(Guest Lecture): The True Cost of Blood Cancer and How to Pay For It (What Newly Diagnosed Patients Need to Know)

pleasure to introduce Diana to you. Diana is a myeloma coach who specializes in financial help for multiple myeloma patients. As a professional financial consultant and former caregiver of her husband who was diagnosed with multiple myeloma, Diana perfectly understands the financial issues facing myeloma and other blood cancer patients. My Diana's new title is the financial program manager and we're excited to have her in our team. The time is now yours to talk about why the true blood of the true cost of blood cancer and how to pay for it was the topic that you wanted to deliver today. Well thank you for the introduction and thank you for everyone who joined. This topic, financial topics, are very sensitive to a lot of people. You don't like to discuss them. Doctors don't want to ask the questions but it is so pertinent that you need to understand what's going on every step of the way on your cancer journey. And for those people who are newly diagnosed, you have an opportunity to really get a grasp on where you are now financially and how are you going to manage the cost of your treatment because it's not going to go on, go down. The cost of that treatment is going to go up and the shared burden from insurance companies that's going to go up as well. So we're going to go over stages of cancer, we're going to go over a lot of things I think you really need to do. In addition to that, our webinar for financial, the financial webinar in March on the 4th will be regarding for the newly diagnosed, we're going to have a workshop. In April, I'm sorry. We're going to go over, I'm sorry this is March, March 1st. We are going to go over documents that you are going to need. We're going to go over things that you need to ask the doctor, things you need to look for for your insurance, look over estate legal things you're going to need and you need to work with AML or appeals for insurance. We're going to go over a lot of things and I really encourage everyone to sign up for that, go online. We're going to have them up on the next week or so, the documents so you can go on and download those documents. So I look forward to seeing you guys in April. The reason I chose is because cancer is so expensive. It's going to cost you for not just direct costs, there's a lot of indirect costs that you're going to come into, it's going to come into play. You're going to realize things sooner than later. That's why we need to go over these things now so you can get prepared. Next slide. So things we're going to cover is understanding what makes blood cancer one of the most expensive cancers and one of the most expensive diseases. Identify the different stages of cancer treatment costs, how to be proactive in managing your care from diagnosis and that is going to be huge. Hidden costs, just waiting to take you by surprise and there are going to be many of those and it is not just about the dollars. There is additional costs that you and your family may incur. Treatment will cost more if you do not speak up. So the sooner you speak up, the more manageable it's going to be. Then there's steps you can take to manage the cost of your care and we're going to go all over all those things and again in April the workshop will help you with even more. There are staggering numbers in the cost of care. Approximately 5% of the United States population or 15.5 million people are cancer survivors. That's a lot of people. Now when you're a cancer survivor, that means a lot of times you're on maintenance treatment or so the cost of treatment is going to go up and the longer we're living, that lifespan will increase so you're going to be paying more for cancer and coming in and going out. Cancer is the second most expensive disease in the United States. Maybe I'll just want to express how important that is. Estimated health care costs of 124.6 billion in 2005 is a huge number to 157 billion in 2020. According to the national cancer, they now suspect that number is going to be higher. Now in addition to that, in 2020 we know COVID hit. 2021 deep into COVID and then the first part of 2022. There's going to be another epidemic and that is going to be people who did not keep up with their ongoing care, preventive care and there's going to be people diagnosed with possibly late stage, later stage cancers and that's going to be expensive as well. So I encourage everyone, if you've got behind on some of your preventive care, get caught up. It's very, very necessary. So these numbers are expected to increase significantly by 2030 up to 34% higher than that 157 billion. The cost of treating leukemia alone is projected to increase by 49%. 8.7 billion to 13 billion. So those are huge numbers. If you break that down, it's for the cost for your first diagnosis, but you have to do your first diagnosis to your treatment, your treatment phase and then later on there's the other stages end of life. We're not going to cover it now because you're in treatment and a lot of these diseases are becoming, or cancers are becoming chronic. So we're going to look at those first two phases. Next slide. So with the inclusion of new novel drugs, which comes at a very high price and the reason they're high is because drug companies are trying to remake some of the money for all of the research and putting those things out. The cost of patients as well as the diagnosis of cancers and patients at an earlier age, even the more recent analysis, the overall cost of treatment may be low, especially since late stage cancer diagnosis presents with more costs of care in regards to hospitalizations and possible other comorbidities. When my husband was in a hospital, he had, there were five or six specialists he had. He had a neurologist, he had a nephrologist, he