The Story of a Carol's Wish Client
Debbie is a 70 year old woman diagnosed with stage three ovarian cancer in 2018. She is a retired business owner with almost no assets and lives off of $1,217 a month in Social Security retirement benefits. She selected her Medicare Advantage Plan when she turned 65, was healthy and had business income. The plan carries an annual maximum out of pocket cost of $5,900 – which while affordable at the time she enrolled in her plan, is now nearly half her annual income.
Typically a patient undergoing treatment for late stage ovarian cancer will hit her maximum out of pocket. In Debbie’s case, though, she was hit with a double whammy. Since she was diagnosed late in the year, she hit her maximum out of pocket in 2018 with testing and surgery. On January 1 her maximum out of pocket reset, and in 2019 with chemotherapy treatments she will hit her maximum out of pocket of $5,900 again. And that’s not including expensive prescription drugs that are part of her treatment plan.
Since she is a low income Medicare recipient, we were able to enroll Debbie in a Medicare Savings Program called Specified Low Income Medicare Beneficiary. This program will pay her Medicare Part B premiums of $135.50 a month, saving her $1,626 in 2019. We were also able to enroll her in the Medicare Extra Help program, which will help her pay the costs related to her Medicare Part D prescription drug program. Given Debbie’s planned course of treatment including very expensive oral medications for multiyear maintenance, the Extra Help program will save Debbie over $11,000 a year. Additionally, we were able to locate an open foundation co-pay assistance fund for ovarian cancer patients for which Debbie was eligible. We enrolled her in the fund, which will cover up to $3,500 a year for her chemotherapy and related costs, and will count toward her health plan’s maximum out of pocket of $5,900. Prior to our work with her, Debbie had never heard of any of these programs and had no idea she was eligible for them.
The last piece in our strategy to make Debbie’s health care affordable for her is to help her switch to a Medicare Advantage Plan with a much lower annual maximum out of pocket cost. Although it is not time for open enrollment, her enrollment in the Extra Help program triggers a special enrollment period, allowing her to switch plans now. We will refer her to a Medicare broker to determine which is the best plan for her, but she is eligible for several plans with max out of pocket costs of $3,000 - $4,500, saving her an additional $1,400 - $2,900 in 2019.
When we met Debbie, she was looking at medical costs (including Part B premiums, prescription drug costs and her maximum out of pocket which she will hit) in 2019 of over $18,000. That’s 125% of her entire annual income just for the cost of treating her cancer. As a retiree scraping by on Social Security retirement as her only income, she absolutely would not have been able to afford her cancer treatment. Our work with her (so far) will save her over $16,000, bringing lifesaving medical care within her financial reach.