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Volume 14, Issues 1 & 2 Download for iPad

PATIENT ASSISTANCE RESOURCES 2019 1, 2

In the fourth quarter of 2018, the percentage of U.S. adults without health insurance rose to 13.7%, representing a 2.8% increase since the low point of 10.9% at the end of 2016. According to the Gallup National Health and Well-Being Index, the 2.8% increase since the end of 2016 represents nearly 7 million Americans who have entered the ranks of the uninsured. Beginning in 2017, the uninsured rate has climbed each quarter and is currently the highest in four years with an estimated 30.4 million uninsured at the end of 2018.

In addition, the numbers of people who are underinsured (those with high health plan deductibles and/or out-of-pocket expenses relative to their income) rose from 23% in 2014 to 29% in 2018.3 The Commonwealth Fund Survey shows that the growth in the underinsured is largest among those with job-based coverage. Still, individuals who bought plans on their own were the most likely to be underinsured, with 42% reporting a lack of adequate coverage.

In this issue, we provide a summary and contact information for some of the patient assistance services and resources that may be available to your patients.

RISING OUT-OF-POCKET PATIENT COSTS: UNINSURED AND UNDERINSURED 3, 4, 5

In May 2019, the National Center for Health Statistics published the Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2018. The report provides insurance coverage estimates using 2018 National Health Interview Survey data. Below are some highlights from the report:

  • 30.4 million persons of all ages (9.4%) were uninsured in 2018.
  • In 2018, among adults aged 18-64, 13.3% were uninsured at the time of interview.
  • Of those with health insurance, 19.4% of adults aged 18-64 had public coverage and 68.9% had private coverage.
  • The percentage of persons under age 65 with private coverage enrolled in a high-deductible health plan (HDHP) increased from 43.7% in 2017 to 45.8% in 2018.

The growth of persons with HDHP coverage continues to increase, enrollment increased from 25.3% in 2010 to 45.8% in 2018. For 2019, the minimum HDHP deductible is $1,350 for an individual and $2,700 for a family and the maximum out-of-pocket is $6,750 for an individual and $13,500 for a family (this limit does not apply to out-of-network services and does not count premiums).

A recent American Cancer Society (ACS) study Prevalence and Correlates of Medical Financial Hardship in the USA examines the correlation of high patient out-of-pocket (OOP) spending with medical debt, distress about household finances, and foregoing medical care due to cost. The study found that medical costs create hardships for more than half of Americans.

Key findings of the ACS research:

  • 137.1 million adults reported medical financial hardship in the past year.
  • 56% of adults reported at least one domain of medical financial hardship.
  • 28.9% of adults 18-64 and 15.3% of those 65+ reported problems paying medical bills.
  • 46.9% of adults 18-64 reported psychological hardship vs. 28.4% of adults 65+.

SHORT-TERM LIMITED DURATION INSURANCE PLANS 6,7

In October 2017, President Trump signed an executive order directing the federal government to expand the availability of short-term limited duration insurance (STLDI) plans and to “consider allowing such insurance to cover longer periods and be renewed by the consumer.” 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 STLDI plans from three months up to 12 months and allows insurers to renew STLDI plans for up to 36 months.

Short-term coverage was originally 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.

STLDI plans are far less expensive than Affordable Care Act (ACA) compliant coverage. However, there are significant drawbacks to these plans including the following:

  • STLDI plans do not have to comply with any of the rules in the ACA.
  • 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 or lifetime limits on coverage.
  • They can rescind coverage.
  • They can require higher out-of-pocket cost-sharing than allowed under the ACA.

The Henry J Kaiser Family Foundation (KFF) explains that while STLDI plans offer substantially lower premiums than ACA-compliant plans these lower premiums offer much less protection if the consumer gets sick and needs care. An October 2018 analysis found that STLDI plans are able to charge premiums that are 54% lower than ACA-compliant plans by excluding pre-existing conditions and severely limiting benefits, specifically:

  • Plans achieve 38% lower premiums by simply denying insurance altogether to people with pre-existing conditions or refusing to cover such conditions for those offered a policy.
  • A further 16% reduction relative to ACA-compliant plans arises from short-term plans’ exclusion of, or severe restrictions on, potentially costly benefits such as coverage for prescription drugs, maternity care and mental health and substance abuse treatment.

