t have Part D or creditable coverage, rounded to the nearest $0.10.

The graphic below illustrates the Medicare Part D late-enrollment penalty using an example of a beneficiary who did not have Part D or creditable coverage for a full 36 months.


MEDICARE EXTRA HELP 14
Extra Help is a federal program that helps Medicare beneficiaries who meet certain income and resource limits pay for the out-of-pocket costs of prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS). Depending on their income and resources, some Medicare beneficiaries may qualify for a full or partial Medicare Part D subsidy.

Beneficiaries who have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid will be automatically enrolled in Extra Help. 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.

Extra Help offers the following benefits to qualifying beneficiaries:

  • Pays for the Part D premium up to a state-specific benchmark amount
  • Lowers the cost of prescription drugs
  • Allows for a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans

More information on Medicare’s LIS/Extra Help program including a Part D LIS/Extra Help Eligibility and Coverage Chart is available from the National Council on Aging at: https://www.ssa.gov/benefits/medicare/prescriptionhelp/.

Medicare beneficiaries can apply online at https://www.ssa.gov/benefits/medicare/prescriptionhelp/.

RESOURCES: UNDERSTANDING HEALTH INSURANCE & LAWS PROTECTING CANCER PATIENTS

ASCO’S Cancer Net 15
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 updated and detailed information on the medical costs and hidden costs of cancer care, questions patients should ask their health care team, 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 16
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.

Cancer Legal Resource Center 17
The Disability Rights Legal Center (DRLC) founded the Cancer Legal Resource Center (CLRC), a 501C-3 non-profit advocacy organization, to address the legal issues faced by people with cancer and is committed to providing information and resources about cancer-related legal issues to members of the cancer community at no cost.

LAWS PROTECTING MEDICAL INSURANCE COVERAGE & CANCER PATIENTS
The Affordable Care Act (ACA) includes protections for patients and their families. Requires health insurance marketplaces to cover essential benefits including cancer screening, treatment, and follow-up care. Prohibits annual and lifetime limits in ACA compliant plans, makes proven cancer screening and other preventative care available at no cost to people in ACA compliant plans, in Medicare and Medicaid. Prevents ACA compliant insurance companies from denying coverage to people with pre-existing conditions, prevents insurance companies from charging more based on the individuals health status.18

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. 19

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. 20

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. 21

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. 22

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. 23

The Genetic Information Nondiscrimination Act (GINA) of 2008 protects Americans from discrimination based on their genetic information in health insurance and employment. GINA prohibits insurers from using genetic information to make eligibility, coverage, underwriting or premiums-setting decisions. Under Title I of this law, genetic information includes family medical history, manifest disease in family members, and information regarding individuals’ and family members’ genetic tests. Title II prevents employers from using genetic information in employment decisions such as hiring, firing, promotions, pay, and job assignments. GINA also prohibits insurers from requiring individuals or their family members to undergo genetic testing and information regarding their genetic tests. Employers are also prohibited from requiring or requesting genetic information and/or genetic tests as a condition of employment. 24

 

