Stories of Carol's Wish Clients
Jenny 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 Jenny’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 Jenny 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 Jenny’s planned course of treatment including very expensive oral medications for multiyear maintenance, the Extra Help program will save Jenny over $11,000 a year. Additionally, we were able to locate an open foundation co-pay assistance fund for ovarian cancer patients for which Jenny 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, Jenny 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 Jenny’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 Jenny, 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.
Beatrice was a 60 year old woman with recurrent and advanced ovarian cancer. She had not been able to work for several years due to the side effects of her treatment, and her sole income came from Social Security disability benefits. Due to her disabled status, she was enrolled in Medicare, which carries a copay of $1,346 for each hospital stay and a never ending 20% copay for office visits and chemotherapy.
When we met her, Beatrice had already spent her entire 401(k) on medical expenses, and her last remaining asset was her condominium. She told our advocate it was her fervent wish to keep her condominium at all costs, as not only was it her home, but she wanted to leave it to her son when she passed. She had just gotten married and her joy over it turned to regret when she realized she might leave her new husband with her medical debt. She was seriously considering foregoing further life preserving chemotherapy treatments due to the financial burden she felt she could no longer carry.
After a nationwide search, we were able to find an open copay assistance foundation fund for patients with ovarian cancer who are receiving the same chemotherapy drugs Beatrice needed. We enrolled her in the fund and she was approved for copay assistance of up to $3,500 towards her chemotherapy and related costs. Unfortunately, she was not able to take advantage of the assistance going forward as her condition worsened, but we were able to apply it retroactively to some of her past chemotherapy treatments to reduce her outstanding debt.
We also helped to enroll her in her husband’s employer sponsored commercial health insurance plan which she had previously passed on because she did not understand that the plan would work together with Medicare – it covered the bulk of the 20% coinsurance that Medicare did not, as well as the majority of her hospital copays under Medicare. Though she enrolled in the plan in January, the coverage was retroactive to the date of her marriage, so she was able to apply the benefits to a hospital stay the previous fall.
Unfortunately this patient did recently pass away. But in her last weeks of hospice care, she expressed her relief and told our advocate she felt the peace of mind that came with knowing that she had “crossed her ‘t’s and dotted her ‘i’s.” She was able to keep her condominium and leave it to her son as was her wish, and we will continue to work with her husband to ensure that her medical debts are taken care of through her two insurance plans and copay assistance.