had a cardiologist, infectious disease doctor. So there's things that may come up in your care where you're going to find higher costs at different times. You're going to have a younger newly diagnosed, the lack of savings, the lack of health insurance or being underinsured as well as other outside costs may present with additional financial burdens. The inability to continue to save if you take time off from work, if you have to retire early, additional costs of care if you're not Medicare age. So there's a lot of things that need to go into play when you're taking care of your cancer care and then your normal everyday things you need to do for your family. Additionally, the overall maintenance cost of treatment phase may be quite longer that I mentioned earlier than those who are diagnosed at an older stage. Next slide. So the cost of cancer is a moving target. It depends on when you were diagnosed, what kind of new novel drugs are out, what kind of treatment your doctor suggests is best for you. In 2020, the American Cancer Society predicted 40.1% of men in the U.S. will face an invasive cancer in their lives. According to the American Society of Clinical Oncology, 60% of cancer patients are 65 years old and older. However, we all know, and some of you may be in this audience now, that there are people who are being diagnosed with cancer at younger ages. I have run across a 16-year-old person with myeloma. That's staggering. I've known people in their 20s with myeloma. That is staggering. So the cost of their care is the novel agents, they may be living longer, but their treatments, the cost of these novel drugs are very, very expensive. So their burden, the cost of burden they have to pick up is going to be extremely high in addition to the other things we mentioned. Maybe taking time off from work, not being able to save for retirement, all these other things, these other costs come into play. Next slide. So what are those drivers in the cost of cancer? Do you have highly trained specialists? And because they train, they're so highly trained, they're going to be compensated for their knowledge and for the risk they're taking. There are specialized treatment facilities, and you've seen cancer centers seeing a pop-up so much in the last five, 10 years. Every hospital has them, they have outstrips of them. So there's overhead calls that have to be paid for, and the highest, the really good equipment that's in those things have to be paid for. Medications, novel medications, we know how much Revlimid costs, Velcade, and some of the medications for AML. These costs of drugs are unbelievably expensive, and the longer they stay as novel drugs and not generics or biosimilars that can be used in place of them, they're always going to be high. New novel treatments like CAR T therapies, and there could be more coming out, those things are expensive. We'll go over the cost of those a little bit later on. Next slide. So there are human obstacles that affect cost and treatment outcomes, and I have to tell you, a lot of these things are, we need to put the onus on ourselves to overcome a lot of these things so that we will find ourselves stuck in something that we could have put in it. A lot of doctors, over 80% of doctors do not ask their patients, are they, can they afford the care? They will write the prescriptions, they will tell you what kind of treatment, but a lot of doctors don't feel like it's their responsibility. They are now beginning to realize how important it is because there's a lot of non-adherence to treatment. Three in 10 patients will say that they are not taking their medications as prescribed because they can't afford them, but did the patient ask? No, the patient didn't ask, the doctor didn't ask if they can afford them. So these are things, obstacles that we need to empower ourselves, ask the doctors every step of the way, how much is this going to cost, are there alternative treatments? So why don't patients ask about the cost of treatment? Well, we've always been told in our society, talking about money is something you just don't do, and so it's become very ingrained in who we are to don't talk about money, but in the situation where you're talking about a life and death situation, the ability to treat yourself, the ability to continue maintaining the care for your family, we all have to ask about the cost of care. It doesn't matter if it's cancer or if it's diabetes or high blood pressure, we all need to ask about the cost of care. We need to ask it until we understand what we're dealing with, and then we need to find out what alternatives are there to help us manage those costs of care. Many people think that they are unable to adequately pay for the care they will be given, and if they can't do it, that they may be getting substandard care, that's not true. Hence, we elect us to speak to treatment teams, and many face financial toxicity as a result. They may not stay in treatment. Additional problems as a result of financial stress, like psychological stress, we know stress causes other problems as well. High blood pressure, diabetes, heart problems, the list goes on and on. So my goal today is to help you identify areas that you can strengthen and be able to talk to your doctors, be able to know how to ask the questions, what questions to ask, and to find alternative ways to make sure you can stay on treatment by finding additional financial strategies around that. Next slide. So identifying the stages of cancer treatment costs. According to the research done by the National Cancer Institute, there are generally three stages that are defined by cost for cost analysis in the treatment of cancer. Each with some estimated degree of accuracy for the cost of care at each stage. These costs can vary depending on number of stem cell transplants, novel drugs used in treatment, age at