Helpful Resources

  AgingCare
Website www.agingcare.com
AgingCare provides resources and information for caregivers as well as a state-by-state list of prescription drug assistance programs at: https://www.agingcare.com/articles/prescription-drug-assistance-programs-state-by-state-programs-171447.htm
  The Air Care Alliance
Website www.aircarealliance.org
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@AndreRiverOfLife.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.
  Assistance Fund
Website www.tafcares.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
Phone 301-984-9496
Email Direct from website
Association of Community Cancer Centers (ACCC) maintains a comprehensive list of industry sponsored financial assistance programs for oncology-related drugs and services.
  Benefits.gov
Website www.benefits.gov
Email Direct from website
Benefits.gov maintains an online screening tool through which 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.
  Cancer Financial Assistance Coalition
Website www.cancerfac.org
Email Direct from website
The Cancer Financial Assistance Coalition (CFAC) is a coalition of 15 member organizations joining forces to help cancer patients manage financial challenges. Links are provided to each of the 15 member organizations. The CFAC website also contains an online tool to find resources based on diagnosis and location.
  Cancer Legal Resource Center
Website cancerlegalresources.org
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.
  Cancer Support Community
Website www.cancersupportcommunity.org
Phone 888-793-9355
Email Direct from website
Cancer Support Community provides information and resources for patients and their families, including a Cancer Insurance Checklist to evaluate and compare coverage for cancer related services and the costs associated with that coverage.
  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 chemotherapy and targeted treatments.
  Catherine H. Tuck Foundation
Website catherinefund.org/Get-Help.html
Email info@catherinefund.org
The Catherine Fund Grant Program helps working women and men nationwide who are struggling to pay their bills during breast cancer treatment by providing short-term aid by making payments for non-medical expenses for rent, utilities, food or transportation.
  Center for Medicare Advocacy, Inc.
Website www.medicareadvocacy.org
Phone 202-293-5760
Email Direct from website
The Center for Medicare Advocacy is a private, non-partisan, 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.
  Centers for Disease Control & Prevention
Website http://www.cdc.gov/cancer/nbccedp/
Phone 800-232-4636
Email Direct from website
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. 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.
  Children's Leukemia Research Association, Inc.
Website childrensleukemia.org
Phone 516-222-1944
Email Direct from website
The Children's Leukemia Research Association's Co-Pay Assistance programs are open to insured 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.
  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, co-insurance and deductibles for those with insurance 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.
  Colorectal Cancer Alliance
Website www.ccalliance.org
Phone 877-422-2030
Email Direct from website
Colorectal Cancer Alliance's Blue Note Fund provides one-time grants of $300 to qualifying patients to help cover screening and treatment-related expenses, or a $200 stipend to cover treatment-related expenses for those currently in treatment.
  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.
  Compassion Can't Wait
Website www.compassioncantwait.org
Phone 310-276-7111
Email info@compassioncantwait.org
Compassion Can't Wait is a 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. This organization meets urgent financial needs of single-parent families of children with catastrophic or life-threatening illnesses who are in financial crisis.
  Corporate Angel Network
Website www.corpangelnetwork.org
Phone 866-328-1313
Email info@corpangelnetwork.org
Corporate Angel Network provides free flights to treatment transporting qualified cancer patients, bone marrow donors and recipients, and stem cell donors and recipients, who are ambulatory and not in need of medical support while traveling. Eligibility is not based on financial need, and patients may travel as often as necessary. Travel is provided on empty seats - on both private and corporate planes.
  FamilyWize®
Website familywize.org
Phone 800-222-2818
Email info@familywize.org
FamilyWize partners with nearly all pharmacies nationwide to negotiate prescription discounts, so patients receive a lower price. The FamilyWize pharmacy discount card is available to patients nationwide, whether or not they have health insurance coverage. The prescription discount card is available online or though the mobile app, and there are no eligibility requirements. This program can be used to obtain savings on prescription drugs that are excluded by the patient's insurance plan, not covered because the plan's maximum limits have been exceeded, or when the discount cards price is lower than the patients co-payment amount.
  Good Days from CDF
Website www.mygooddays.org
Phone 877-968-7233
Email info@cdfund.org
Good Days provides financial support through co-pay, travel, premium and diagnostic testing assistance for certain diseases.
  Healthcare Hospitality Network
Website www.hhnetwork.org
Phone 800-542-9730
Email Direct from website
 Hospital Hospitality Houses (HHH) provide free or significantly reduced cost lodging to patients and their families while receiving medical care away from their home communities.
  Healthwell Foundation
Website www.healthwellfoundation.org
Phone 800-675-8416
Email grants@healthwellfoundation.org
Healthwell Foundation is a nonprofit, charitable organization that helps underinsured individuals with 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, travel costs 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
Email Live Chat and email direct from website
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.
  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
Phone 800-955-4572
Email Direct from website
The Leukemia & Lymphoma Society (LLS) Co-Pay Assistance Programs provide financial assistance (for certain diagnoses) for cancer treatment-related co-pays, private health insurance premiums, Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, and Medicare Advantage premium, and Medicaid Spend-down or co-pay obligations. Funding may also be available to cover some transportation costs, and non-medical expenses for certain blood cancer patients or their families.
  The Lymphoma Research Foundation
Website www.lymphoma.org
Phone 800-500-9976
