(Guest Lecture): October 2022 - Medicare 101 for Myeloma Patients: What You Need to Know for 2023

It's now my pleasure to introduce Diana and Courtney to you. Diana is the financial program manager who specializes in financial health for multiple myeloma and AML patients. As a professional financial consultant and former caregiver of her husband who is diagnosed with multiple myeloma, Diana perfectly understands the financial issues facing myeloma and other blood cancer patients. Courtney Bowman is currently working as a software consultant at Change Healthcare for the past three and a half years. She specifies in medical code editing to pay her claims. This role involves working with Medicaid, Medicare, and commercial LOBS. Her healthcare experience goes beyond her current role. She previously served as a manager in consulting at Humana, Inc. for 17 years. She has worked with all lines of business but more in the Medicare Advantage space. Courtney is a certified medical coder, CPC, through the AAPC. And in addition, she has much experience with CMS regulations and how that correlates with payer policy. Again, today is Medicare 101 for blood cancer patients. What you need to know for 2023, we host an annual event on this topic which is highly requested and anticipated. And we see that through the attendance numbers today. Diana will further explain why she brought our special guest Courtney on and why this topic is so pertinent for myeloma and AML patients and their families. Diana, the time is now yours. Great. Thank you, Audrey. And thank you, Courtney, for taking the time to share with us, taking time out of your day to share all this important information. As you all know, October 15th is a big day for your open enrollment for Medicare Advantage. Very important for those of you who are new to Medicare, this is a great first start and first information seminar that will help you guys. For those of you all who have been at Medicare for two or three years or more, please, if you are, if you or your caregiver or someone with a blood disorder or any kind of illness, please take the time to review your current plan because these things do change annually. Plan changes come on and off all the time. If you are expecting or have made a, have been a different treatment plan this year and you expect a different treatment plan next year, please take the time to review what the costs are going to be. A lot of doctors do not take the time to ask about costs. They'll describe, describe, describe. But you need to be aware of the cost. Understanding the cost of your treatment is going to be the foundation of your treatment plan. So make sure you take advantage of this, put that into work in your own financial health, health household so that you can make sure that you're covered appropriately for you, health today and in the future. So again, another disclaimer, disclaimers everywhere. Please be aware that this is general information, a general overview of Medicare Advantage. This presentation includes some of the upcoming changes that we're going to be, that are going to be, that we are aware of as of the time of this presentation. Be aware that maybe some coming out that we are not aware of. By the time CMS will wait until the last minute to get some things out. And things are subject to change, except for these costs. These costs have been in place and they're not going to change. The changes in the costs. Please go to the CMS.org website to seek specific questions and answers about your plan options. Very important, you can go on there and compare your plans because that's what you're needing to do right now, everyone. Next slide, please. So some of the topics we'll cover, some will be in more depth than others. We're going to talk about the enrollment periods, the changes to Medicare for 2023, some great things that are coming out. How to read your ELBs, that's been something that some of the patients have asked of us and we're going to do that today. Medicare Advantage, what is it? What does it cover? What does private fee for service mean? And what is meant by assignment of benefits? Something very important for you all to understand. Does Medicare include nursing home coverage? I know this seems like it's thrown in, but it is so very important because my experience and other people's patients' experience that I've talked to, there's times where if you are in the hospital, you may have to go to a nursing home facility or a qualified facility for a short period of time. And it's very important if you understand what your cost burden is. And we're going to go over that briefly. The next slide. So this is where I'm going to have Courtney come in. Courtney is a great resource. She looks at things a little bit different than I do because she's more on the technical side and understanding how the plans work when they're putting those new plans out. So Courtney is going to join us to start going through this. Courtney? Thank you, Diana. Hello, everyone. I'm pleased to be here and thanks for having me. So what I will do is I want to first start by talking about Medicare Advantage versus Medigap plans. I know that sometimes you may hear those interchangeably, but Medicare Advantage, those are filed through CMS while the Medigap plans are not regulated through CMS. Also, Medicare Advantage and Med-Sup generally are not offered together. You generally want to have the original Medicare or, for original Medicare A and B and then purchase a Medigap or Med-Sup or Med-Supplement plan, you may have heard it, with your Part A and Part B to supplement for the 20% that you have to pay. But in this specific piece, my part in this webinar, I will be speaking for the Medicare Advantage plans. Next slide, please. Okay. So Medicare enrollment period. When looking at, according to the CMS website, October 15th through December 7th is the time of enrollment. So you got about four days to get in there. This is the same every year. So whenever that comes up, just know that October 15th or December 7th, that is the standard timeframe. The information for what type of plans there are and what will be coming is usually published in October of that year for the plans for next year. So, for example, for October 2022 now, which we are in, the information for the 2023 plans has come out to explain things. So, and another thing we want to talk about besides the Medicare Advantage enrollment period, you know, some folks may have the private insurance or the marketplace insurance. That is, you know, November 1st through November 15th. With this time period, your effective day or coverage day, coverage will begin on January 1st of 2023. January 15th is the last day to sign up for a plan in 2023. The final day, you know, will be, if you enroll on the final day of coverage, February 1st of 2023 is the enrollment day. You won't be able to have the January 1st enrollment day. So, if you want to get in on January 1st, make