Open Enrollment-Got Questions? We’ve Got Answers-Part 3


Open enrollment season is upon us! This is the third in our series of blogs summarizing the material from our #getcovered tweet chat and highlighting important facts about open enrollment. Be sure to check the blogs every Tuesday thru December 5th for great tips and tricks to help you navigate the complicated insurance maze.

Remember that you can always get more in depth information about insurance via the OncoLink Health Insurance webinar series, available now, www.oncolink.org/insurance. All modules are available to listen to on demand and are free of charge!

My treatment may change over time. How can I plan to reduce out of pocket expenses?

  • Cancer treatments are changing all the time and your care team wants to provide you with the most effective treatment. But, this means that your treatment plan can change often. Talk with your care team about potential treatment options, what may cause a change in the treatment plan, and what types of treatment (chemotherapy, radiation, immunotherapy, IV or oral) may be options for you.
  • Be sure to ask your care team for an estimate of costs every time your treatment plan changes.
  • Know your numbers: deductible + copay + coinsurance = maximum out of pocket. Compare these between plans you may be considering.
  • Remember that infusion (IV chemo) and oral medications are often covered by two different parts of your insurance (major medical and pharmaceutical). Its important to understand your coverage responsibilities for both types of plans.
  • It can be helpful to look back to the previous year for expenses you incurred to help you estimate upcoming charges.
  • Ask for help. If your prescription medications are too much for you to afford, there may be co-pay assistance or co-pay cards available, depending on your type of cancer and your insurance. Your oncology social worker can help identify resources to help pay for your treatment.
  • Think outside the box: is fundraising an option? Read our article on fundraising for some important information and resources for fundraising.
  • Is a clinical trial an option for you? This can also provide some assistance in accessing treatment.

I’m on an expensive oral medication. What do I need to know about prescription drug coverage when choosing a plan?

  • The number of oral medications being used in cancer treatment is growing rapidly. These medications can also be very expensive.
  • Be sure you understand your pharmacy coverage. Familiarize yourself with your plan formulary. This is the list of medications your plan covers. This varies from plan to plan so check carefully and every year!
  • Does your plan have steps for therapy? This means you must not have the desired effect from a lower step, less expensive medication.
  • Does your plan have a tier system? Tier 1 medications are the least expensive-Tier 5 the most expensive. What are the costs per medication per tier?
  • Are you a low income Medicare Part D recipient? Extra Help/Low Income Subsidy (LIS) is a program managed through the Social Security Administration. It can be a fantastic resource to help lower your drug costs. Your social worker can help you apply for Extra Help/LIS
  • Again, depending on your cancer type, your insurance and the medication, co-pay assistance or co-pay cards may be available.
  • Talk to your care team if you cannot afford your medications. It is important that your team knows if you are unable to fill your prescriptions. We want to help.

Can I buy a supplemental plan to cover any gaps in my marketplace plan coverage?

Note: this does NOT apply to Medicare supplemental plans-please see the 11/21 blog for more information on these plans.

Yes, but you need to SHOP AROUND. These plans have a huge variety in what and how they pay their benefits.

  • There are also many different types of supplemental plans: major illness, hospitalization, cancer and long term care plans just to name a few. It is much more expensive and difficult to buy these plans AFTER you get sick. So, buying a supplemental plan requires some forethought and planning.
  • You may want to consult with several different insurance brokers regarding the potential supplemental plans they offer, cost, and how to make claims.
  • Check with your employer. Many employers offer accident and disability insurance in addition to medical coverage.

Next week in our final blog of the series, we will address other resources available to help navigate open enrollment and the health insurance maze.

Thanks again to Triage Cancer, Young Survivors Coalition, CARIE, NCCS and the National Patient Advocate Foundation for all of your contributions to our Tweet chat and our open enrollment blogs.