Have you been in this Catch-22?
You had great medical insurance when you were working. But, you’re not working anymore. Your insurance now comes with a $6,000 deductible and it no longer covers any medications. That $6,000 is about a fifth of your yearly income. You took early retirement because of your MS, but the pension you’re getting puts you over the limit to receive Medicaid help. You can’t get Social Security disability payments because you’re older than 62 so you’re eligible for regular Social Security benefits. But you’re not yet old enough to receive Medicare.
I recently read a post very similar to that on one of the social media sites I follow. Sad to say, that situation isn’t unique. In fact, the day I read that post, the Kaiser Family Foundation released research showing that you might have a lot of trouble paying your medical bills, even if you’re on Medicare. According to the KFF study, in 2013 more than 50 percent of the people who were on traditional Medicare (Parts A, B, and D) spent at least 14 percent of their total income on out-of-pocket healthcare costs. Twenty-five percent of them spent nearly 30 percent. Ten percent spent close to 60 percent of their income.
It would seem to me to be an understatement when the study authors wrote:
“With half of all Medicare beneficiaries living on annual per capita income of less than $26,200, out-of-pocket health care costs can pose a challenge, particularly for beneficiaries with modest incomes and those with significant medical needs.”
Not surprisingly, it’s worse if you’re in poor health, if you’re 85 or older, or if your income is less than $20,000.
It’s probably not going to get any better
The Kaiser analysis projects that, under current U.S. government policies, by 2030 the number of people spending 20 percent of their income on health care will rise from 36 to 42 percent. This is particularly important to understand as politicians talk of paying for income and corporate tax reductions by reducing spending on Medicaid, Medicare and Social Security.
There are some ways to ease the financial crush
The Multiple Sclerosis Society of America has programs to provide, at no cost, some simple things such as cooling vests and assistance equipment. And the MSAA recently added a biggie: assistance paying for some magnetic resonance imaging (MRI) exams.
In the United States, many drug companies have programs to provide their high-cost MS drugs to patients at a deep discount, or in some cases for free. The National Multiple Sclerosis Society has an excellent, drug-by-drug, list of programs on its website.
If your drug company isn’t able to help with your copay, a foundation is a good place to turn. It takes patience and good timing to obtain help from these nonprofits, but it can be worth the effort. If you qualify for the help (there’s still an income ceiling, but it’s usually fairly high), a foundation will approve a monetary grant for you. The grant will cover your copays and be paid directly to the pharmacy that’s providing your drugs for a specific amount of time — usually a year. A list of some foundations that are paying for MS drugs is found at the bottom of the National MS Society webpage that I mentioned earlier.
A couple of suggestions from MS patients, which I found online, include:
- If you have no insurance, see if your medical provider will give you a cash discount and/or make it possible for you to pay over time with no interest.
- Ask your pharmacist about prices for prescription drugs using, and without using, insurance. Sometimes it’s cheaper to pay cash. You can also look up prices on GoodRx. It also pays to check different pharmacies in your area.
Will Amazon impact the future of healthcare?
Details are scant, but Amazon has announced that it’s joining with financial giants Berkshire Hathaway and J.P. Morgan to cut healthcare costs for their employees. Could this be the start of a healthcare revolution? Stay tuned.
(This is an edited version of my column that originally appeared on www.multiplesclerosisnewstoday.com)
We had great coverage while my husband was working. When he went part time we went on medicare full time. This year he basically retired full time except once in awhile when he is called in to sub for someone. My copay for my MS med is about $6000/year. I heard President Trump yesterday talk about helping get the costs of medications down. I wonder if this would include brand name drugs as well as generic. What he said sounded reasonable but who knows what will really happen?
After 12 years on brand name Copaxone (although this could change) I am concerned that insurance could force me to go on a generic drug (or I may need to change meds after I see a specialist soon.) It is all up in the air right now — if I need to change meds and what our income will be in time. The ins. company did send me a generic form of my drug without saying anything to me about this. I was upset and my neurologist was unaware they were going to do this so he sent in a new script with brand name checked off; I returned the generic drug and received the brand name. There is something to be said for freedom of choice!! It was the lack of transparency that really bothered me.
Thanks for your comments.
I totally understand your concerns. When I retired I was able to carry my employer’s drug plan with me. However, 3 years later I went on Medicare and my drugs became more expensive. It seems as if it should be the other way around. The “plan” President Trump announced yesterday fails to do two, major things that would help. It doesn’t change the rules to allow Medicare to negotiate drug prices with the pharmaceutical companies (and Mitch McConnell has said he wouldn’t allow a vote in the Senate on doing that anyway). It also doesn’t allow Americans to buy some lower priced drugs from foreign countries.
(Notice that the stock prices of pharmaceutical companies ROSE after the announcement). There were some small changes that might help our costs, but the major changes weren’t there.
Here’s an article that takes a good look at what was proposed: https://nyti.ms/2KWTvdZ
Ed
Thanks so much for this article. I’d spent tens of hours in the months preceding trying to get “prior authorization“ (PA)for Modafinil which I’d been taking for several years under a different insurance plan. Although covered under my new plan, I needed PA but they denied it despite my dr.’s and my protests because I’m not narcoleptic, don’t do shift work or have apnea. Yesterday I saw this article and looked at GoodRx. I was skeptical, but I printed out a coupon, got a fresh hard copy of my rx, and headed off to Costco. With trepidation, I presented both to the pharmacist and asked if the coupon would work there. He replied in the affirmative and I went about shopping, still doubtful. I hadn’t been on a shopping expedition for quite some time but there was a scooter available so I was able to actually shop instead of just “quickly” try to gather necessities. I went back to the pharmacy, and to my surprise, not only did the coupon work, but their price was even less! No question or mention of insurance. I had a script and they filled it at 1/10th of the cost elsewhere. That’s what a pharmacy is supposed to do. All that time I spent stuck in the mindset of insurance and I didn’t even need it. Unbelievable. Such a weight off my shoulders. Thanks again.
Hi Zoe,
I’m so glad what I wrote was able to help you. It’s amazing how the drug insurance companies have us bamboozled. I especially understand how you feel about modafinil, which I also use. Though my insurance covers it, the co-pay is probably the highest of any of my drugs. The next time I need a re-fill I think I’ll take my own suggestion and see what I can get it for with a coupon at Costco.
Ed
Well written blog with a lot if helpful infirmation. I have bookmarked it and will pass it along ti anyone else that I hear if that needs help with MS medications. I will keep this information for me too if I ever need help with my MS medications. Thanks.