(Guest Lecture): May 2022 - How to Pay For Expensive Medical Bills Without Going Bankrupt

We're going to be talking today about how to pay for expensive medical bills without going bankrupt. We always talk about toxicity that comes to the physical body due to myeloma treatments and myeloma itself. But something we also want to help patients avoid is financial toxicity. Diana does an incredible job with this, and I'd love for you to share. Diana, why did you choose this topic for today? I think- Hello, can you hear me? Now I can. It just took a minute to connect, but yeah. Thank you, Audrey. With everything that's going on with inflation and with recession, and the normal things that go on in our world, when you have a diagnosis with cancer, you understand that there is going to be so much in your life that's going to be disrupted, and the financial aspect is one of the bigger parts. It doesn't just interrupt for you, but it's for your entire family. I lived it, I watched other people go through it, and as a result, I decided I wanted to give back and help people so that they can avoid some of those toxic horrible areas that you end up in. This is the reason I use expensive medical bills, because you need to be able to pay them and to continue on your treatment. This is one of the big areas I think everybody really need to get a handle on. I try to do our webinars succinctly where one thing flows into the other. Later on in the webinar, I'm going to talk to you about next week, we're going to be talking about appeals for medical bills, and that's huge. You can keep money in your pocket so you can pay the amount that you were actually responsible for and not too much. Let's get on with this. Again, if you have any questions, please leave those to the end. I will answer your questions, and if I can't, I will find a way to get back to you to ask those questions. Some of the things we're going to accomplish today, factors that contribute to the cost of cancer, who pays for the price of cancer treatment, and you'll be surprised at how that works. Who was responsible for what? How to be proactive in managing the cost of your treatments, and where can you go for help? You're going to find there's a lot of resources out there, I didn't even know, that are available to you to help you keep money in your pocket so you can continue to live and take care of your everyday expenses. Next slide. Who pays for the cost of cancer? Everybody does. With the cost of your premiums, with the cost of your copays, deductibles, medicines, everybody pays for the cost of cancer. With increase in health insurance premiums and so much more. However, the burden of cost is not borne equally. Those who carry a heavier burden are patients with lower incomes. You'd think that they would find a way to decrease their burden, but it is not decreased. The less educated, those with late diagnosis, minorities, and the under or uninsured. Those are people who carry the biggest burden because the bigger portion of the out-of-pocket cost, and in some respect, all the costs, they will bear that burden themselves. Next slide. So the out-of-pocket cost nationally, this was done for, I believe, 2020. The total patient out-of-pocket cost was $5.6 billion in our country, and that is not something that's going to go down. That's something that's going to go up. We talk a lot, and I know you all have participated in a lot of financial assistance programs through pharmacies, and there's a catch-22 in anything. As you know, whenever somebody gives you something on the other side, they take it away. You may not see it, but there's other things that can happen in the background that where you are getting a benefit, you think, upfront, and somehow somebody else is not getting the benefit from the same thing you're getting. So that's going to be another discussion at another time, but if you look at this, the $5.6 billion, that is a huge, huge number, and again, that's not going to go up. That's not going to go down. That's just going to go up. So it's going to be very prudent for us to find ways to make sure that we pay only what we are responsible for, that we advocate with our doctors to find ways to mitigate the cost of out-of-pocket, and that we are aware of what our treatment costs are going to be from the jump start so that you can better manage your finances. Next slide. So some of the factors that contribute to the cost of cancer, the cost that you're going to be paying for. The cost of cancer treatment is very significantly from person to person, depending on your insurance status, whether you're insured, very well insured, or partially insured, and the type of insurance that you have. Uninsured patients are responsible for the total cost of their care, and as a result, a lot of people don't get care because they can't afford it. Options available to them may be the Affordable Care Act, Medicaid, hospital charity care, drug discount programs that a lot of people don't take advantage of, even those who already have insurance can take advantage of those programs, or price negotiations for some of your bills. For those with insurance, the kind of insurance and the design are important aspects in determining the ultimate cost for you, the patient. That is the cost sharing or out-of-pocket requirements that you are responsible for. Having the right insurance for your needs is the most important jumping off point. It will determine the rest of your out-of-pocket costs from day one. That's why it's so important to get it right every year. So every year, you should be looking at your insurance and understanding what your projected treatment is going to be so that you make sure that you are in the insurance that's going to best protect you and give you the best coverage. Next slide. Again, some more factors that contribute to the cost of cancer. Your treatment plan, the type of treatment such as oral chemotherapy, immunotherapy, duration of your treatment, the stage of your diagnosis, because generally if you're at a later stage, the cost is going to be more expensive. Choices are lack of between treatment regiments and cost can vary significantly between patients. Again, geographic location. If