Financial Advocacy and Navigation

Cancer centers (and other specialties that administer or dispense high-cost drugs) have found that employing dedicated financial advocates (or navigators) allows the clinic to mitigate bad debt and helps to alleviate the financial toxicity (financial distress) experienced by patients. Indeed, the need for an organized and systematic financial advocacy program increases as commercial insurers continue to shift more direct medical care costs to patients through higher premiums, deductibles and coinsurance.

Financial advocates 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, to assess patient financial needs, and to assist patients with financial assistance applications.

Still, challenges remain as third-party patient assistance programs (PAPs) tend to run out of money soon after opening enrollment. And financial advocates must have an in-depth knowledge of available resources and program requirements including the many pharmaceutical manufacturers that offer patient assistance programs based on the patient’s coverage and financial need.

The Association of Community Cancer Centers (ACCC) maintains a list of manufacturer programs on their website at accc-cancer.org. In addition, ACCC’s Financial Advocacy Boot Camp is an online program consisting of education and resources for practices and oncology financial advocates. The Financial Advocacy Boot Camp is free to ACCC members at https://www.accc-cancer.org/home/learn/financial-advocacy/boot-camp.

For more information and tips on Financial Navigators see the Oplinc Best Practices Review Newsletter’s article Practical Strategies: Implementing a Comprehensive Financial Navigation Program http://www.oplinc.com/newsletter/BestPracticesReviewDec2018.html.

Federal Poverty Guidelines 8

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

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

The 2019 Poverty Guidelines for
the 48 Contiguous States and the District of Columbia
Persons in Family/Household Poverty Guideline
1 $12,490
2 $16,910
3 $21,330
4 $25,750
5 $30,170
6 $34,590
7 $39,010
8 $43,430
For families with more than 8 persons, add $4,420 for each additional person.
The 2019 Poverty Guidelines for
Alaska
Persons in Family/Household Poverty Guideline
1 $15,600
2 $21,130
3 $26,660
4 $32,190
5 $37,720
6 $43,250
7 $48,780
8 $54,310
For families with more than 8 persons, add $5,530 for each additional person.
2019 Poverty Guidelines for
Hawaii
Persons in Family/Household Poverty Guideline
1 $14,380
2 $19,460
3 $24,540
4 $29,620
5 $34,700
6 $39,780
7 $44,860
8 $49,940
For families with more than 8 persons, add $5,080 for each additional person.

SOURCE: Federal Register, Vol. 84, No. 22, February 1, 2019, pp. 1168

The majority of health care institutions and health care providers that offer discounts on services to uninsured and/or underinsured patients use 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. 

2019 Medicare Costs 9, 10, 11

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 $437 each month for Part A coverage. In most cases, individuals who choose to buy Part A must also have Part B and pay monthly premiums for both.

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

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

Individuals who did not get automatically enrolled or sign up during the Initial Enrollment Period, 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 - 2019

  • $1,364 deductible per benefit period
  • $0 coinsurance for the first 60 days of each benefit period
  • $341 coinsurance per day for days 61–90 of each benefit period
  • $682 coinsurance per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime)
  • All costs beyond lifetime reserve days

Skilled Nursing Facility Stay – 2019

  • $0 coinsurance for the first 20 days of each benefit period
  • $170.50 coinsurance per day for days 21–100 of each benefit period
  • 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 2019, the standard Part B premium amount is $135.50, however some Medicare beneficiaries with higher incomes will pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA), and beneficiaries who get Social Security benefits generally pay less. The 2019 Part B deductible is $185 per year, after the deductible is met Part B beneficiaries typically pay 20% for most physician services, outpatient therapy and durable medical equipment (DME).

Part B premium rates for 2019 are based on the Medicare beneficiary’s 2017 income and tax filing status.