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 assist lymphoma patients with expenses related to their treatment.
  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.
  Medicine Assistance Tool
Website https://medicineassistancetool.org/
Email Direct from website
Building upon the Partnership for Prescription Assistance (PPA) Pharmaceutical Research and Manufacturers of America (PhRMA) created the Medicine Assistance Tool (MAT) to provide a dedicated search engine that allows users to search for financial assistance resources available to them, their loved ones or patients in their lives through the various biopharmaceutical industry programs available for patients who are eligible.
  Myriad Financial Assistance Program
Website myriad.com/myriad-cares-2/financial-assistance-program/
Phone 800-469-7423
Email billing@myriad.com
Myriad offers financial assistance to reduce out-of-pocket costs for qualified underinsured and uninsured patients in the U.S., depending on their household income level.
  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 Council on Aging
Website www.ncoa.org
Email www.ncoa.org
National Council on Aging’s (NCOA) national network of Benefits Enrollment Centers (BECs), provide personalized assistance to low-income Medicare beneficiaries who want to access programs that help pay for health care, prescriptions, food, utilities, and more.
  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) a nonprofit organization, is dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. NORD provides premium and co-pay assistance, diagnostic testing assistance as well as working with other organizations to provide travel and lodging assistance for study participants enrolled in specific rare disease clinical trials.
  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.
  Patient Access Network Foundation
Website www.panfoundation.org
Phone 866-316-7263
Email info@panfoundation.org
The Patient Access Network Foundation is an independent, national organization dedicated to assisting underinsured patients with out of pocket costs such as deductibles, co-pays and coinsurance, travel expenses and health insurance premiums. 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
PAF is a national 501(c)3 organization that provides direct case management services and financial assistance to patients and caregivers, including help navigating the health care system, working with health care providers, payers and employers to assure that patients have access to affordable care, financial and co-pay assistance and teaching self-advocacy to patients and caregivers.
  PatientTravel.Org
Website http://patienttravel.org
Email Direct from website
PatientTravel.org provides a single point of contact to facilitate patient access to appropriate charitable or discounted transportation including airline tickets for patients and patient escorts.
  Pink Fund®
Website www.pinkfund.org/about/
Phone 877-234-7465
Email grants@thepinkfund.org
The Pink Fund provides 90-day non-medical cost-of-living expenses to breast cancer patients in active treatment for breast cancer, so they can focus on healing, raising their families, and returning to the workplace. Applicants must have a household income of 500% or less of the federal poverty level based on last year’s federal tax return.
  Quest Diagnostics Patient Assistance Program
Website http://questdiagnostics.com/home/about/corporate-citizenship/community-giving/assistance.html
Email Direct from website
Quest offers tiered discounts that take into account income and family unit size. Discounts are based on guidelines provided by the US Department of Health and Human Services and can be as much as 100% of the amount due.
  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.
  Ronald McDonald House Charities®
Website www.rmhc.org/home
Phone 630-623-7048
Email info@rmhc.org
RMHC can help address problems including finding housing that’s near a hospitalized child, the expense of staying together in another city, or getting basic medical and dental care in a vulnerable community. RMHC has local Chapters in 65 countries and regions.
  Rx Outreach
Website www.rxoutreach.org
Phone 888-796-1234
Email questions@rxoutreach.org
Rx Outreach is an independent, is a mail order nonprofit pharmacy that offers prescription medicines at an affordable price to individuals and families, as well as those who have limited prescription drug coverage. Financial qualifications and applications are available on the website.
  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
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.
  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.
  Sisters Network Inc.
Website www.sistersnetworkinc.org
Phone 866-781-1808
Email infonet@sistersnetworkinc.org
Sisters Network® Inc. (SNI) is a national African American breast cancer survivorship organization that addresses the breast health needs of African American women through its affiliate chapters and partnerships with existing service providers. Sisters Network has a breast cancer assistance program (B-CAP) that provides assistance to women facing financial challenges after diagnosis. The program provides financial assistance for mammograms, copays, office visits, prescriptions, and medical-related lodging and transportation. An application form to apply for assistance may be obtained by calling or sending in a request via e-mail.
  State Health Insurance Assistance Programs
Website www.shiptacenter.org
Phone 877-839-2675
Email info@shiptacenter.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.
  Susan G. Komen® Treatment Assistance Program
Website https://ww5.komen.org/BreastCancer/FinancialResources.html
Phone 877-465-6636
Email helpline@komen.org
Find information about financial assistance programs, including those for prescription drugs and other medical costs, transportation, lodging, child care and elder care.
  Taking Charge of Money Matters
Website https://www.cancer.org/treatment/finding-and-paying-for-treatment.html
Phone 800-227-2345
Email Live Chat and 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.
  Triple Step Towards the Cure
Website http://triplesteptowardthecure.org
Phone 424-258-0313
Email Direct from website
Triple Step Toward the Cure provides support to women undergoing treatment for triple negative breast cancer. Triple Step Towards the Cure has established a financial support program for women diagnosed with triple negative breast cancer that includes selected co-pay assistance and other financial support programs.
  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.
  Wigs and Wishes
Website www.wigsandwishes.org
Phone 856-582-6600
Email info@wigsandwishes.org
Wigs & Wishes® By Martino Cartier is a non-profit organization founded by Martino Cartier, that is dedicated to providing wigs & granting wishes to individuals battling cancer.