people are surprised to understand that your cost can vary where you live. It can be different from one side of town to the other side of town. It can be different from one treatment facility to the other treatment facility. In areas that have a high cost of living, generally also tend to have a higher treatment cost. So treatment settings. Costs may differ depending on where the treatment is obtained. It could be a clinic, a hospital, or physician's office. Many hospitals will charge facility fees that increase your overall cost. See if you have a choice as to where you can receive treatment such as x-rays. Lab work. Sometimes if you go to a lab work outside of a hospital or x-rays or bone scans, things outside of a hospital may be cheaper than a hospital facility because you're paying that additional facility cost. Try to get price comparisons before treatment. Make sure your doctors are in network for your health insurance. A lot of people will go from even within their own city, will go from place to place. They find out that doctor's out of network. So the additional cost is gonna be a lot higher because you're not gonna get the coverage. Next slide. So there's indirect costs of cancer which you can forget about. Transportation to and from treatment. Lodging if you have to go down the state. Loss of wages or income if you have to take time off from work, whether it's a short period of time or for a long period of time. And a lot of people don't understand it. If you go on disability for your job, you're still not getting 100% of your pay. You're getting 60 to 66%. And again, it is taxed if your employer is paying for that premium. And then there's secondary effects. You may have additional comorbidities or things that you may have to continue to get treatment for such as diabetes, such as you may need physical therapy or occupational therapy. That's additional costs. That's additional funds out of your pocket. And then there's caregiving costs. In my situation, I left work to stay home with my husband to help take care of him for several years. And that's a huge cost. It's a cost you don't understand until you're in it. You're no longer saving for retirement. You're no longer had that additional income coming in. And then your other costs from your spouse's or the person who's your patient, their costs have increased. So your overall standard of living can be greatly reduced if you don't manage the costs of your care. Next slide. So some other types of cancer costs include, in addition to common approaches to cancer treatments, additional treatments such as stem cell transplants, blood transfusions, immunotherapy, mental health services, nutritional counseling, cardiology, nephrology, and other consultations may be necessary as a result of cancer. At one point in my husband's care, he had five different specialists. And later on there was even seven and they were sometimes in a room together consulting. So it could be very, very costly. So be aware of the other specialists may come into effect if you end up with kidney problems, may have a nephrologist, if you end up with infections, you may have an infectious disease doctor. So there's a lot of specialists coming in which means there's more money going out to specialists and specialists are costly. Because of the complexity of cancer treatment and the necessity of multiple specialists, this remains one of the larger drives of cancer patient costs that we need to be aware of and anticipate and be aware of so we can manage those costs. Next slide. So survivorship costs again that I mentioned, even when a person has completed their treatment and they're in remission, there may be ongoing costs. They may have to go to a physical therapy facility for a period of time, or they have long, long conditions such as neurophobia where you may need additional treatment for that. So many cancer survivors deal with cancer symptoms and side effects of treatment months to years after finishing treatment. So if you were in maintenance or if you're fortunate enough to have not take any medicine for a period of time, you may still have some of these lingering symptoms. So maintenance drugs, even in low doses can be very expensive. As you know, Revlimid, even as a low dose, doesn't matter, it's very expensive. As well as the cost of care for neuropathy, drug-induced diabetes and rehabilitation such as physical or occupational therapy, these things can continue for years. So be aware of those costs. Next slide. So cancer treatment is expensive, everybody knows that. If you've been treated for over a year now, you're probably using Revlimid. It's one of the costiest medicines when it comes to myeloma. In addition to other treatments such as CAR-T treatment, it can be over $28,000 a half per year, I apologize, per month. So you can understand how costly that is. Even the new generic linolinamide, which became available to a limited degree in March, is costly, it's approximately $24,000 a year. So 28 to 24, it is expensive, it doesn't matter if it's 28, 24. The cost is still ridiculous. Then there are other treatments, including like I said, stem cell treatments, which can be expensive and it can vary depending on where you are in the country. CAR-T can be upwards of $400-some thousand just for that one infusion, and it doesn't include all the other costs associated with it. And I was, to my understanding, the cost for CAR-T with all the ancillary costs associated could be well over a million dollars. And there's other things as well. Travel to medical treatments, loss of income or loss of insurance, lack of income protection programs. And some of the things people are not aware of, how important those are if you are working and you have an employer program, benefits that carry disability insurance, and insurance, your income protection, you really need to participate in those programs. Lack of financial education or experience and lack of access to financial resources that can help with the cost of treatment. And this is what we are trying to make available to you, make you aware of what those financial resources are for a variety of different treatment costs or ancillary costs associated with them. Next