sure you enroll sometime between November 1st and December 15th. But if you do enroll after January 15th, you'll need to qualify for an SEP. And there are, you know, different qualifications that you need to have for this, and that is included in the website we've provided. In this presentation at healthcare.gov. Next slide, please. So, original Medicare, we were just talking a little bit about Medicare Advantage enrollment. But now let's talk a little bit more about original Medicare, and then we will discuss the Medicare Advantage as well. So, original Medicare is that coverage you receive when you are, you first of all, become eligible at age 65, or you can be younger than 65 with a qualifying illness. And this is 24 months after you are on SSDI, so your disability insurance. Any age with a diagnosis of ESRD or end-stage renal disease or amyotrophic lateral sclerosis. U.S. citizens and legal citizens, you have to live, you have to have lived in the United States for at least five years in a row, and five years, including the five years just before applying for the original Medicare. And another quality, the last qualification is receive a disability person from the Railroad Retirement Board. Next slide, please. Now let's go back and let's review how we talk about original Medicare and the Part A and Part B, what each of those are for. So, for the beneficiary, your Part A, that is, when you hear that, that's for your facility or hospital benefits. When you are, when you hear the term Part B, that's your physician services, so that's going to be your office visits, your outpatient services, things of that nature. Then we have the fee for service plan, which is, fee for services is, if providers can choose to, with this, the providers may choose to accept the fee assignment or they may not, and the fee assignment is usually based on something you call, the CMS has is a physician fee schedule. So, things go off of that. And then with the Part B drug plan, this is not included in your Part A or Part B premium. It is also a separate premium. It is not baked in the same premiums as the A and B. So, can we go to the next slide, please? Diana, I think this is you. I'm turning back over. It is. It is. So, Medicare Part A changes for 2023. This is something that's very important. I think you guys have been waiting for. So, Medicare Part A covers, as we mentioned before, inpatient, skilled nursing facility, hospice, inpatient rehabilitation, and some healthcare services. About 99% of Medicare beneficiaries do not have premium expenses since they have at least 40 quarters of Medicare covered enrollment. That means you have to have worked for a period of time and paid into Medicare. The cost is increasing for 2023 from $44 to $1,556, from $1,556 to $1,600. So, that's the daily coinsurance for the 61st to the 90th day increases from $389 to $400. Now, we're talking about inpatient rehabilitation. Daily coinsurance for lifetime reserve days increased from $778 to $800 per day. So, you need to be aware of these costs if you're going into a rehabilitation. And I mentioned before that sometimes that may be something you need to do if you've got extended days out beyond the 61st day. Skilled nursing facility coinsurance increased from $194 to $200. So, these are things to be aware of. If you think you're going to be in for, let's just say, a stem cell transplant or CAR T, when you know you're going to be in a hospital, that's going to be covered. But then there's additional fees if you have to go into a rehabilitation for a period of time. So, get everything together. Make sure you're aware of these costs, the anticipated costs. And talk to your treatment team so they'll be up on what insurance you have and what options you may have available to you. Next slide. So, additional Medicare Part A changes for 2023. So, enroll a 65 years old and older who have fewer than 40 quarters of coverage, that means qualifying, time working, and paying into Medicare. And certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. So, generally, if you've paid enough into those quarters, you don't have anything to pay into Medicare Part A, it's free to you. Individuals who have had at least 30 quarters of coverage or are married to someone with at least 30 quarters of coverage may buy into Medicare Part A at a reduced monthly premium rate, which will be $278 in 2023, a $4 increase from 2022. So, other people who have less than 30 quarters of coverage or their spouses have less than 30 quarters of coverage, and certain individuals with disabilities who have exhausted other entitlements will pay the full premium. It can be costly, which will be $560 a month. Sorry, there's a typo there. And in 2023, a increase of $7 from 2022 expenses. Next slide. Good, Medicare Part B changes for 2023. Medicare Part B, which includes your physician services, outpatient services, certain home health services, durable medical equipment, and certain other medical and health services that are not covered by Medicare Part A. So, I'll need you all to remember that Medicare Part B monthly premiums is based on your income. So, some people will pay quite a bit more based on their income. There is a rate chart on the CMS.org website. I really suggest you refer to that if your incomes are over some of these tiered income. So, changes for 2023. The decrease of the standard monthly premium, which is great to hear, right? It decreased to $164.90 for $170.10. So, $5 or so. A decrease in your annual deductible for all Medicare Part B is $226. It's a $7 decrease from 2022. Every little bit helps because, as we mentioned before, some of those other things for inpatient rehabilitation have increased. Next slide. So, what are the reasons for your decreases? I think everybody's aware of the controversial drug for Alzheimer's. Forgive me if I pronounce this wrong. Aduhelm. It's a very, very costly drug. Medicare, when they're looking at the prices of your Medicare Part B, they were looking at how much that drug was going to cost. And so, they anticipate that with those costs. Would they increase your costs last year? Well, they overshot, which means there was a lot more funds in their reserves to pay for this when they had fewer people subscribing or being offered that drug or taking that drug. So, the lower than projected spending on both that and other Part B items and services results in a much larger reserve in your Part B account of the Supplementary Medical Assurance, which is SMI, their trust fund, which can be used to limit future Part B premiums. Hence, future 2023, they're reducing that cost for you. That's that $7 and whatever it $5 cost. This piece aligns with the SMI reserves and is now being passed on to your Medicare Part B beneficiaries. The next slide. So, Courtney, I didn't know if you were taking this or am I taking this one? Yes, I'm taking it. Okay, run with it. Thank you. And now we're getting back in this presentation