The third chat, called, “Benefit From Your Benefits: How to Make RA Treatment More Affordable,” featured Dr. Laurie Ferguson (a health psychologist), and Liz Schultz (a rheumatology practice manager).
The discussion focused on the types of insurance that people with RA have and how to make sure you get the coverage you need. The chat was broken up by type of insurance: commercial or private, which 68% of those who took part in the chat have, Medicare, which 26% of those who took part in the chat have, Medicaid, which no one who took part in the chat had, and 5% of people on the chat were not sure what type of insurance they have.
For those who couldn’t attend, here are some highlights:
• There are resources available to help you pay for medications regardless of insurance coverage – Some drug manufacturers have special discount programs for particular medications. Unfortunately, if you are on Medicare or Medicaid, you are not eligible for such programs.
During the poll, those on the chat were asked about how many of them knew about drug manufacturer discount programs. 47% of those present were aware of such programs, while 53% of people were not. This surprised both Dr. Ferguson and Liz Schultz, but it doesn’t surprise me. Many people simply are never made aware that such programs exist. But now you know!
• All types of insurance will cover biologics – One of the poll questions asked which type of insurance covers biologic medications. As it turns out, commercial and private insurance, pharmacy benefits, Medicare Part B, and Medicare Part D all cover biologic medications.
• There is a difference between insurance benefits and pharmacy benefits – There are two ways to take biologics and two ways to pay for them. For those with commercial or private insurance, if you receive your infusion or injection in a doctor’s office, hospital, or infusion center, this will be covered under your medical benefits. For those on Medicare, this would be covered under Part B. If you do the injection at home, this is covered by your pharmacy benefits for those with commercial or private health insurance, and by Medicare Part D for those who are on Medicare.
• Be proactive – Make sure you check with your insurance plan about their specific requirements for coverage. Liz Schultz mentioned that most often, doctors’ offices have people on staff that are knowledgeable about the various types of insurance. I would tend to disagree. In the increasingly complicated environment of insurance plans through the marketplace/exchange, I would argue that this is not the case and that if you ever have questions, you should absolutely contact your insurance company directly.
• Be organized – And find out what your coverage is.
• Discuss coverage options with others – This includes your family, friends, doctor, or other people that you trust, to help you find the best coverage for you.
• Open Enrollment for 2015 – Open enrollment allows you to make changes to your current insurance plan or allows you to sign up for a new plan. While most of the people on the chat felt that they were very happy (19%) or that their insurance was adequate (38%), others felt neutral (19%) about it, or that their insurance coverage was inadequate (19%), and 6% of people felt they definitely need to find new insurance.
For those looking for new insurance, here is a timeline:
If you have commercial or private insurance, you need to decide by November 30.
If you have Medicare, open enrollment starts October 15 and closes on December 7.
If you have insurance through the marketplace/exchange, open enrollment starts November 15 and ends February 15.
If you are planning on changing your insurance coverage, make sure that the doctors you want to see and the treatments you require are still covered. And even if you aren’t planning on changing your health plan, your coverage may change in 2015, so make sure to check in to any changes that may impact you.
This is a complicated topic, and I would highly recommend you watching this chat more than once. I consider myself to be a pretty proficient patient in most things, but even I had a hard time keeping up with this one.
Want to learn more? There is one more webinar in the Joint Decisions series:
January 14, 2015 – “Right Track RA: Helpful Tips for Continued Success in the New Year”
All chats are from 7:00 p.m. to 8:00 p.m. EST.
For more information and to register, visit CreakyJoints JointDecisions.
* It is important to note that these chats are not a substitute for medical advice. Always talk to your doctor before making significant changes to your treatment regimen.