1 NPR. 9 States Reopen ACA Insurance Enrollment to Broaden Health Coverage. https://www.npr.org/sections/health-shots/2020/03/20/818981380/9-states-reopen-aca-insurance-enrollment-to-broaden-health-coverage. Accessed March 20, 2020.

2 Jack Reed United State Senator for Rhode Island. News Release: Reed, Senators Urge Trump Admin to Re-Open the Obamacare Enrollment Window. https://www.reed.senate.gov/news/releases/reed-senators-urge-trump-admin-to-re-open-the-obamacare-enrollment-window. Accessed March 13, 2020.

3 HealthCare.gov. High Deductible Health Plan (HDHP). https://www.healthcare.gov/glossary/high-deductible-health-plan/. Accessed February 15, 2020.

4 Federal Register. Short-Term, Limited-Duration Insurance. Final Rule. https://www.federalregister.gov/documents/2018/08/03/2018-16568/short-term-limited-duration-insurance.  Accessed February 1, 2020.

5 Kaiser Family Foundation. ACA Open Enrollment: For Consumers Considering Short-Term Policies
 https://www.kff.org/health-reform/fact-sheet/aca-open-enrollment-for-consumers-considering-short-term-policies/. Accessed February 1, 2020.

6 The Commonwealth Fund. Health Care Sharing Ministries: What are the Risks to Consumers and Insurance Markets? https://www.commonwealthfund.org/publications/fund-reports/2018/aug/health-care-sharing-ministries. Accessed February 1, 2020.

7 Federal Register. Annual Update of the HHS Poverty Guidelines. https://www.federalregister.gov/documents/2020/01/17/2020-00858/annual-update-of-the-hhs-poverty-guidelines. Published January 17, 2020. Accessed March 3, 2020.

8 Medicare.gov. Medicare Costs at a Glance. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. Accessed February 25, 2020.

9 CMS.gov. Late Enrollment Penalty (LEP) Appeals. https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Late-Enrollment-Penalty-LEP-Appeals.html. Accessed February 25, 2020.

10 Medicare.gov. Part A & B sign up periods. https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html. Accessed February 25, 2020.

11 CMS.gov. Fact Sheet: 2020 Medicare Parts A & B Premiums and Deductibles. https://www.cms.gov/newsroom/fact-sheets/2020-medicare-parts-b-premiums-and-deductibles. Accessed January 30, 2020.

12 Centers for Medicare & Medicaid Services Medicare Medigap Guide, 2020 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare. https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf. Accessed March 1, 2020.

13 Medicare.gov. Costs for Medicare drug coverage. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage. Accessed February 1, 2020.

14 Social Security Administration ssa.gov. Extra Help with Medicare Prescription Drug Plan Costs. https://www.ssa.gov/benefits/medicare/prescriptionhelp/. Accessed February 15, 2020.

15 American Society of Clinical Oncology. Cancer.Net. http://www.cancer.net.  Accessed February 1, 2020.

16 The American Cancer Society. Understanding Health Insurance. http://www.cancer.org/treatment/findingandpayingfortreatment/understandinghealthinsurance/index. Accessed February 1, 2020.

17 Cancer Legal Resource Center. https://thedrlc.org/cancer/about/.  Accessed February 1, 2020.

18 HHS.gov. About the Affordable Care Act. https://www.hhs.gov/healthcare/about-the-aca/index.html. Accessed February 1, 2020.

19 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 1, 2020.

20 Information and Technical Assistance on the American with Disabilities Act. https://www.ada.gov/ada_intro.htm. Accessed February 1, 2020

21 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 1, 2020.

22 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 1, 2020.

23 Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program (NBCCEDP) https://www.cdc.gov/cancer/nbccedp/. Accessed February 1, 2020.

24 Govinfo.gov. Public Law 110-233 110th Congress May 21, 2008. https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination. Accessed February 1, 2020.

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ABOUT THE EDITOR
Risė 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 2020 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.

Copyright ©2020 Oplinc, Inc.

Oplinc, Inc., grants permission to distribute this newsletter without prior permission provided it is forwarded unedited and in its entirety.

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