slide. So chemotherapy, make sure you have the right insurance. If not change, if you have the option to do so, Medicare included, look at those plans every single year because they do change. And you may find yourself in a plan that's not gonna give you the best coverage or the best cost. Choose in-network providers and make sure if you change providers, if you add a specialist, that provider is in-network or you're gonna end up incurring additional costs. Plan for out-of-network visits and see if you can have those taken care of. You can petition to your insurance company if that particular specialist is not available to you where you live, they can look at those things separately. Call your insurance provider to see what's covered before you get the treatment. Make payment arrangements, seek out financial assistance for travel, lodging and needs. And we do have those posted on our Health Tree website. Get a full list of your treatment needs. Call your insurance company to see what again, what's covered. Call pharmacies in advance to make sure that your medicines can be covered and find if there's additional ways to get it cheaper. Perhaps a mail is cheaper than getting it monthly from your pharmacy. Shop around for the best price. Take advantage of prescription cards such as GoodRx or Needy Meds. Sometimes these cards will take care of reduced costs and sometimes it's better than your actual insurance coverage. Make sure they've run those before running your insurance. Next slide. Explore alternatives. Ask your doctor about substitutions for your treatment that insurance is more likely to cover, especially for those things like diabetes, neuropathy, all these other things. And then ask for biosimilars. There aren't a whole lot of them out for some of those really expensive drugs like irreplenet. One just came out, but it's still, I gotta say it's very similar in cost. But ask if those things are available. You'll never know unless you ask. Check to see if you need pre-approvals. Here's a big thing that a lot of people get hung up on. Sometimes they wait for their doctor to be pre-approved as the time goes by and the doctors are assuming that you're gonna take care of it. You need to know your insurance in and out to find out what needs to be pre-approved and what doesn't. Because it's not only the cost out of pocket money, monetarily, the cost of your treatment, but time is very expensive too. You can't make delays. Sometimes it may take a while for your pre-approval to come back. Make sure this is done ahead of time. Pay your health insurance premium. Failure to pay can cause a lapse in insurance, leaving you uninsured and paying for the full cost of your care. A lot of people don't understand that if you go on disability for your job, a lot of times you are now, although they may not be pulling out your insurance premium, you are still responsible for paying that premium. You don't want your insurance to lapse. Then you're gonna have a huge problem. Keep track of all of your bills. Get help organizing bills. Ask for a friend or a family member to organize those bills. Organize your evidence of benefits, your EOBs that come in, so you can match those things up. And if they are not correct, always question, especially if you've been in a hospital for a period of time, a week or more. Because a lot of the bills, over 80% of medical bills are incorrect. And if they're incorrect, it's usually on the benefit of the hospital. I've said this many times before, but less than 2% of medical bills are actually appealed. That means there's a lot of money that's going out of people's pockets that really should not be going out of their pocket. So make sure you look at those bills, make sure they are correct. Question them, get receipts, get itemized bills and talk to your insurance company. Seek help with inaccurate ones. There's a company called Co-Patient, and they will help you with any bill, any and every bill over $500. You give them a copy of that bill, they'll run with it. Sometimes there's free, depends on what kind of offers they have. Other times there's a small fractional cost you have to pay to make sure this is done, but it is well worth that little bit of money. Seek financial assistance. Get help with co-pays, premiums and deductibles. A lot of people are aware that there's assistance for a lot of people, depending on what your income is, that can help you get refunded for your premiums, even for Medicare premiums. So seek those out. Again, we have a lot of these resources available on HealthTreat in our financial section. Next slide. So know the cost of clinical trials. Is that something you're considering or it might be in the future, even if you don't think you're eligible for one now, make sure you understand how clinical trials work. If you're considering it, get ideas of the cost and find out how it can be covered. Go to www.cancer.gov always, and also call your insurance provider. Do you know things that may be coming up? Talk to your doctor and see if it might be something you may be eligible for. Then find out the costs ahead of time so you can be ready to go. Learn about payment options for medical bills again. Learn about payment plans, reduced rates, payment assistance programs and help from charities. A lot of hospitals have charity programs that you may not be aware of. They'll also should offer you payment plans where you can pay a small amount so that you can stay in good faith with them so that you can continue to get your treatment. You don't wanna be cut off with your treatment facility. Request to have a case manager at the insurance company to assign to you that way. I'm telling you, we spend, there's millions of hours that were spent every year just talking to health insurance companies. And if you've called, you understand how you might be assigned to one person, to the other person, to the other person. If you have a case manager assigned to you, that is the best position you can be in because you don't have to repeat your story over and over again. They will have a written dialogue of what you spoke to them about, the time and what the status of everything is. Always ask for a case manager with your