diagnosis, and other complicating comorbidities, as well as the stage of cancer at diagnosis. There is the initial or diagnostic stage, there is the treatment stage, and then there is the end of life stage. Again, we are only going to cover the first two. Next slide. So again, we are going to be covering the initial stage or diagnostic stage and the secondary stage or the maintenance treatment stage two. This is because you are newly diagnosed, the other cancers are becoming more chronic disease, especially myeloma, so we are going to look at these first two stages. Myeloma is rapidly becoming a chronic illness, the treatment options that have become available in the past ten years have made this possible, and AML life expectancy has also increased due to new novel lines of therapy. So we are going to go over some of the costs of these new novel lines of therapies a little bit further on. Next slide. The cost of blood cancer in the initial stage. Now, this could be a really fudgy area because the initial stage depends, especially with multiple myeloma, could be mGus and all the bone scans and everything leading up to that blood work you are in and all those things, and then you have the ongoing maintenance of that to see where you are in the stage if you progress, then they are smoldering myeloma a lot of the same things, you are going to the doctor regularly to make sure that nothing has progressed, and then the actual initial phase from when you are actually diagnosed with myeloma. So that is where a lot of the real things start, when the treatment design is coming into play, and again, how far along you are in that disease in that process. The costs included would be oral prescription drugs, diagnostic tools such as MRIs and CAT scans, lab work, doctor and specialist costs, other baseline tests such as minimal residual disease or MRD tests, as well as other testing, especially if you have other form of abilities such as kidney problems as well. So that is additional costs of care that you are going to need to incur. The second phase, which is a treatment or maintenance phase, generally is long term, especially when looking at myeloma. I know people who are 20 years, 23 years out in myeloma. All of that time has not been with any kind of treatment, but for them to get to that point has been kind of long with different lines of therapy. Associated direct costs include costs of oral meds, in-health treatment, chemotherapy, immunotherapy, possible costs of different specialists, ongoing labs, ongoing doctor visits, and possible travel or lodging expenses, co-pays and deductibles. So there is a lot of costs involved with this. I would mention here, again, if you have heard me, if you have been on any of my other webinars, you have heard me mention again, understand your insurance because that is going to be your foundation of your treatment and your care and it being managed and taken care of and paid. We are going to mention this further along in the webinar. I would encourage everybody to look at the documents I am going to have later on. It will help you pull all of these things together. Next slide. Some of the big ticket therapy costs, these are mind-boggling. AML is extremely expensive and it is one of the most expensive blood cancers with CAR-T therapies ranging in costs from $375,000 for a single transfusion. Wrap your head around that. That is unbelievable for a single transfusion. Other costly therapies include stem cell transplants. You could have more than one. My husband had three. As well as expensive oral drugs that can cost more than $100,000 per year. Does Belkaite, Revlimid sound familiar? Those are big ticket items. Pumil therapy drugs may be $100,000 a year. This is why it is important to look at your insurance. Look at what insurance will pay and if you have options to get into a different insurance, maybe at your next enrollment period or if your Medicare is not covering what you think it should cover, we need to look at options. Don't just get into one thing and say that is what I am stuck with. I was surprised last week I was talking to a friend of mine and her husband had quit his job unexpectedly and she was not working and they had no insurance. She said a friend told her there was no insurance you could get. That is why the affordable healthcare is there. A lot of people don't understand if you don't have to be a certain income to sign up for that, you can sign up for it any time there is a lifestyle change. Please, if you feel like you don't have the right insurance, when it is appropriate to look at your insurance and the timing of it so you can sign up, look at it. Review what you currently have. The importance of planning as soon as possible is speaking to your doctors regarding the cost of all lines of therapy and treatments as you go along in your lines of treatment. For as long as you are doing treatment. Most by and large, the cost associated with this line of therapy depends on the individual's health insurance plan. However, for a single infusion, the cost is approximately, and this is approximately, varies based on where you are getting it in the hospital, $419,000 a year. I don't know anyone who has $419,000 sitting aside just for a single infusion for a treatment, for any kind of disease. It is very imperative that we look at the cost of therapy, look at the cost of your therapy and your treatment and find out how it is going to be managed so you can stay on treatment. Next slide. Tips to understand your cost. Be aware of costs from the start of your care. It can vary from treatment center to center, from state to state, from facility to facility in your same city. It can vary greatly depending on where you live, what state you live in, what insurance you have, and what each hospital charges. Fortunately, there are laws in place now that hospitals have to