MEDICARE PART B RATES

If your yearly income in 2017 was You pay each month in 2019
File individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less $135.50
Above $85,000 up to $107,000 Above $170,000 up to $214,000 Not applicable $189.60
Above $107,000 up to $133,500 Above $214,000 up to $267,000 Not applicable $270.90
Above $133,500 up to $160,000 Above $267,000 up to $320,000 Not applicable $352.20
Above $160,000 and less than $500,000 Above $320,000 and less than $750,000 Above $85,000 and less than $415,000 $433.40
$500,000 or above $750,000 or above $415,000 and above $460.50

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.

MEDICARE PART C

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

CMS reports that the average monthly premium for MA plans decreased by 6% to $28.00 in 2019, largely due to the increase in MA plans available.12 The monthly Part C premiums, deductibles and services vary by plan and plans may charge different out-of-pocket costs. However, the maximum out-of-pocket spending limit for in-network services is consistent for all plans and in 2019 it is $6,700. 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
  • Open Enrollment Period (OEP) – from January 1 – February 14*

*The new OEP replaces the Medicare Advantage Disenrollment Period.

On August 8, 2018, CMS announced that beginning January 1, 2019, MA plans will have the option of applying step therapy to manage physician-administered and other Part B drugs. Step therapy is used by insurers to control drug costs by requiring patients to try lower-cost drugs first. If those drugs are not effective, then the patients may receive the more expensive medication prescribed by their physician. Patients and their physicians can request an exception to step therapy, plans have 24 hours to respond to expedited exception requests and 72 hours for regular exception requests. 13

Under this new policy, step therapy can only be applied to new prescriptions or administrations of Part B drugs for beneficiaries that are not actively receiving the affected medication. MA plans are required to share any savings achieved through implementation of step therapy with the Medicare enrollee.

MEDICARE PART D 14

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

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

In 2019, the Part D National Base Beneficiary Premium is $33.19 (down from $35.02 in 2018). 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 $85,000 and filing individually, or above $170,000 if married and filing jointly, may pay more for their Part D coverage. These higher income beneficiaries will pay an extra amount under the IRMAA, based on their yearly income and tax-filing category, in addition to their plan premium.

2019 Part D Premiums by Income

If your file status and yearly income in 2017 was: You pay each month (in 2019)
File individual tax return File joint tax return File married & separate tax return  
$85,000 or less $170,000 or less $85,000 or less Your plan premium
Above $85,000 up to $107,000 Above $170,000 up to $214,000 Not applicable $12.40 + your plan premium
Above $107,000 up to $133,500 Above $214,000 up to $267,000 Not applicable $31.90 + your plan premium
Above $133,500 up to $160,000 Above $267,000 up to $320,000 Not applicable $51.40 + your plan premium
Above $160,000 and less than $500,00 Above $320,000 and less than $750,000 Above $85,000 and less than $415,000 $70.90 + your plan premium
$500,000 or above $750,000 and above $415,000 and above $77.40 + your plan premium

2019 Medicare Part D Estimated Prescription Drug Plan Monthly Premium Based on Income and Tax Filing Status.

Most Medicare Part D plans have a coverage gap (commonly called the “donut hole”) during which there is a limit on what the Part D plan covers for drugs. The Affordable Care Act (ACA) of 2010 included a provision to begin closing this coverage gap, and when fully implemented, Medicare beneficiaries will have a 25% coinsurance during the coverage gap.15

In 2019, Medicare Part D enrollees entering the coverage gap will receive a 75% discount (70% paid by the drug manufacturer and 5% paid by the Medicare Part D plan) on brand-name drugs and a 63% discount on generic drugs.
Under the standard 2019 Medicare Part D plan, the Medicare beneficiary will have a yearly deductible of $415 (up from $405 in 2018) and a 25% coinsurance. After the deductible is met, the Medicare beneficiary and Part D plan each pay their share until the combined amount (plus the deductible) reaches the Initial Coverage Limit (ICL) of $3,820 (up from $3,750 in 2018). At this point, the Medicare beneficiary is in the coverage gap and responsible for 25% of the plan’s cost for covered brand-name drugs and a maximum of 37% copay of the plan’s cost for covered generic drugs.