insurance company. Know the details for your home care before you leave the hospital. If you're gonna have a nurse for a period of time or occupational therapist or physical therapist that's gonna come into your house, find out the cost of that before you leave the hospital. Find out the times, the dates, if you need assistance, additional prescriptions for your doctor to get help at home, such as a raised toilet seat or grab bars or things like that. A lot of those things can be written off through Medicare. So make sure those things are taken, are managed in advance of you going home. Ask for help with travel costs. A lot of resources out there, such as looking at the Phoma Society will offer help you with travel costs or getting your medical care. Be aware that a lot of these resources are used up sometimes during the year. Keep checking back because sometimes they are refunded. Ask for help with those travel costs as well as for lodging, for food, because sometimes they'll cover some of the food as well. For you to contact National Center of Institute Cancer Information, service at 1-800-4-CANCER, and there's a lot of information for you there. Next slide. So look at online tools for help managing your money and budgets. Go to benefitcheckups.com. It can help you with budgets, and I've done a budget webinar before. You can go online or ask for information about those other seminars I've done. There's also sheets, budget sheets, so you can start understanding how to budget, calendars for your medicines, so you can understand where your cost is going and when that's being pulled out of your funds at home. Get emotional support, right? Cancer is a very emotional illness. And if you're on some of these chemotherapies, everybody's aware of chemo brain. It's very, very stressful. And if you have all these other things to worry about, like work or not working or children in college and all the other things that go along with living, seek out help. Don't wait until you're in crisis to get help. So stress can affect your physical health, and guess what? It means there'll be more costs out of pocket because it can affect your heart, it can affect everything. Please reach out to cancer support groups. They are invaluable to support you because they understand what you're going through, especially if it's a myeloma group. They understand myeloma, they understand treatments. They can even give you advice as to doctors or how they are managing treatment. Look for ways to ease everyday tasks. Ask for help, ask for neighbors. I was surprised at the neighbors who were willing to step up and take care of our animals, our pets, when we were at the hospital, or to drop us food that we just did not have time or the energy to cook or to clean the house or to manage our yard. It's invaluable, it takes a lot of stress off of your shoulders. So ask for help with somebody getting your groceries. You can have groceries delivered, which is something that was not very big when my husband was ill, just a short eight years ago. But be more efficient with your time. That time gives you more time to focus on your health and to get better. Seek help for your family, neighbor, friends, and church community. You'd be surprised how many people are willing and want to help. Next slide. So again, there are many financial resources for patients. These include nonprofit organizations such as Leukemia and Lekoma Society, HealthWell, Cancer Cares, Patient Advocacy Foundation. There are quite a few out there that can give you help should you need it. Pharmaceutical financial assistance programs, depending on what your drug is, you can call them and your income. Even those people with Medicare can a lot of times get help with pharmaceutical programs. They think they can't, but you can. You can get help with travel, with lodging, utilities, food assistance, and more. You can also find local, state, and federal help. Additional assistance could be found for medical appeals or reduction of bills. Seek copatient.com is one I talked about earlier. There are a lot of financial resources with types of assistance on our website. Visit the financial and helpful resources on Health Tree and request a financial coach to help you through some of the specific issues you may have. And I want you to understand these financial courses, our coaches and all the coaches who help through, they are free. And it's not just a one and done. If you need help over a period of time, more than one, it doesn't matter. We are here to assist you to make sure that you get stay on treatment, to help you become your best advocate so that you can get the best outcomes for your health. So I think that brings us down to the end of this webinar. I would like to open this up for questions. I know this could be very convoluted, could be very difficult to understand, but trust you me, financial coaches, all of the coaches on Health Tree, whether financial or not, if they want to help you with stress, we are here to help. This is something that's in our heart, is in our souls to help. That's what we are here to do. So how can I help you with any questions? Thank you so much, Diana. Thank you so much, Diana. And yeah, just a reminder, if you want to enter in your questions at the bottom, there's that Q&A icon. If you click it open, you're able to type in your question and ask. And I think one of my favorite parts about your presentations, Diana, is how detailed you are in the slides, because I always look back at your slides and apply them. Those slides are going to be sent out to each of the registrants, even if they're not watching here live. So I just wanted to make you guys aware of that. And again, I'm kind of jumping ahead, but Diana mentioned next month, we're going to be doing an interactive workshop. We'll actually be able to see each other in this informational session. And we're going to be going deeper into that medical bill appealing, co-patient.com, that kind of thing. So I'm looking forward to that as well, especially after our discussion today. No questions so far, just a couple of thank yous in the chat for an excellent presentation. You really did do such a great job. Mary is asking a question. How much