disclose the charges of their care, of their treatment. It may be difficult to find, but they have to disclose that. You can ask. Ask what it is going to cost for each of your treatments. Know the cost of clinical trials. I encourage everybody to look at the clinical trials. We seem to leave those things to the very last option, but there are so much of clinical trials, so many clinical trials that are out there, and there is a lot of positive feedback for those clinical trials. Patient care costs and research costs are very important to understand. Learn about payment options for medical bills and hospital bills and talk to your doctor again about all costs of your care and treatment. There are teams in place, not just the doctor. There are social workers that we are going to go over, those allies in your care. We are going to go over those resources here shortly. Next slide. Ask social workers for help in learning about programs beyond insurance. If you work, ask your HR department about your insurance plans. Contact your provider. Get to know them. They want you to know about your insurance. They want to provide you with options that you may not be aware of. Look into payment options for household bills, utilities, any other bills, mortgages. Maybe split those in half, and a benefit of that is you can pay your mortgage off sooner. But find ways now before you are at the 12 o'clock hour in stress to find out how to manage these things so you will already be prepared. Learn where to find resources and other financial support. Go on to Health Tree. We have a lot of resources under the financial resource side. Ask about options for lab tests. They may be less expensive if they are off the hospital ground. Surprisingly, they are generally more if they are done at the hospital or the hospital lab. You may be able to get those done off the hospital grounds at an independent lab. Next slide. So how can you be proactive in managing your treatment costs? Myeloma and AML are complicated cancers and they are different for different people. There are different types of myeloma, meaning the care, the treatment may be different. So it is imperative to understand your cancer. Go to Health Tree. Health Tree University gives you as much information as you can possibly get on your disease. We have so many other resources like the round tables that are done. There is so much information. You can talk to some of these researchers directly. You can ask some questions. This is invaluable for you to understand your cancer and to help you decide what treatment with your doctorate partnership, what treatment is best for you. You need to study reliable sources. Don't just get on the internet and look for things you will get confused. Find reliable resources. Get connected with great support groups. And most importantly, ask questions of your treatment team. Solicit a friend or relative to be with you in a room every time you go to the doctor to help you with asking the questions. Go prepare with a list of questions so you can be respectful of your doctor's time. And that person with you can hear the things that you missed, that you maybe stuck on the last answer going over things. Make sure you have someone who can cover all of those bases for you. Take notes. Take copious notes because you're going to want to refer to those things later. Ask about the cost of your care as early as you can. First treatment, why that treatment, how much it's going to cost, what facility you're going to need, all of those things. Am I going to be out of work? What does that look like? So that you can prepare both at home, at work, and when you're treating. Ask about anticipated cost with treatment options every step of the way again so you can be proactive. Not behind the, try to catch up, but be proactive in managing the cost of your care. Next slide. Understand your insurance inside and out. The insurance companies want you to understand that. They have so many resources online. If you don't have access to that online, call them. They will get all the information you need. Know who pays for what and how much, including in treatment care, out of pocket, pharmaceutical costs, co-pays, and deductibles. Any travel costs, including lodging, second or third opinions. That's very important. If you are uninsured or underinsured, what are your options to get insurance? Private government plans. Find out, get the answers to these. Understand your employer benefits. Should you need to take time off from work, such as short or long-term disability if you have it, if you have the option to sign up for it. FMLA, ADA, pay time off, whether they have a bucket where people have donated time off or people who are ill. Find those things out. Start deciding how much you're going to let your employer know. At what stage do you think it's important? Get a support network who can help you make calls and accompany you on doctor visits. I'm telling you, once these medical bills start rolling in and you have to make sure those medical bills are right, because very often they are not, you need to make sure that you're paying what you own, not more than that. Again, take copious notes with the person you spoke with, whether it's the insurance company, your doctor's office, with the time and date of call or the visit. That way you can refer back to it if you need to do so. Make sure your bills are accurate so you will be paying your correct share. Seek out help for medical bill appeals. There are resources online that shows, tells you where you can go to help find someone who can help you with that. Speak to your social worker to help find financial grants that help you cover the cost of care. Again, on our health or our coach financial page, there are a lot of resources for travel lodging, pharmaceutical care, non-profit care. There's a lot of things for grants. Keep