to the Medicare Advantage. I just want to mention some things with Medicare Advantage that may be confusing and could help with knowing the difference between original Medicare and Medicare Advantage. First, you may hear the term Part C. Part C, that is Medicare Advantage. And what is included in that is the Part A and Part B. There are supplemental benefits that are available that are not original, that are not available through original Medicare. Additionally, the insurance providers such as the Humanas and Cignas, they actually offer the Medicare Advantage and the Medicare Advantage prescription drug plan. When you do choose to enroll in a Medicare Advantage plan, that does replace your original Medicare's Part A and Part B. So, I know that's also been a question. And then with the Medicare Advantage, you know, they offer some different type of coordinated care plans. These listed below here, the plan options, HMO, HMO-POS, the PPO, and private fee for service are probably the most common plans you have heard. There are different ones, but we're not getting into those right now. But let's start to break down what each of the plans, these type of plans are and what you need to know about those. So, first of all, the HMO plan, that stands for the Health Maintenance Organization. And with this, you are required to have referrals from your primary care physician for services your primary care physician does not furnish. This would be considered the most restrictive simply because there is no out of network. It doesn't have the different networks as you do with the PPO, and we will get into that here in a second. With the PPO, which stands for Preferred Provider Organization, there are no referrals needed as you would need with a HMO plan from your PCP. This is a network of providers that are in network, which means, and if you could go to the next slide, I'm sorry, because that gets more into it. The network of providers, when they say the network, it means that they are, I mean, in network, let's say they are contracted with the insurance companies for a special rate, a discounted rate. If they're out of network, that means they do not have a contract with the, your insurance company, and you are subject to higher cost because they can charge more. Providers who are not contacted, I mean contracted, which are considered out of network, the benefits are not going to be as rich as an in network benefit. For example, say that you're going in for, let's say, some type of procedure, where the, you'll see in your evidence of coverage, it will say that the in network is 90%, and then if you look at the out of network, it may say something like 70% just depending upon the benefit. But you will see that the cost or coverage that the insurance company will cover is lower when it's out of network. Next slide, please. Then earlier when we were talking about Original Medicare, of course, we know, with Original Medicare, they only offer fee for service. With Original Medicare, I mean, with Medicare Advantage, we are talking about these different types of coordinated care plans, and one of them that they have that's, that may sometimes get misconstrued with fee for service is the private fee for service. Now, there are no referrals needed for this. There is, what the difference is, is there actually is a network of providers that the insurance plan can offer to you, whereas with fee for service, that's not usually the case. How those are paid, that is if the provider accepts Medicare fee assignment, and earlier when we referred to that, that is usually from the different fee schedules that are out there for providers to reference. Also, the private fee for service through the insurer, they must cover all Part A and Part B services, whether or not the private fee for service plan has a full network of contracted providers. So, that is something that's also different. I mean, not different, but required of the health plans when they do offer the Medicare Advantage private fee for service. Next slide. I think this is going back to Ms. Diane. I'm going to punt that over to you. Okay, so more changes to the Medicare Advantage and Part D drug plans. And so, because as AML patients, myeloma patients, you know the cost of drugs are unbelievably high. You know that Revlimid, one of the highest cost drugs is roughly between $25,000 and $28,000 a month, and you know that we look for all these different options, may be available to you to get help, financial assistance, and these things to take care of. What is very important is for you to be aware of what your drugs are, what may be coming down on your tiers for your Medicare insurance provider, so that you can be most positioned to take advantage of the coverage that you can get. So, the average projected monthly cost for Medicare Advantage plans will fall by $1.52 to $18, while the average month premium for a basic Medicare Part D prescription drug plan will fall by $0.58 to $31.50. Now, that's the average cost, projected cost, that is in the middle. They're higher, and there's maybe some of you a little bit lower, but make sure you are picking the best Medicare Part D drug for your needs. Be sufficient for next year. Please review that. The Inflation Reduction Act will limit the monthly cost sharing for insulin costs to $35, a reduced cost for adult vaccines. The reason I mention this is because it's becoming very important. For many people, many of you who may be on Rev-Lit, and you may be on high doses of, not Rev-Lit, but dexamethasone, that lovely drug, so needed, but it has all those side effects, and one may be medicine-induced diabetes. It's very common. Or you may have already had diabetes. It's very important for you to understand how this inflation reduction act is going to affect your cost of drugs. And with vaccines that are going to be ongoing, I believe, since COVID has become part of our everyday daily lives, it's important for you to understand what that cost is going to be to you. Keep up with what's going on. You can also talk to your, if you don't have the time to talk to your doctor, if they don't have time to talk to you about the cost of these things that they prescribe to you all the time, wherever you get your prescription drugs, whatever pharmacy, the cost of your vaccines and reductions, some of those things, I want to interject here that it's very important for you to pull out. Don't just look at your insurance. There are some great other options available to you, just as good medical insurance card. It is not insurance, but it reduces the cost for a lot of your out-of-pocket costs for your prescriptions through that. Of course, you'd have to request they run that prior to running it through your insurance. And you can get online, available to you in your area, and determine which one is the lowest cost. There are a lot of variations in the cost among pharmacies. You'd be surprised. Sometimes, a lot of times, your good