of the financial assistance is based on income or savings? I have money in savings that I need to safeguard and don't want to have to spend it down in order to qualify for financial support. Well, savings, I have never had them ask how much you have in savings. Generally, a lot of them will ask about your income level. They want to find out where you are in a federal poverty program. But even then, if you go to some of the pharmaceutical assistance programs, they're basically asking, they're going to ask some of that, but there's a lot more leeway with that to help you. They're looking at how well insured you are. Now, if you go through things like Ukiim and the Fund with Society, Health Well, they will ask about your income levels. And they're pretty general across the board. But then there's other resources we can look at as well. So don't give up on the fight. I mean, there's things you could, especially if you're going to be taking time off, they can ask, do you think your income is going to drop significantly this year? Is it different from last year? So there's a lot of things that they will take into consideration when you're asking for financial assistance. But savings, they never ask how much you have in savings. Yeah, something I was going to mention too, there's been so many couples that I've known that said, I didn't think we would qualify. I had no idea we would qualify and now look at us. Like we're getting support that we need. So even if you are, even on the upper end of income, then the average, not upper, upper, we're not talking to Elon Musk here, but there is, you don't have to pay what you've saved up in medical bills. I mean, there are programs out there to help us. I just wanted to encourage people. Yeah. Ida is wondering- Always better to ask, I'm sorry. It's always better to ask than not to ask. But the worst thing you know is, no, I don't qualify, right? And even if it's something as simple, sorry to get us off track a little bit, but something as simple as someone was able to get their cable bill reduced because they were older cancer patient. Like there are programs that we're not even aware of really, and the general public that can help save money. Anyway, it's just beautiful. I think it's beautiful what you're doing because again, we just, we care about carrying myeloma, yes, but we also care about improving quality of life. And that includes avoiding at all costs, financial toxicity. Obviously I'm very passionate about this. Very well said. Ida is wondering how far back can you appeal for financial assistance? Can it be backtracked? Normally not. Normally you're gonna be paying for something during the year that you received it. There are however, some programs where you can go back maybe a year and get refunded for some things. I'll tell you what, there is a financial coach that we have, Patrick Kelly, who is very good with that, going back further and getting additional funds. So please get online and reach out to him, ask for him, because he can answer some of those questions. He can actually walk you through it. He'd be glad to talk to you about that. He would, he's awesome. I'll make sure to include that in the resources email as well. I'll just call it like maybe back pay reimbursement. I don't really know how to say that. Reimbursement, I guess, I don't know. All right, another patient is saying they are on disability and on husbands insurance, which covers almost everything. Is it worth applying to Medicare at this point, or should they stay on husband's insurance as the primary? Very interesting. We've got a, it's a very broad question. Yes. It depends on what his insurance is to your husband. And if you are eligible for Medicare, it's always your advantage to sign up for Medicare when you are originally eligible, because you may be forfeiting some other options such as, you have to get on Medicare part A, but if you don't get Medicare part B, depending on what the insurance is with your husband, you may be end up paying a larger premium for that forever. You need to check with that, your husband's insurance company to find out what they require. You don't want to go past that and end up not being able to get like Medigap plan where you get guaranteed issue. So there's a lot of things you need to be aware of. If you go into medicare.gov, it will explain some of these things to you, but you still need to reach out to your husband's insurance and find out what their requirements are. You need to make sure you have creditable insurance. And a lot of that is based on what type of insurance your husband has, if it's a retirement, retiree insurance, that isn't, or it's a COBRA, it's not necessarily always considered creditable insurance. Right. And I think too, this would be a good situation. If you wanted to talk it out with somebody, a financial coach, their free services would be a really good thing to take a look at. Because there's a lot involved with everybody's situation and with different insurances and your age and disability. There's so much involved and it's very specific to each individual. So we can help walk you through that. Yeah. Someone else is asking, in addition to their myeloma, their partner has an expensive chronic disease. Do any foundations take this into consideration when you're seeking financial assistance? Well, not necessarily. They don't ask about your spouse's other chronic disease. However, your spouse with their chronic disease may be able to find assistance through organizations that support their illness. That might be a benefit to you. I think there might be a little misunderstanding even in my part. Is the financial assistance, let's say, from the LLS, it's not that they have tons of... It's not like a scholarship. It's not like there's a lot of people applying and then they choose the best ones that they want to sponsor. Right? It is, here's our funds. If you apply, we believe you, we trust you. And do they get vetted? What's the process there? Do they get vetted? Do they choose certain people over others? Like, what is that? It's a fairly straightforward process. If you call LLS and call or get online and fill out the application, LLS offers grants, and it's not