a file of all out-of-pocket expenses. Good for your tax filing later on. Be proactive about new treatments and their calls, such as CAR T. Be aware of things that are out there that are available to you. Be aware of clinical trials that you may qualify for. Next slide. So there are realized calls and there are unrealized calls of cancer. So many other things are loss of income due to time-off treatment. How are you going to manage the loss of income? And I need to also say that if you have a disability program through your employer and they pay for that premium, then you are going to be taxed on that income they're replacing. The income they're replacing is going to be maybe 60%, possibly, rarely now, 66% percent. Possibly, rarely now, 66% of your income. And then all of that is taxed. So you may be coming home with possibly 40, maybe 45% of your income. And you continue to live on 45% of your income, meaning all of your other expenses. You may have loss of savings due to loss of earnings. You no longer feel safe with your 401K and your regular savings accounts or emergencies. So all of these things could be taken into consideration. Mental costs of patient and family. This is one of those unrealized calls of cancer. It's a very stressful, psychologically stressing time. And it can affect people in different ways. You may need additional care, additional psychological or mental health during this time, both you and your family. And that's an additional cost that might be like taxing as well. Find out what your insurance will pay for. We know financial stress can lead to increased psychological distress, increased physical health issues. So monitoring and managing your care, the cost of your care, getting a lot of this out of the way before you get into the thick of treatment is so beneficial to you and your family. I always say plan for the best, for the worst, but expect a better outcome. This is the less expensive option. Believe me, it's the less expensive option. When you do your work ahead of time, you've already anticipated a lot of things that may come ahead and you're ready for it. You may experience asset depletion by accessing your retirement dollars prior to retirement. And that means you'll have additional tax responsibility, because if you would access your retirement early, you still have to pay taxes on it. And you may incur penalties if it's not withdrawn correctly. So that's an additional cost burden that you may have to have if you don't anticipate these things and plan for other options as well. Next slide. You may have, again, you may have a possible need for early retirement or you might find yourself taking more time off from work to get your care. The cost of additional therapy such as physical therapists or occupational therapists, changes of loss or health changes or loss of health insurance and possible higher premiums as a result. The possible loss of caregiver income, which means, again, the difficult time leading your other expenses. And then travel costs for treatment, whether it's travel for gas, if you had to go long distance, time off from work to do that travel, lodging, meals, all of those things come into play when you're talking about the cost of your health care. Next slide. Health insurance coverage, again, review that insurance coverage you have, look, see if there's any options available when you can sign up for them. Look at your, get your employer benefit focus so you can review every benefit that the employer offers. Get your last year's taxes, info you'll need to apply for financial grants because you're going to ask for what your income is last year. And if there's going to be, if you know there are changes now that you've incurred for this year, you might want to let them know that because sometimes they can take that into consideration. Look at, pull your social security statements, know what you and your family members may qualify for if you file for social security disability. Budgeting plan or financial plan, if you have one, if not, get it done. I cannot stress enough how important this is. Life insurance review, see if your insurance has cash options that might help you cover some of the costs of your treatment. Find out if you need to change your insurance plan, things that can be done for you to help protect yourself, stay on treatment, and protect your family. Review the type of insurance you have and make adjustments if and as soon as possible, from temporary insurance, possibly to permanent insurance without having to go through medical underwriting or a partial conversion, depending on what your needs are. Next slide. So it's going to cost you more if you don't speak up. You, if you're going to end up paying for things that you may be able to find grants for and that's less money in your pocket to make your other expenses. You may not share with the treatment team all symptoms due or fear of additional costly treatment, but how is that going to be helping you in the far end? You may not take prescriptions as required in order to stretch out medications, treatment, non-inherence. You'll end up with poor outcomes, end up with more stress, fuel your family, everyone will suffer as a result. Loss of access to grants and other financial help, if you don't ask, it may not be offered. So here's where it's important for you to ask. Ask what's out there, research what's out there. We have a lot of resources available to you. We have financial coaches. If you don't understand what may be out there available to you, we can help you find those things. Next slide. So finding allies and managing your care. Become aware of all the human resources at your treatment facility available to help you navigate the cost of care, not just your treatment facility. Allies and support groups, allies with non-prostholic health treatment, international Myloba