Once the Medicare beneficiary has spent $5,100 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, most enrollees pay $3.40 for generic or preferred multi-source drugs and $8.50 for all other drugs, or 5% of the drug cost whichever is greater, for the rest of the year.

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 70% donut hole discount paid by the manufacturer on brand-name drugs.

Part D plans must offer either the standard benefit or an alternative equal in value, and they can also provide enhanced benefits. Part D plans vary in their benefit design, cost-sharing amounts, and utilization management tools such as prior authorization, quantity limits, formularies and step therapy requirements. However, all Part D plans are required to cover all drugs in 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 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 ($33.19 in 2019) times the number of full, uncovered months the Medicare beneficiary didn’t have Part D or creditable coverage. The Medicare Modernization Act (MMA) defines creditable coverage as coverage that is expected to pay on average as much as the standard Medicare prescription drug coverage.

MEDICARE EXTRA HELP 16

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.

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.
More information on Medicare’s Low Income Subsidy (LIS) or Extra Help including a Part D LIS/Extra Help Eligibility and Coverage Chart is available from the National Council on Aging (NCOA) at https://www.ncoa.org/search-results/?q=extra%20help.

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

 

RESOURCES: UNDERSTANDING HEALTH INSURANCE & LAWS PROTECTING CANCER PATIENTS

ASCO’S Cancer Net 17

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 18

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 19
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.15

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.20

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.

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.22

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.23

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.24

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.25

 

Helpful Resources

  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.
  The 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 reimbursement assistance programs including 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 a 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.
  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.
  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 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. 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
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.
  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 bquinn@hhnetwork.org
 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, 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.
  HRSA Bureau of Primary Health Care
Website bphc.hrsa.gov
Phone 877-464-4772
The Health Resources and Services Administration (HRSA) helps patients find federally funded health centers to care for them, even if they have no health insurance. Patients pay what they can afford, based on income. An online health services locator is available on the HRSA website to identify local health centers.
  IRS
Website www.irs.gov/
Phone 800-829-1040
The Internal Revenue Service (IRS) can provide information about tax deductions for medical costs that are not covered by insurance policies. For example, tax-deductible expenses might include mileage for trips to and from medical appointments; out-of-pocket costs for treatment, prescription drugs, or equipment; and the cost of meals during lengthy medical visits.
  Joe's House
Website www.joeshouse.org
Phone 877-563-7468
Email info@joeshouse.org
Joe's House website lists accommodations that cater to cancer patients, their families, and caregivers, and provides a centralized list of appropriate housing.
  The Leukemia & Lymphoma Society Copay Assistance Program
Website www.lls.org/support/financial-support
Phone 877-557-2672
Email copay@lls.org
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.
  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 https://myriad.com/myriad-cares-2/financial-assistance-program/
Phone 844-697-4239
Email billing@myriad.com
Myriad offers financial assistance to reduce out-of-pocket costs for qualified underinsured patients in the U.S. to no more than $295, 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 203-744-0100
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
Patient Advocate Foundation (PAF) provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their chronic/debilitating or life-threatening illness. The PAF website contains links to many helpful resources for patients and caregivers, including a National Financial Resources Guidebook providing an interactive state-by-state database of available financial assistance and resources.
  Patient Services Incorporated
Website www.patientservicesinc.org
Phone 800-366-7741
Email uneedpsi@uneedpsi.org
Patient Services Inc. provides premium, co-payment, co-insurance and travel assistance programs for qualified patients with certain diseases.
  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 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.
  Pink Fund®
Website www.pinkfund.org/about/
Phone 877-234-7465
Email Direct from website
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.
  Rx Outreach
Website www.rxoutreach.org
Phone 888-796-1234
Email questions@rxoutreach.org
Rx Outreach is an independent, 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.
  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 News.gallup.com. U.S. Uninsured Rate Rises to Four-Year High. https://news.gallup.com/poll/246134/uninsured-rate-rises-four-year-high.aspx. Accessed February 1, 2019.

2 KFF Henry J. Kaiser Family Foundation. The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/. Accessed February 1, 2019.