repayable. You don't have to file for your taxes up to a certain amount. I believe it's $11,000 this year. And this is just for financial assistance, help for copays, deductibles, premiums, things like that. And what they'll ask is what your income is, and they'll verify your income. And they'll ask you, are you in current, are you in active treatment? And they'll verify things with your doctor. They will ask you, if they can't verify on a... I don't know how they do that. I guess it's almost like a credit thing. Find out what your income is, and they'll ask you to support, give them supporting documentation with tax returns. And they'll give the information to the doctor. There's a form the doctor will have to fill out to verify, yes, the person has myeloma, yes, the person's under treatment. And that's how they actually do it. And almost all of the nonprofit organizations like LLS, HealthWell, they all do the same thing. It's basically the same thing. And they'll give you either a card, a card, so that you can pay those, pay for your premium, your deductible things that way. Or in some cases, you submit bills, pay bills or bills to them, and they will be paid, depending on who you're going through. OK. Does that answer the question? Yeah, no, that's good. It wasn't anybody's... It was my question. Carrie's wondering, what are the services that these myeloma financial coaches are offering? Is it possible to talk to somebody to decide which Medicare insurance would be best for me personally, or is there a different counselor, a different resource that she could be using in order to find out what the best Medicare insurance would be? Well, we can help walk you through, but when it comes to the best, every state has different insurance companies that are participating in a Medicare program. And it depends on what your... It's a lot. If you call a broker, there's Aon. We have those listed on our financial resource page that can help walk you through the insurance and they can actually ask you, what are your medications? All of these things, what kind of treatment do you have? What doctors you go to? Because we want to make sure they're all in treatment. They can help you pinpoint the best insurance with you. They'll go through Medicare Advantage. Now, Medicare supplement plans are not part of the... There are Medicare approved plans, but they're not through like your Medicare.gov sort of area. But there's a broker, there's brokers that can help walk you through the best insurance for you, for your coverage in your city and your state. And it varies. And it'll vary every year. They may add or delete or drop. And that's why everybody needs to check those things every year. Yeah, I was getting the link so that we could send that in the chat or in the not the chat, but the answers to the... It's... How would you say that? Retiree? Retiree. Retiree.aon.com. Anyway, it's there for them. It's hyperlinked so people can click that if they're interested in looking at that. That's a great question. And you can also reach out to us and we can help direct you through some of those things. Yeah, definitely. Yeah. What does it mean when you've met the annual catastrophic max with your insurance? Well, if you like your max deductive amounts out of pocket, is that what we're talking about? I'm not sure. All I have here is annual catastrophic. If you've reached your max out of pocket, if you've reached your max out of pocket, that means your insurance now should be picking up everything. Now, we're only talking about if you're talking about just for medical expenses. That doesn't necessarily mean for prescription because lifetime your prescription plans has their own deductibles. Oh, gosh. Yeah. And with how expensive things are, it's ridiculous. OK, another patient that's navigating the confusing world of Medicare. And... Let's see, this is a little bit longer, so I'm trying to be condense it a little bit. OK, I'm being told that under Medicare, I can expect my out of pocket to be over one thousand a month. I'm reaching out to Bristol Myers Squibb for financial assistance, and they have a form for my doctor and myself to fill out and send them. But my doctor says they won't fill it out until they find out on my first month how much my out of pocket bill is. Interesting. Do you have any experience or information about these types of programs? I think the pharmaceutical assistance programs. Yes, they will send that form to the doctor. I'm just surprised the doctor is... I would appreciate if you could reach out to us, because that sounds like a specific situation. And I don't... Need to clarify what you're actually asking. Something just doesn't seem right, because usually it's a doctor. The doctor just fills out, yes, you're... You're under treatment, what your treatment is, and what the medication is. So you can... So the pharmaceutical company can verify that. Or even the non-profit can verify that. Usually they're not saying how much it's going to cost. The doctor usually doesn't get involved with the cost. They just know what treatment is. OK, I'm typing in how they can find you on the My Alarm Coach website. They can request you to be... Make sure you're on the My Alarm Coach website. Make sure... So there's two buttons, by the way, on the coach website. There's send message and request to be a coach. Our notifications have been weird and not giving us notifications. So I highly recommend just requesting to be the coach instead of sending a message, because otherwise sometimes they won't see the message. So just so you guys know, when we're talking about finding a coach, request somebody to be your coach so that they can get an email triggered and reach out to you. Awesome. OK, this is a great question. How do you assemble a budget when you're not aware of the treatments that will be needed year to year, or you're not sure whether or not you'll be able to stay employed just due to being able to physically keep up with the job? I didn't hear the last part of that. Oh, how do you create a budget without knowing what medications you're going to be on and without knowing what your state of employment will be? I understand that. So I think in any situation, we