Foundation, all of these, all of these pre-medical public society, all of these programs and organizations have information that can better you, that can help you become aware of all of these things. Social workers at your place of treatment, patient advocates, nurse navigators, patient navigators, cancer support groups, pharmaceutical patient assistant programs, they are huge in helping you cover the cost of pharmaceuticals. Hospital charity programs, a lot of people don't know that hospital charity programs can help you reduce those costs of those hospital bills that you cannot seem to manage. Non-profit organizations such as Human and Pharma Society, HealthWell, Cancer Cares, Patient Advocate Foundation, all of these things have resources available to you and you can put in type of medication, they'll tell you everywhere that you can get help with those medications. Next slide. So one of the greatest gifts you can give to yourself and your family that will pay off an ongoing dividends is to learn how to advocate for yourself and have someone who can advocate for you when you cannot. You need to become your own best advocate. I cannot tell you how many times when my husband cannot speak for himself, but I was there all of the time and I actually helped save his life. It is imperative that you find someone who's going to be there to help you and for you to speak up if you don't understand something, if you see something is off, you need to ask questions. The nurses are, if you've ever been to a hospital, you find out how valuable nurses are. I have such high regard for nurses because they see things that doctors don't see. They are your first line of defense if you're ever hospitalized. Take advantage of all the resources available to you on the Health Tree website to help guide you through understanding your myeloma, the treatment options, financial resources, to coaching, to everything in between. If you don't know where to start, call Health Tree and tell them you are newly diagnosed and don't know what questions to ask of your doctor or treatment team. They can help direct you to the right resources and the right coaches and people there who just cannot wait to help you understand and offer you the assistance you need. Support, support, we all need support and they are invaluable in this. These are people who care, who really want to do this to help you. Next slide. You know, and I say this with love, you do not have the liberty to be a spectator in your care. Your life depends on your active participation and part of the active participation is learning about what you have to, what you're dealing with. The earlier in your diagnosis and treatment that you start actively participating in your care, the better off you and your family are going to be. That includes learning about your cancer, asking questions about options for treatment, side effects of treatments, how to minimize side effects, how much everything is going to cost every step of the way. Make sure you understand what is happening to your body. Don't stop asking until you're satisfied with the answer. Come prepared to your appointments with the list of questions and most importantly, make sure you are working with a specialist and oncologist that listens to you. This is going to be a long relationship. Make sure your communication and goals are aligned. That's very important. Next slide. So in summary, I know it's a lot of information and we're going to cover a lot of this and go through a lot of the help tools, help resources with some of those work documents that you're going to have on there. So summary, seek your help immediately. Ask questions about the cost of your treatment every step of the way. Understand your cancer. Go on HealthFree. They have HealthFree University that will help you understand your labs, help you understand how to read those labs, help you understand what other treatments are available. You may find your twin. There's so many resources out there that HealthFree has that just taking a half hour a day or 15 minutes a day to review those things are going to be so great in optimizing and managing your care. Understand treatment options and their associated side effects. Know your treatment team. All of those people, your social workers, patient navigators, nurse navigators, all of those people will be there are resources to help you. Understand your health insurance. This is going to be your foundation of where you're going to be a treatment jump off. This is going to be your start, your foundation as to what kind of treatment you're going to have, how much is going to be out of pocket for you and how much is going to be picked up by your insurance company. Become a self-advocate in your care and be proactive. Don't wait until you're stressed. You have the bills rolling in because then you're behind a ball and that stress is very difficult to overcome. Thank you for joining us. Please join us on March 4th for the workshop for newly diagnosed. There's so much information that we can give you. This pulling these things together is going to make it so much easier for you. Guaranteed. Definitely. And thank you so much, Dayana. I love the passion that you share as you express this information to our group. You can tell you really care and I know you put so many hours into it and I just really appreciate you. If you have any questions for Dayana, please feel free to enter them into the Q&A a little box that you can, or the icon, click the Q&A icon and you can submit your questions into the box that way. We're really, we're getting some questions in right now. One of the questions that I think is an important one is where does Medicare fall into this and how much are they willing to pay when it comes to the cost of care considering a large majority of cancer patients are on Medicare? Exactly and Medicare is