Rx may charge you a lot less than your insurance is going to pick up. So, very important to look at those good Rx, needy meds. Prescription drug cards, that can be a great tool in your arsenal when you're talking about paying your medicine out of pocket. Next slide. Some additional income-related changes. To help with Medicare costs, low-income seniors and adults with disabilities may qualify to receive financial assistance from Medicare savings programs, or called MSPs. It may pay for Medicare deductibles, COIP, or payments for those who meet conditions of eligibility. Now, I suggest, and I've spoken to quite a few patients who may qualify for this, is to go to Medicare.gov and look into their Medicare savings programs. There's a great, there's a lot of information in there. If you get Medicare, look at the Medicare booklet. It's huge. I don't, do this with you. It's so big. It's so complicated. I'd be surprised if the people who are passing these laws, if you don't actually understand it. But it is very complicated. There's a lot to it. So, when you go in there and look at it, if you have any questions, we do have financial coaches on our side, myself, and we have four or five others that would get ready to bring some more on board. They'll be glad to answer some of your questions. We go through training. We can't get into the specific, very, very, very, very specific things because we are not, we don't sell Medicare plans. But we can help direct you to the information that you need and answer some of the questions you may have. The next slide. Courtney, ELBs are up to you. This is something a lot of people have asked over the year to explain to them the ELBs. This is going to be your tool to understanding what you're paying. You may be paying too much, but the bill is incorrect. This is your tool to keep up with on a daily or weekly basis. Courtney. Thank you. We're playing musical chairs on this presentation, this keeping things moving. What we have here, it is an example of an actual CMS or Medicare ELB. And in here, we have some good literature on how to read this and the different, what the different columns mean and how that applies to you. If we could go to the next slide. Okay. So let's first start with explaining the ELB. That's, the ELB is not a bill and you'll see that across usually the top right hand corner. It'll say this is not a bill. And so it does not come from the provider. It actually comes from your insurance company. This is not the same as a Medicare summary notice. And again, it's not a bill. Just to overview that previous document, and I apologize, we're not looking at it and going through it and I'm happy to go back to it again if someone needs that in the question and answer. But what it basically shows you is the insurance amount that will be paid to the provider, the member cost responsibility based on plan benefits for services performed, then the total charges for the provider services performed that were on the claim. And then it also has instructions for if you think there's some fraud going on. So there are instructions on how to do that. Next slide, please. Now, also, there is clear information about the plan's MOOP. You may have heard that or maximum amount of pocket limit. As you know, with the fee for service under original Medicare, there is no MOOP limit or maximum out of pocket. But CMS does require that the Medicare Advantage plans, they have to have a maximum out of pocket spending for the beneficiary. The enrollees current total out of pockets in relation to the plan's maximum out of pocket spending limits and also details about the amounts the enrollment has paid towards the plans deductible. To get additional information to see this again, please make sure you can follow the website here for Medicare.gov. Next slide, please. This is now going back to Diana. Okay, so understanding Medicare Advantage prescriptions, evidence of benefits. They're usually mailed once a month if claims are made. So if you get an ongoing dose of Revlimid or dexamethasone or any of those other things. Sorry, guys, I was talking to myself there for a second. So understand that, can you hear me, everybody? So understanding Medicare Advantage prescription plans are usually mailed evidence of benefits. So these are usually mailed once a month if claims are made. So if you're getting Revlimid every month, or you're getting prescriptions once a month for your treatment, you're going to get this evidence of benefits, eligibility of benefits or evidence of benefits, whatever is being paid. Summary of the claims, the plan process for the enrollee during the monthly reporting period, including the name and cost of each drug. Check those things for accuracy, please. Some of these things can be incorrect. The summary of payments made by enrollee, the plan and other programs paid. Errors can be made. Look at all those things. I encourage you to look at these things as they come in and keep a diary of some of these things, especially those high cost prescriptions. There may be times when you're changing prescriptions, or for some reason they have it automatically set up to send to you. You need to check those because you may be paying for medicines that you're no longer taking. The enrollee's current drug benefit stage, deductible, the initial coverage, the coverage gap, very important to know, or your catastrophic coverage areas. So you need to know all of this because it's going to determine how much out of pocket you're going to be spending. A record of the enrollee's total out of pocket costs and total drug costs is also going to include the cost of each drug, including amounts for each enrollee, the plan and other programs paid. Other programs paid will be anything else that's paying for your prescriptions because you know how you go to LLS and you can get help through them to pay for copay, deductibles, things like that, out of pocket costs. Well, that's not going to count towards your deductibles. So your ELB is going to look at what was been paid and what that's going to affect your deductible or your maximum out of pocket. Next slide. So the change in the total cost of each drug shown as a percentage on your ELB since the time the enrollee got the drug in the current benefit year. So it's also include a list of lower cost alternative drugs, if available, that are similar to the drugs the enrollees currently get. As you know, Revlimid now has a biosimilar, linoleumide, and you're going to show the cost of that. They're going to refer you, they would prefer you to get the generic drug if possible. But between you and your doctor, you need to verify whether getting the benefit, getting the biosimilar or the generic is going to be in your best interest. For some people I've heard that it does not help, that it's better for them to stay on the brand name drug. Okay, so these these drugs could be lower in cost sharing or a lower drug price. I will tell you