should all have a budget because you know you have expenses going out, money going out. And if you already know what you currently have, what your what your leeway and spending is, that's going to help you make decisions about your treatment or biosimilars or seeking financial help. When you find out what your financial health needs are, when you find out what your treatment is going to be, even when it changes, because budgets can change. They change. They need to change if you have additional costs associated with them. So when you know that, you're better able to manage everything that comes after that, whether you're going to be leaving work and need to find additional assurance or end up on COBRA or all of those. You need to have a baseline. It's like you go to the doctorate, and they get a baseline in your health. You need to get a baseline in your financial picture. And everyone needs to have it, whether you're ill or not, so that you can better maneuver your financial world and manage that. Yeah. I'm making a note to include. I'm also reading the questions at the same time. I see lots of people asking questions. I'm reading the questions at the same time. I'm also reading the questions at the same time. I see lots of people asking questions about Medicare, even about estate planning and trusts. I am going to be asking you those questions, but you can answer them briefly because I will be including as well. When Diana went way more into depth on these subjects, I'll be including those recordings in that follow-up email as well. We had two whole sessions at the end of last year about Medicare. We had a Medicare informational session. And then we had a Medicare question and answer session that answers a lot of these questions. Not saying they're not important to be answered right now, but she can go more into depth later on these questions, as well as the questions about estate planning and trusts and wills and things like that. Okay. So Cindy's wondering if you find yourself moving to a different state and have a Medicare advantage plan, how does that affect insurance choices? Well, first of all, you need to notify Medicare that you've moved. And then you get a, a different, a special enrollment period possibly to get into the insurance programs that are in that state. So you will always be a network. So the first thing is to find out if you know ahead of time, that you're going to be moving, find out what that state offers. So that you won't end up going there out of network, paying for out of network. So you won't have the additional costs out of pocket, but. Yeah. Call, call Medicare and they'll tell you what you need to do. Yeah. Awesome. Thank you. Cindy's wondering if you have any advice for people who are looking to get a better education. I think it's important to know that you're going to be doing a lot of things. So you're going to have to be really, really careful about what you do. And then you're going to have to be really, really careful about what you need to do. Yeah. Awesome. Thank you. Cindy is wondering, you know, kind of the difference between Medicare advantage programs and traditional Medicare. Would you recommend one over the other? Traditional Medicare is your Medicare part. A and part B. Those are your traditional programs. Now, as you know, there's this, this, you may end up with a hole or you may not have all the. The things you need. Medicare advantage. Helps cover a lot of things that aren't covered. And then there's a lot of options. And then there's a lot of options. And then there's a lot of options. And then there's a lot of options. Through your regular Medicare part, a and part B. And then there's additional Medicare. A Medicare. Programs that also gives you additional coverage. Medicare advantage may have a part D, which is your prescription plan associated or attached to it. Or you may have a standalone party. So there's a lot of options. And it depends on what those Medicare plans that are offered in your state. What they cover and the cost, because the cost can vary. But the cost can vary. And the cost can vary. Between the insurance plans because they manage to call. So those. Of those plans. But Medicare part A and part B is just your baseline tradition. Baseline Medicare plans. Those years are traditional. Awesome. Yeah, it's a compliment. I liked what that patient said earlier. It's a complicated world. Really is. I think, you know, I think that's a good point. I think that's a good point. I think that's a good point. And then there's the financial coach. You mentioned the Patrick Kelly was really good at kind of reimbursement. Is there a financial coach that assists with trusts in particular that you would recommend? No trust. There's so many different types of trust people to understand. Trust. I don't. And we just go over basic. Assets and how you can title assets. And I think that's a good point. I think it's important to look at the real estate. The real estate that you're in as well. What their state laws are. To seek a trust attorney. Now, does that mean everybody needs a trust. Everybody thinks. No. You don't. It varies on how, what your, how much assets you have, what type of assets you have, you get real property in and out of the state you live in. answer a lot of your questions because it's very, very important. If you have assets, they'd be protected. If you think at any point you might end up in a nursing home or a spouse in a nursing home or get other people you need to take care of. If you have a dependent, a child is dependent on you, maybe dependent even as adult, there are things that you need to do to set up and trust, protect that, protect you and protect that person. So that is when you need to speak to an attorney. Okay, very important. This person, yeah, this person was specifically, they clarified irrevocable trusts is something that they're looking into. So that's a good recommendation. Thank you. Now, if you're talking about just regular assets, I work, I currently work with an attorney and a state attorney with a client who has assets that are putting in trust and we've been doing for a specific reason. But again, there's an attorney that's involved to do