huge. A lot of people that I, we speak to from the financial cultures find that a lot of people with Medicare still have those gaps in pharmaceutical costs. But Medicare is great and what I tell you to do is find out what Medicare options you have. Make sure you sign up for Part A and Part B, traditional Medicare, and then decide whether Medicare Advantage or Medigap plan is going to be better for you. And then again, look at it whether it's HMO or PPO or where you could be traveling to get your care. A lot of this is important. When you sign up for one insurance, whether it's Medicare Advantage or a Medigap plan, it doesn't necessarily mean that's one you're going to have for the rest of your life and I would encourage you to say no it is not because those plans change every year. Go and review those things and look at your open enrollment period and make sure that you do have up-to-date best insurance plan for you at what you can afford. And even if you have Medicare coverage, they're covering a lot of your care. Medicare covers so much of your care. You may find there may be gaps but there are pharmaceutical companies will still help you if you've gone through all the other grants as well. First, like Health Tree, Luke E. Willam Fomal Society that has the grants. I mean, you can get tens of thousands of dollars worth of grants to help you cover the cost of your pharmaceutical care. A lot of people don't realize they help you also with toilet lifts, with things at home to modify your home. They forget that that is an associated cost with some of these things. Making sure that you can get up and down stairs, having someone come in and say, do I need to remove carpet? There are so many things that Medicare, as long as your doctor writes a prescription for a lot of these things and you can go to some of these equipment supply companies for health care, there's a lot that Medicare will take care of. That's less money out of your pocket. Yeah, definitely. And who do they go to in order to know which Medicare plan is right for them or what's available to them? What's some of the resources out there to help guide them with this Medicare plan? There is AON. If you earn Medicare, they can go through all the plans based on your state. They can go through that with you. You can call an individual broker in your state. They will have the programs that are associated with them. I would caution you when you're doing this because a lot of insurance brokers or insurance agents will try to sell what they make the most money off of. They have to make a living. That's why I always suggest going to some of those other resources like eMedicare. Talk to Medicare.gov. Get your list of medications, the kind of treatments, things that you have, and they can actually walk through those to tell you what coverage you have on those things. Don't forget occupational therapy and physical therapy because somewhere down the road, those things may, you may need to have those things. Make sure those things are covered. Awesome. Thank you so much. We have a question that's a very good one. It's talking about a lot of assistance looks at, financial assistance looks at last year's income. This specific person has had a reduction, significant reduction in their income this year. They're wondering what can they do to advocate for themselves to get help based on what they need this year versus what was given in last year's income? That's interesting. It depends on when you got those grants. The grants run for 12 months. If you got that grant, let's say in January and then it's now September this year, you may not know your income has been reduced after January 1st. It doesn't hurt to tell them, my income has been reduced this year, because then in January, you can reapply again for that grant based on your current income. If you've done your income taxes, sooner you get those done, the better off school is going to need to prove that. If your grant runs from July to July, then you've had some time to understand if your income has changed. You have time to do your 2021 taxes. If your anticipated income has been reduced, you may get letters from your employer if your time has been reduced. You've got part-time. There's so many things you can do to verify that your income has been reduced. If you don't ask those people who get grants, they'll never know. But ask them how we can use your current income tax statement, your current income with verification. That can give you opportunity to get more grants. Yeah, this specific person hasn't received a grant already, but they can definitely still take those same principles when talking to financial assistance people. I didn't know how to do that. Get your income tax done so you can verify that's different from last year. A lot of those nonprofits will ask, what do you think is going to be a significant danger to your income? Has there been a significant danger to your income? A lot of them will ask. If they don't ask, you make sure that they are aware of it. Okay, perfect. Thank you. You might have already answered this question, but does Medicare Supplements pay for the cost of care? So I'm not sure what supplements means in this case. Yeah, Medicare Supplements usually pick up what your Medicare Part A and Part B do not cover. So yes, you need to have, other than your Part A and Part B and your Part D for your prescriptions, you need to have some kind of supplement plan, whether it's Medigap or Medicare Advantage, to pick up the additional cost. That's not going to be covered. And if you have not done that, you want to make sure you do that because there are time limits into getting guaranteed issue under your Medigap plans when you are eligible to sign up for Medicare. Wonderful. We are getting questions as well about if the slides are going to be distributed, and yes, they will. So Diana has