that the Revlimid example, the biosimilar is less, but only by a few thousand dollars you would think will be a drastic difference. It isn't. Because that drug is not out, completely out with all the pharmaceutical companies, pharmacies. Then that's why it's so high. Once it becomes more common out in the pharmacies where you can purchase it, then that drug price will probably drop. Any adjustments like the reverse claim or corrections like a clerical error to cost information for your benefit year is going to be included on that ELB. The total drug costs for the month as applicable and totally rolly out of pocket costs. Those are great big things you need to keep up on. Make sure you're paying your fair share of what you're going to be paying for based on the plan that you chose. Next slide. So, additional things you need to be aware of any formulary updates that affect the coverage or cost of the drug in a rolly takes. The contact information for member services and that you have a question regarding your anything on your ELB. And instructions for reporting suspected fraud, appealing the plans coverage decision or reporting an error. Very important. If you don't look at your ELBs, you don't really know what's going on on the financial side. You need to really be up on those things. The next slide. So let's summarize all this stuff that we've talked about. It's a lot. Some of the big takeaways you're going to want to know is what your changes in your costs, your monthly costs is going to be for your Medicare, Part A, Part B, for your advantage plans. And again, please look at your income levels that they change drastically gone up or gone down. That maybe may affect what your costs are going to be. And remember, plans can change yearly. If you have a plan last year that was really, really great for you. That doesn't necessarily mean that plan is going to transfer over to the next year, depending on what your treatment plan is going to be. So Medicare can be and is very complicated and confusing. And we've included the slide links. There are links in the slides for you to refer to if you have any questions. If you have any specific questions, we'll try to answer those for you. If you get onto Health Tree website, the request, some of those requests, a financial coach, we'd be glad to refer you or find information for you or show you where you can find it. Also, don't forget to ask your health care team if they have anyone on staff that can refer you to a Medicare specialist can assist you. A lot of hospitals right now, even pharmacies will have people there that can assist you on this Medicare enrollment by telling you what's going on with the changes and answer some of the questions you may have. As always, again, information regarding Medicare on associated with the associated web hyperlinks that we had in this webinar. If you're on this, you sign up for this webinar, you'll have access to that. Or you can go to the financial resource page at healthtree.org. You go on coaches, go on to financial resources, you'll find a lot of links for to help you make the decisions you need to do. Please, everybody, go in and review your plan just because you had a great plan this year does not mean it's going to transfer or the as a great plan for your next year. Your treatment may have changed course costs change your income may have changed your entire financial picture may be completely different from last year. If you want to make sure that you can continue on your treatment plan, continue to pay for what you need to pay for. It's important for you to have this in control, have control of everything that's going on so you can anticipate, find additional financial resources that may be available to you. And please, please ask for a financial coach. If you don't ask, we cannot help you. There's a lot of resources to help you. We'll be glad more than glad to reach out to you and help you with your situation. So I think we've gotten right about to the time where we can ask questions. And again, please let's not be very specific, personally specific, let's make it broad so we can include maybe some information and a lot of people on the call have questions about as well. Wonderful. Thank you so much, Diana and thank you Courtney for your expertise and sharing. I really appreciate your preparation today. I'm going to stop sharing the screen. However, as Courtney mentioned I can always go back to sharing the screen if you have questions about the which I do see a couple questions here. Let's just start with Deborah's question. It's a great one. What about those who are eligible for Part B that still work full time? What are their options? And Diana, I'll give this one to you. Okay, if you're still working part, still working and you have insurance through your employer, you don't necessarily have to pay, sign up for Part B now because you have creditable coverage. I would make sure that I would talk to your benefits to make sure that would apply because things can change based on your employer and your benefit plan. But generally, if you're already getting a creditable coverage through your employer, Medicare Part B, you do not have to sign up for until you're no longer covered under Medicare. Awesome. Thank you. Kristen was wondering what vendor of Plan D medications has the best coverage for Revlimid? I don't know if this is one that we could answer, but I'd love to hear feedback. Yeah, that's a personal one. I would suggest, because I don't know what their plan is, I would suggest they not just look at just the Revlimid, we look at all their drugs that they may be on both now and later on, and do some comparison shopping. You can go to CMS.org or you can call some brokers local. There's a Medicare brokers in your area. They'll be able to go through your drug file and find out what prescription plan may be best for you. You have time to do that because open enrollment is starting in a few days. You have time to do that to make sure you get the best plan for you. So say that one more time. How can they find and then contact those brokers? You can go, if you're, if you're a retired, a retiree, you can go to AON.Medicare, enrollees, Medicare retirees, they will go through Medicare plans. If you're talking about the Medicare Part D, they can help you with that. They can go through each medication you have and determine best plan is for you in your state. You can also go into the Medicare, healthcare, Medicare plan website that we put up earlier, Medicare health plans and go through those as well. Do some comparison shopping. Very important. Okay. Courtney, did you want to add to that? No, that's what I was just going to say. Can't hear you. I think you're muted. I don't have anything to add. You're more of an expert in that than I. No problem. All right. So Debbie's saying for clients on Social Security Disability, I believe, is SSDI. Under the age of 65, what resource do you recommend for