3 The Commonwealth Fund. Underinsured Rate Rose From 2014-2018, With Greatest Growth Among People in Employer Health Plans.  https://www.commonwealthfund.org/press-release/2019/underinsured-rate-rose-2014-2018-greatest-growth-among-people-employer-health. Accessed March 1, 2019.

4 Centers for Disease Control and Prevention. National Center for Health Statistics. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2018. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf. Accessed May 10, 2019.

5 American Cancer Society. Prevalence and Correlates of Medical Financial Hardship in the USA.
http://pressroom.cancer.org/YabroffFinancialHardship. Accessed May 5, 2019.

6 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 May 5, 2019.

7 KFF Henry J Kaiser Family Foundation. Short-Term Health Insurance Plans Charge Less Than Half as Much in Premiums as ACA Plans by Excluding Pre-Existing Conditions and Severely Limiting Benefits. https://www.kff.org/health-reform/press-release/short-term-health-insurance-plans-charge-less-than-half-as-much-in-premiums-as-aca-plans-by-excluding-pre-existing-conditions-and-severely-limiting-benefits/. Accessed May 5, 2019.

8 Federal Register. Annual Update of the HHS Poverty Guidelines. https://www.federalregister.gov/documents/2019/02/01/2019-00621/annual-update-of-the-hhs-poverty-guidelines. Published February 1, 2019. Accessed March 3, 2019.

9 Medicare.gov. Medicare Costs at a Glance. https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance. Accessed March 01, 2019

10 CMS.gov. Late Enrollment Penalty (LEP) Appeals. https://www.cms.gov/Medicare/Appeals-and-Grievances/MedPrescriptDrugApplGriev/Late-Enrollment-Penalty-LEP-Appeals.html. Accessed March 1, 2019.

11 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 March 1, 2019.

12 CMS.gov. Press Release: Medicare Advantage Premiums Continue to Decline While Plan Choices and Benefits Increase in 2019. https://www.cms.gov/newsroom/press-releases/medicare-advantage-premiums-continue-decline-while-plan-choices-and-benefits-increase-2019. Accessed March 12, 2019.

13 CMS.gov Fact Sheet. Medicare Advantage Prior Authorization and Step Therapy for Part B Drugs. https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-prior-authorization-and-step-therapy-part-b-drugs. Accessed February 1, 2019.

14 Medicare.gov. Costs for Medicare Drug Coverage. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage. Accessed March 12, 2019.

15 HHS.gov. The Affordable Care Act. http://www.hhs.gov/healthcare/about-the-law/read-the-law/. Accessed March 12, 2019.

16 Social Security Administration ssa.gov. Extra Help with Medicare Prescription Drug Plan Costs.https://www.ssa.gov/benefits/medicare/prescriptionhelp/. Accessed March 14, 2019.

17 American Society of Clinical Oncology. Cancer.Net. http://www.cancer.net.  Accessed March 14, 2019.

18 The American Cancer Society. Understanding Health Insurance. http://www.cancer.org/treatment/findingandpayingfortreatment/understandinghealthinsurance/index. Accessed March 14, 2019.

19 Cancer Legal Resource Center. https://thedrlc.org/cancer/about/. Accessed March 14, 2019.

20 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 March 14, 2019.

21 ADA.gov. United States Department of Justice, Civil Rights Division. Information and Technical Assistance on the American with Disabilities Act. https://www.ada.gov/ada_intro.htm. Accessed March 14, 2019.

22 United States Department of Labor, Employee Benefits Security Administration. COBRA Continuation Coverage. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/cobra. Accessed March 14, 2019.

23 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 March 14, 2019.

24 Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program (NBCCEDP) https://www.cdc.gov/cancer/nbccedp/. Accessed March 14, 2019.

25 Govinfo.gov. Public Law 110-233 110th Congress May 21, 2008. https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination. Accessed May 1, 2019.

Published by Rise Marie Cleland.Sponsored by Lilly Oncology

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

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

CPT® is a Trademark of the American Medical Association Current Procedural Terminology (CPT) is copyright 2019 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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