prepared these slides and they'll be available for distribution. She also mentioned several resources. We are going to be including those resources in the follow-up email, how to get to Health Tree University to learn more about myeloma and AML, how to access a myeloma coach, how to, you mentioned so many, how to contact, it was great, it was great, how to contact our patient experience team, how to get connections to understand your labs a little bit better, how to reach out to the financial coaches. We're going to be including those resources for you in our follow-up email so that you're able to receive them that way. We do have time for a couple more questions if people want to keep submitting. I think that was a very good summary of what you gave, Diana. You gave a lot of details there and I'm looking forward to reviewing that myself. Again, on our, I'm sorry, on our April 4th webinar with the workshop for newly diagnosed, we say newly diagnosed, but I think a lot of this is going to be for anyone if you haven't done some of these, taken some of these steps. There's going to be a list there of questions to ask your doctor. There's going to be a list there about insurance information together for insurance, what you need to be looking at for a short-term, long-term disability, how it affects your income and your taxes. We're going to be looking at some Medicare information, insurances. We're going to be looking at additional ways to find cash, whether it's in the neighborhood, your neighborhood, for utilities, for home improvements. A lot of people are aware that there are grants available for you to do home improvements in your home that you don't have to pay back, depending on what your age are and what state you're in, what city you're in. But there are so many resources. I'm going to have a lot of these things you can download and you can take these things with you to the doctor, how to keep up with your medical bills, what things to look at, how to apply for appeals. We're going to have step-by-step-by-step things so that you'll have your own booklet, your own big baggage. I hate to say this, but it's going to be complicated, but you're going to have everything where you can keep in one place, things you need to carry with you to the car regarding your medication list. All of these things, where to get discounts on medication, like through RxCard, MedRx, all these cards, all these things where you can get help that you may not be aware of. We'll have that for you. Good. And people are wondering how to sign up for that event. We'll make sure that the link to sign up for next month's event is actually on the 5th, April 5th. So it's the first Tuesday of every month, April 5th. And we're going to include the registration link for next month's event in the follow-up email for this event. So keep your eye on your email. That should be sent within 48 hours of the event concluding today. And then we'll be able to, you'll be able to just register right away in that email so that we can. And we'll be on a Google Meet. So we'll be a little bit more interactive. So you're able to ask Diana questions as we're explaining things. And like she said, we will have PDFs for you to download. So Diana, if you could get me those as soon as possible, and we'll be sending out to all of the registrants the link to download all of those documents. So it's going to be really exciting. I'm excited for the growth of this Myeloma financial chapter. And a thank you to all of our AML patients who joined us today as well since Diana is giving financial advice for blood cancer patients. So you're more than welcome to join next month as well to those with AML. And we're glad that you're here today. All right. With that being said, I'm just going to go to our outro announcements and we'll finish up. So like we've been mentioning, I just wanted it to some people learn by reading. So on April 5th at 1pm Eastern is going to be this newly diagnosed Myeloma and AML patient financial workshop that we've been discussing and we're really looking forward to it. You may be interested in other Myeloma crowd community events that we have coming up. On the third is our stem cell transplant chapter. We're going to be hearing about how to determine whether or not a stem cell transplant is successful. I know that some patients become discouraged or even nervous thinking, what if this intense procedure doesn't get me to MRD negativity or even into complete remission? And so we're going to be talking about, you know, do the risks outweigh the benefits, outweigh the risks and what constitutes really being successful or unsuccessful in this case. On the eighth, we have two events. One of them is our non-secretory Myeloma community chapter. And we're going to be talking about what tests are used to measure your non-secretory Myeloma. This is a relatively new community chapter. We wanted to open it to those who are experiencing non-secretory Myeloma. Our SoCal community chapter is also on that day. It is at 6.30 p.m. Pacific, considering it's a regional chapter. So for those who are in the SoCal or Las Vegas area. And we're going to be hearing from Caitlin Costello. And she is going to be talking about hope, action, and evolving Myeloma research. 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 the slide and will be included in our follow-up email within 48 hours after the event has concluded. Once again, another thank you to our sponsors, Bristol Myers Squibb, Amgen Oncology, Genentech, Adoptive Biotechnology, Sanofi, Janssen Oncology, CarioFarm Therapeutics, Takeda Oncology, and Abbe. And thank you to each of you for helping us build a strong Myeloma crowd community. I appreciate you. And Diana, thank you so much for your time and participation. We hope that you all have a great rest of your day and we'll see you next month. Thank you.