shopping MetaGap and Advantage plans? MetaGap plans are scarce and high premium for those who are under 65. There, there seemed to be no options for Plan B, K, L or M when I put an age under 65 and premiums increased by 100 to 300 a month. This is based off of what they were able to find on Medicare.gov. So to summarize, what options are there for those who are under 65 and on disability in terms of MetaGap and Advantage? That's a great question. And I'll be honest, I'm not 100% sure about that and not sure how the Medicaid would plan to this because there are situations where folks are dual eligible for both Medicare and Medicaid. That can sometimes be the case because I know my sister, who was also a cancer survivor, she was eligible for both A and B and she was not yet 65. I mean, original Medicare and Medicaid. So she was able to coordinate benefits that way. Okay. As far as with MetaGap, that's something that I'm happy to look into. I'm not sure how that works. I just, you know, know that there are cases where, you know, when you're under 65, you are eligible for both Medicare and Medicaid coverage. I would suggest people go out and find and talk to someone, a broker in your state. Because there's, there's every state has may have different options. I know California has so many different options for Medicaid and Medicare that a lot of states don't have. Check with your state Department of Insurance. They may be able to direct you as well to someone who can help you answer some of these questions. Yeah, that's great. Thank you. Courtney, this one's for you. Deborah saying that she hasn't seen anything regarding her specialty meds on the EOB. Is there, does the EOB, can you speak to that a little bit? Yes. And that's a great question Deborah and I, that may have been a little bit confusing because let me clarify. The EOB that I'm speaking of is specifically to your procedures, you know, hospital, office visit, that type of thing. I believe that, you know, Diana, you correct me if I'm wrong, you were actually discussing the Medicare Part D plan, EOB. Yes, yes. So do you want to take that piece because I, that's not the, they're a little bit different. Okay, the Medicare Part D prescription plan, they would have the type of medications you're taking, the percentage of you're taking, the cost, your cost, the maximum out of pocket you've paid, that all should be included there. Now you may get a separate statement for specialty drugs. Now, let's again talk about whether these are infusion drugs. So you're covered on your medicine, your Medicare, Medicare, your other plan, your Medicare Part D plan versus your prescription plan which is usually oral medications. So I would check to find out which one of those are, but your specialty medications, everything you get should somehow go through because you're not paying for all of it. And if it's being paid by Medicare, you should get an EOB that will state how much you're, how much you're paying, what especially how much the drug is and that cost of the drug, the cost sharing. And if you don't find that to be the case, please, please contact me so we can figure out what's going on with your EOB, how it's being, how it's being billed. Okay. And then you can contact Diana through the financial or through the coach website, let me put that in the chat right now as well. It's healthtree.org slash myeloma slash coach. This time, if you're an AML patient and joining us today or a caregiver and would like to communicate you can also go on to that and create a profile for now in order to contact Diana, she does help AML and myeloma patients even though it says myeloma coach. Can I add something to that that was just thinking about? If you're getting specialty drugs and you're getting paid through an organization like LLS or some of the other things, you're not going to show that on your EOB. You may not see that on your EOB because it's being paid outside of your, your insurance provider. Okay, and it does not apply to your deductible. All right. How much will revelment cost with Medicare Advantage, I don't know if we can answer this question. Can't answer that because we don't know which planet is we and I can't answer that. And it could vary depending on where you pick that up what pharmacy you can pick that up from. Am I allowed to say too much? Yes, yes. Way too much. If you go with Medicare Advantage, can you switch to traditional Medicare on a future enrollment. So Courtney if you want to take that one. Okay. I believe that you can switch switch back from part C to your original Medicare, but I would like to confirm that and and follow up. Awesome. Thank you. Okay, this is a good question and I think it has to do with part D probably maybe part D, part B if it's a different kind of drug as we were talking about. But this attendee was wondering what if drugs need to change many are in the plan doesn't cover the new drug, what can they do. Diana. I think this is the frustrations actually that we get quite quite frequently that it's almost like they're expecting you to know your entire treatment plan and open enrollment. And myeloma also makes it a lot more complicated. It's not as simple as well these three drugs could be my option. No, it's like these 24 different drugs and procedures could possibly be in my future not literally but Diana what advice do you have in this kind of situation should they discuss with their specialist. What's the best approach. Yeah, this is very complicated because you can be honest and say you're on. Dar dar dar deluxe or something and then they want to change you to something else. And it's mid year you've already had your plan. It's very difficult that I would suggest if you anticipate any changes again, talk to your health care provider and talk to they should have a navigator there on staff to help you look at those prescription plans, if they anticipate this coming into future. A lot of times your, your, your protein numbers will start indicating something's coming up. And, and if you're anticipating something's coming, coming up in the next year, next three, four or five months, you already have time to do that for next year, because the doctors are saying this is going to be your next. Based on what you're doing now this is going to be your next plan of action. So we can look at what kind of medications we're going to switch you to because we know there's a three to four for drug combinations and you may have already done two or three you're falling out of that because of your, your treatment plan, no longer staying on that levels you need to be on. So they're already anticipating what the next drugs are going to be again health free, the wealth to your hub site will help you with that. Determine what your drugs are, are keeping putting your information in. If you need to do something mid, mid year. If you've already gotten a drug plan, it's very difficult to change out of that just because of