that. Yeah, there's echoes that yes, it's a great idea to have a trust presentation. So let's let's make that happen. That's exciting. So a follow up question from before when they were talking about moving states with a Medicare Advantage plan in the original state, but when they move, are they able to just change to that traditional Medicare or is it only the first year after qualifying for Medicare? No, so Medicare Advantage, you can change anytime during the year. Could you change it to Medicare Part A and B though? Part A and Part B you have to have before you get a Medicare Advantage plan. Part A and Part B is your traditional plan. You have to have that before you get the Medicare Advantage plan. Okay. Are there any Medicare policies that cover travel flights and rental cards, lodging, etc. Or is that only through financial assistance? I'm sorry, can you repeat that again? Are there any Medicare policies that cover travel like flights, rental cars, lodging, etc. for people that live outside of or don't live near medical facilities or is that only through financial assistance? That's through financial assistance. Now if there's an emergency that comes up, and say you're in a hospital, they transfer you to another hospital. Sometimes those things we take care of through Medicare, but be aware those costs could be in hundreds of thousands of dollars depending on where you're going. I have heard some people, Medicare will say we're going to help you, but you end up they only pay a percentage, a small, small percentage of the point and you're stuck with the rest of it. But I encourage you to always look on our resource page to find out for travel lodging. American Cancer Society is huge. They can help you with lodging. They can put you up in really nice places depending on where you are. It's unbelievable the resources that are out there. There are, it's called Flight Angel, there are pilots who own their own planes. And a lot of times they will volunteer their time and the gas and everything there to fly you from one state maybe to another state. Or there'll be ground transportation to help carry you from one place to the other, from one part of the city or one part of the state to the other part of the state. But there are a lot of resources that are on our Health Tree website on our financial resource page for you to look at for all of those things. Utilities, help, where to go get help for utilities, food, and all those things. I put that link as an answer to the question there. I put the link to our website and the financial resources that are there because there really are some great ones that you've compiled. And just a couple other thank yous for a great presentation. This was really well done and quite understandable and I'm excited to be able to review it. You're welcome. Thank you so much. We do have time for a couple other questions. But if I think if people are good then let me start with just some closing announcements and if we have a couple more questions by the end we can get to those. I would love for you to join us next month. It's going to be June 7th. We meet the first Tuesday of every month at 1pm Eastern. And you can join us for that workshop that I was talking about earlier about how to appeal medical bills that are incorrect or inaccurate. It happens more than you think and I think this is something that I've learned lately with Diana. I had no idea before that medical bills could have such a high rate of error but there are organizations dedicated to helping you appeal those and fight those and we're excited to learn more with Diana in that interesting way to save. And you may be interested in other myeloma crowd community events we have coming up on the 4th at 7pm, aka tomorrow, is our health tree moves for myeloma chapter. That's our fitness chapter and our chapter lead, Linley Sweeney, is going to be leading us in Pilates and explaining how Pilates can benefit myeloma patients. The fifth we're going to have our Spanish speaking chapter meet together and we're going to be talking about Entiendo Tus Estudios de Mi Aloma or in other words, understanding your multiple myeloma labs. And then on the 10th at 7pm Eastern is our Southern California myeloma community chapter. Actually that's not 7pm Eastern, that's something that I'll need to correct. That's actually 6.30pm Pacific. That's something that was my error, I apologize. But we're going to be talking about emotional aspects of myeloma. May is Mental Health Awareness Month and we're going to be talking about information for patients and their loved ones that's important to know about how to deal emotionally with myeloma. The link to sign up for any of those events and even more events I did not mention today is found at the bottom of this slide and will be sent out in the follow-up email along with the other resources that I've mentioned throughout this presentation. Before we finish up, I just wanted to make sure where do we find the chat and Q&A when we receive the recording? I don't know what you mean there Cindy. I don't really usually share the chat or the questions when I send out the recording. If that's something you're interested in, you can definitely email me. And then Diana, there was one more question if you're okay to answer that one. They said, if a combined Medicare and Medicaid dual plan is available, do you know if this type of plan is beneficial? It's on a situation. I know people who are on Medicaid, Medicare and all states don't have those combined plans. It depends. That's a question that you need to be aware of what's going to be available to you in that state, what your coverage is going to be, what your treatment plans are before you sign up for something, you find out it's not something you need or it depends. Okay, good question to contact you guys about then. Right, love it. Okay, awesome. Thank you to our sponsors, Bristol Myers Squibb, GSK, Genentech, Janssen Oncology, and Abbey. And a big thank you to all of you for helping us build this Milo McCloud community. I really appreciate you. Thank you for your questions. Thank you for your support and I hope that you have a great rest of your day. Thank you everyone. Thank you, Diana.