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  • My dad has terminal cancer and he is currently at home. He has no insurance, but Medicaid is pending. We're trying to get hospice or some support. What can I do?

    It must be a very difficult time for your family and you are to be commended in seeking out resources and support services that are available to assist your family.

    Hospice is paid for through the Medicare or Medicaid Hospice Benefit and by most private insurers. If a person does not have coverage through Medicare, Medicaid, or a private insurance company, hospice will work with the family to make sure needed services are provided. In order to receive hospice services, your father’s doctor will need to make a referral to a local hospice provider. You may also contact a local hospice to find out what steps you should take.

    The National Hospice and Palliative Care Organization (NHPCO) offers information and resources about end-of-life and hospice through its Caring Connections website. The Caregiver Resource Directory also can provide you with extensive information. We’ve created a fact sheet, Caregiving at the End of Life, that provides guidance as you care for your father.

    It’s important that you continue to follow-up with his Medicaid application, as benefits will be retroactive to the date when he applied and can be used to pay any medical bills that may be incurred during the application period. CancerCare’s fact sheet Sources of Financial Assistance, may also be helpful in finding resources.

    If you continue to have difficulties finding hospice services for your father, please call us at 1-800-813-4673 (HOPE) to speak with an oncology social worker.

  • How do I figure out which Medicare plan is right for me? I don't know if I should get a Medicare Advantage plan or a Medigap plan, or if I should just keep my original Medicare and do neither.

    When you become eligible for Medicare you receive Part A, which covers certain hospitalization costs. If you want coverage for outpatient services, you should choose Part B as well. Even with Medicare A and B there are still “gaps” in coverage: for example, there is a 20% co-insurance fee for Part B services, and neither A nor B offer drug coverage. Most people choose to supplement their coverage with a retiree plan if their former employer offers it, or a “Medigap” plan, which plugs most of the holes in coverage (except medications). The rest, roughly 18%, choose a Medicare private health plan, called a Medicare Advantage Plan. These plans must offer at least the same benefits as original Medicare but have different rules, costs and coverage restrictions.

    Medicare Advantage plans can be useful for those looking for all-in-one medical and drug coverage. However, Medicare Advantage HMOs restrict which doctors and hospitals you can use. An article in Kiplingers magazine sums up the differences well: “Medicare Advantage plans may charge lower premiums than you’d pay for Medicare plus a Medigap policy and Part D prescription-drug coverage. But you could end up paying higher out-of-pocket costs throughout the year. Some Medicare Advantage plans charge higher co-payments for big-ticket items such as hospitalization, or for critical services such as chemotherapy. Or they might not pay for the first 20 days in a skilled-nursing facility (which traditional Medicare covers). In addition, a plan may provide limited coverage if you travel out of state.”

    Please note: A study of cancer patients by an affiliate of the University of Pittsburgh Cancer Institute suggests that members of Medicare Advantage HMO plans are opting out of clinical trials because these policies generally require that the patient pay 20% of the costs associated with a trial. In contrast, Medigap plans generally cover those costs.

    You can learn more about Medicare coverage options and find plans in your area by visiting the Medicare website. The Medicare Rights Center is also an excellent resource for Medicare questions.

  • I have insurance, but I still have bills that are stressing me out. I thought I'd be covered, but I don't know how I'm going to pay the part I'm being told I owe.

    If you are insured and struggling with outstanding medical bills, consider the following options:

    • Read your insurance policy and understand the terms of your contract. If you have questions, ask your insurance company, insurance broker, or the human resources staff at your employer to explain it to you. Your insurer may have denied a claim even though you are entitled to coverage. HealthCare.gov has an excellent guide on how to dispute claims with your insurer.
    • Double check all bills and EOBs (explanation of benefits). You’d be surprised how often billing mistakes are made. Look for incorrect dates of service (you shouldn’t be billed for the room on the day you were discharged) and duplicate fees for tests and procedures.
    • Ask the hospital or doctor to consider the insurance payment as “payment in full.” Many people don’t think to do this, and it is often more successful than expected. Some hospitals have funds to offset medical services that aren’t fully covered by insurance.
    • Negotiate the outstanding balance by asking for a discount. According to a Wall Street Journal survey, 70% of adults who talked with a hospital say they were successful in negotiating a lower price for their medical bills; 61% were successful with their doctor. You will likely get a greater discount (sometimes as high as 50%) if you pay the outstanding balance in a lump sum. You can also set up a payment plan.
    • Explore the resources for co-payment and other medical cost assistance.

    Remember to reach out for help—medical debt understandably causes emotional stress and it’s important to get as much support as you can. Speaking with a counselor can help you manage some of your stress and come up with a plan so that you feel more in control.

  • I think I may have cancer but I don't have any insurance and I'm not sure I can afford it. What can I do?

    I understand your concern about the cost, but if you think you have cancer, you can’t afford not to visit the doctor. Cancer responds to treatment better when it’s caught early, and if it turns out that you don’t have it, you will have peace of mind.

    There are 5 main ways to get health insurance:

    1. Your, or your spouse’s, employer or union. If you or your spouse has a job that offers health insurance, ask if you’re eligible to receive it or buy into it. If you had insurance but lost your job within the last 60 days, ask if you’re eligible for COBRA. COBRA is a law that lets you keep your insurance for 18 months, sometimes longer. You pay the full cost.

    2. Your school. If you are currently a full-time or part-time student, check with your college or university to see if you can get coverage through them.

    3. Purchase it on your own. You can buy insurance either directly through an insurance company, or through your state’s Marketplace/Exchange. If you buy it directly through an insurance company, you will not be eligible for discounts based on your income. If you buy it through your state’s Marketplace/Exchange, your income will be taken into account, and you may receive an immediate subsidy, which will lower the cost of your premiums, and possibly your deductibles and co-pays as well. To find your state’s Marketplace, go to www.healthcare.gov. Please note: whether you buy it directly from an insurance company or through the Marketplace, you can only buy insurance during Open Enrollment. Open Enrollment occurs once a year, generally between November and January. There are a few exceptions to this rule – if you lose your job-based coverage mid year, get married, have a baby, move to another county or state, or become eligible for Medicaid, you are eligible for a “special enrollment period”. For more information on special enrollment periods, visit www.healthcare.gov.

    4. Medicaid. Medicaid is a state-administered health insurance program that provides free or low-cost coverage to millions of Americans. In the 33 states (including Washington DC) that have chosen to “expand” Medicaid, it covers all children and adults below 138% of the Federal Poverty Level, which for 1 person in 2018 is $16,754. In the remaining 18 states, it only covers low-income families with children, pregnant women, the blind, and the disabled. To see if your state has expanded Medicaid, and to apply, visit https://familiesusa.org/product/50-state-look-medicaid-expansion.

    5. Medicare. If you are 65 or over, or have been deemed disabled by the Social Security Administration for 2 years, you may be eligible for Medicare. Contact www.medicare.gov for more information.

    If you are unable to afford insurance and are ineligible for Medicaid or Medicare, ask about charity care and sliding scale programs (fees based on your income) at hospitals and clinics. Some hospitals are required to see patients who are uninsured. Contact your local department of public health, social services, or business office of your hospital of choice for more information.

    Finally, if you are concerned about either breast or cervical cancer, the National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured women access to screening and diagnostic services to detect breast and cervical cancers. Women who are subsequently diagnosed with cancer may be immediately eligible for limited Medicaid.

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