drugs because we'll have people doing that all day long, and they'll never know what to do. Once you're in that plan, unless something else happens for special enrollment. That's what plan you're going to be in. Awesome. Thank you. I'm Courtney Are there any resources that help us decide between traditional Medicare plans plus implementals versus advantage plans. Yes, there are things in when you go and look at the different websites for the insurers you can also find it there. You can also go to Medicare gov. Because it addresses both Medigap and Medicare advantage as well as traditional Medicare. Also, you, I believe that most, most insurers have a patient portal, where you can go in there and look at the different type of plans they have look at what you have. You could also make sure that you check your, what is called an EOC or evidence of coverage, and look at what the benefits really are when you are trying to make a decision on whether or not you want to switch plans or stay within your plan, but you get evidence of coverage every year with when you choose a plan they send that in the mail to you. It's complicated. I will caution people when you signed up for a Medicare Medigap plan, or you have not signed up for a Medigap plan when you're first eligible to sign up for Medigap plan. Then, after a year you may not be able to go in there and get that that they can, they can be client that Medigap plan. You have guaranteed issue when you when you first come eligible for that plan to sign up for it. And if you don't sign up for it, you may lose the option or the ability to sign up for later on. Awesome. Thank you. Rex was saying suppose you go back to work full time, can you turn off Medicare until you retire for a second time, or do you have both insurance from your employer and Medicare. Generally, if you're age 65, you would generally have both of those, you'll have both of those insurance plans, one would be secondary to the other. Awesome. Thank you. Okay, let's explain Medicare Part D a little bit more. Someone's asking they have a Medicare Advantage plan does that cover Part D automatically is Part D something separate that you have to enroll in. Where does Medicare Part D fall into Medicare. Okay, Medicare. So you have a and part B is your original Medicare, and then you have Medicare Advantage which could, which could automatically have a Part D in there. Or you can do Medicare Part A, B, and then again it's a separate Part D prescription plan. Medigap plan, you'd have to get Part A, Part B, your Medigap plan and then choose additional Medicare Part D plan for your prescription coverage. And Jane here is actually giving us some advice she said she's a licensed agent who also has multiple myeloma. You can ask your Part D plan to have your prescription added as an exception. They can say no and if it is approved it will be added at a higher tier. So thank you Jane for that input that's very helpful. Thank you so much Jane, could you send that information to us please. I have to get that is very important. I have will have record of it that she said that. Okay. Can you apply for Medicare if you have been approved for LTD benefits. I'm not sure what LTD long term disability. Oh, perhaps. So long term disability is through your job, usually can last, I don't know. It depends depending on how your has it set up working last age 65 if you're no longer working. It is usually an employer private plan, long term disability, unless you watch your own personal plan outside of an employer plan you can have You can go on social security disability you can go on Medicare depending on what your age is, and they will coordinate those benefits through social security disability and your long term disability plans. Tax, tax, the tax complications be depending on whether you pay your own plan is from your employer. Now when you're going through Medicare, Medicare looks at if you're on social security disability for two years or more, for 24 months. Their criteria is disabled on social security disability before you can go into a, which is a government plan, go into a Medicare. So you'd need to go and apply for social security disability as well if you're on long term disability and make sure that you're on there for 24 months before you can go into the Medicare plan. If you're under age 65. Awesome. Thank you, Courtney. Did you have anything to add to that. I don't. Okay, that's fine. Thank you. Sandra saying that she believes you may have to when we were talking about going. Anyway, she says I believe they have to go through Medicare medical underwriting if you want to return to traditional Medicare Part B plan. Do you know anything about Diana. I'm sorry you blinked out I didn't hear the entire question. Yeah, she said I believe you may have to go through medical underwriting if you want to return to the traditional Medicare Part B plan. No, I'm not. I am not aware of that I will find out. Okay. Thanks for bringing that up. Okay. And there is a question here about the relationship between Medicaid and then Medicare. For example, this person's. This, this, this, this question is a little bit too personal but can we explain the difference between Medicaid and Medicare. Yeah, do you want to take that. Yeah. With the Medicare that is offered, you know, through seeing by CMS, or through your insurer who has filed with CMS to be able to offer these types of plans to you. As far as with Medicaid that that is also a CMS but it is at the state level, and a state can file that and choose how to administer it in that state because it could vary. I'm not sure if that's the opinion, the opinion upon where you're at. But that would. That's what I know to be the differences. And trying to think of anything else. Those are the biggest income as well. Medicaid income. Huge. That's a driving force of your Medicaid plan you had to be You know, the income levels have to be exceedingly low in order to qualify for Medicaid not working or are not make enough money based on, you know, federal poverty levels, a big thing if we want to be aware of that really is what's the driving force on Medicaid. Awesome. Medicaid plan is different how they administer that different. As if things weren't already complicated. Okay, wonderful. We still have time for questions if anybody else has additional questions that they would like to ask. I know that this can be confusing and sometimes more personalized help is is required and again our financial coaches it's a free program that we offer. And if you want to connect with one of our financial coaches who can either get you connected with somebody else who can help you like a broker, or they can answer general questions that you have. Courtney was there and I would also like people to know that that we have but there's financial assistance for you who are paying for you. I'm sorry, Audrey. I'm paying premiums for their Medicare, like, human health society, they are closed for right now for I'm in release into their plans. And we have financial programs that will reimburse you for your Medicare premiums. So if you have you're paying a lot of money out of pocket for your premiums and you're paying money for your prescriptions. We can help you with a lot of these things and a lot of people say I don't want to do it I won't leave that money for someone else. The reason they have a qualifying qualifiers on there that allow people to participate is because they know that is a group of people who really need it. So don't say I'm not going to apply because somebody else needed and then continue to suffer and pay these thought a lot of this money out of pocket, where we can provide a benefit for you that's going to help you on your financial situation prevent you from being financially stressed. Yeah, great point, Diana. Courtney, were there any closing statements that you wanted to give before we finish today. Yeah, great point, Diana. Courtney, were there any closing statements that you wanted to give before we finish today. Just thank you Audrey for allowing me to come in and anything, if there are any questions that I was unable to answer because I'm by no means expert but I'm very good and have had a lot of experience of researching these things in depth. Diana sits with that. I also wanted to mention, because the open enrollment is coming up. You may also want to check with your agent and I know that we have someone on here to that's asked questions as an agent about you know special needs plans. There, there, there's different types search for diabetes there's dual eligible, and there's all kinds of conditions are for. If you're institutionalized there's one. So you might want to ask about that. You know, if you, when you go because those are tailored to, for instance, like diabetes, they're going to tell is tailored to, let's just say, you get more Lancet's than you normally would on a non dual plan. I mean, not dual but diabetes plan so just, it just enhances it more for the condition that you have. Awesome. Thank you so much. There were a couple more questions asked as we spoke, which is great we have time. So Meg was wondering if we could explain the state ship resources or sh IP. What those are, I'm not familiar with them Diana Do you want to Courtney I think I'm going to pass this on to you. Hello. Hello. Sorry. Can you explain this ship plans. Gosh, I believe it. And I have not worked in that a long time. I just remember there's income levels involved in it. I can't say 100%. And I think it also had to do with. Gosh, children were included in that, but I cannot say for sure in that and, but I, I'm happy to look into that. Yeah, that's something we could do a little bit more research on. Thank you. And then Joe that's question was with employer supplied insurance Medicare part A is a secondary insurance. When would that even come to play would it only be in the event of hospitalization or large, extremely large costs. So, I'm sorry. No, go on. I'll repeat it. It's okay. When employer supplied insurance Medicare part is this secondary insurance would you only use that in the event of hospitalization. Like when would the Yeah, if you have your primary insurance to your employer and Medicare is your secondary Medicare Medicare is only going to play out pay out what your what your primary would pay out anyway. But if you are at the age for you're required to sign up for it, and you're going to get penalized if you don't sign up for it. You need to have it now. If you don't have it, if you don't have part A, and you lost your employment, then what insurance you have, you're going to automatically and be a role in any way if you're at 65. So it doesn't provide any extra coverage financially, it, it generally pays your Medicare at that point will only use the only cup what your primary insurance was going to cover anyway. Is there additional benefit. But again, you're not paying for a premium for part A either. Is that Courtney. I'm sorry, go ahead. Say that again. Was that correct. Was that correct. As far as a Medicare. The termination of benefits that you brought up as far as, you know, when you're through an employer that will come before your, your part A, and, and I think the, the person also asked if it would only apply to, you know, if they were in patient hospital. Yes, because part A is just for your facility inpatient hospital benefits. But I believe you are right, Diana, that they're just going to pay what like the deductible and things that are or I'm sorry, what the, the supplemental or the employer is going to pay. Right. Awesome. Thank you. This has been a great session. I thank you guys for sharing your expertise with us and for the participants for asking your questions. I also appreciate the participants asking us questions that we wouldn't normally normally know and we can do a little bit of research on. It's very rewarding for us to be able to grow and know how to best serve you. Thank you all for taking the time to attend. And, Courtney, thank you so much for being our guest here today we really do appreciate you. We're going to finish with just a couple of outro announcements, and Diana thank you to you of course, for, for your guidance in this in this chapter, and for your presentation today. So as a reminder as you leave the session we would really appreciate you filling out that feedback survey was today helpful. How can we be of better use to you in the future, and how wonderful are these two women that took the time to present to us today. Zoom will prompt you to take that survey, when you leave both the myeloma and a male communities can meet us next month on November 1 as we talked to talk about how to prepare for survivorship financially myeloma or a ml will always bring extra or adjusted costs into your life. Prepare financially to live long term with your cancer, while assessing survivor needs. Then there might be other events might be interested in tonight at 630 pm Pacific is our Southern California regional chapter. So that's why it's in Pacific time zone. We're going to be talking about transforming cancer care with visionary leader Dr. Edward Kim. Then on the 12th is our stem cell transplant chapter we're going to be talking about options for support during a stem cell transplant when you don't have a primary caregiver. And then the 13th at 630 pm Eastern is our northeast regional chapter, we're going to be discussing the black myeloma health initiative, and how you can support locally in your area. I'd like to sign up for any of those events and even more events I haven't mentioned is found at the bottom of the slide, and will be included in our follow up email. Another thank you to our sponsors with some Mary squid GSK genetic, Abby and Amgen, and a big thank you to each of you for helping us build this community. We appreciate you and hope you have a great rest of your day. Thank you everyone.