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Financial Requirements for Transplant Medications Laurie Shore, MSW, LCSW Transplant Social Worker (813) 251-8017 X1162.

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Presentation on theme: "Financial Requirements for Transplant Medications Laurie Shore, MSW, LCSW Transplant Social Worker (813) 251-8017 X1162."— Presentation transcript:

1 Financial Requirements for Transplant Medications Laurie Shore, MSW, LCSW Transplant Social Worker (813) X1162

2 Medication Coverage & Insurance Medications after transplant are expensive Patients will need to begin planning how they will pay Will need one or more forms of insurance Responsible for co-pays/deductibles Premiums paid by AKF are discontinued following transplantation

3 Commercial, Private & Supplemental Patients need to know the terms of their policy Review insurance manual Call insurance company

4 Insurance Policy Inquiry What is the cost of medication co-pays? Is there an annual limit on medications? Is there a maximum lifetime benefit on the policy? What is the cost of annual deductibles?

5 Medicare Eligibility Most patients with ESRD are eligible for Medicare Part A beginning Hemodialysis – 4 th month of treatment Peritoneal Dialysis & Transplantation – 1 st month of treatment or transplant Length of coverage Under the age of 65 – provides coverage for 36 months Over the age of 65 or if disabled for another reason other than ESRD – coverage will continue to be provided

6 Medicare Coverage Patients must have Medicare Part B for anti-rejection medications to be covered at a percentage Medicare Part B covers 80% of anti- rejection medications Patients will be responsible for the remaining 20% for each anti-rejection medication Additional insurance should alleviate these costs

7 Medicare & Employee Group Health Plans (EGHP) Enroll in Medicare A & B even with EGHP To avoid future penalties Ensure immunosuppressant coverage Immunosuppressant coverage could change if your employer changes insurance policies Immunosuppressant coverage could change if you change employers Immunosuppressant coverage could change at age 65 if Medicare declined at time eligible

8 Medicare Part D Medicare Prescription Drug Coverage Medicaid recipients can change plans once a month Medicare recipients can change plans once a year Coverage for drugs under Part B will not change Consider what drugs you may need in the future i.e., Valcyte

9 Medically Needy Patient Obstacles: No longer meet share of cost Must have coverage for 20% of immunosuppressants 20% out of pocket costs could range from approximately $ per month

10 Military Veteran If a Veteran with an honorable discharge Determine eligibility Establish as a VA patient Confirm coverage for immunosuppressants If Medicare and VA only-20% of LifeLink bill arranged by Ins. Verification Dept.

11 Financial Options Patient options when lacking 20% coverage: Self pay Spousal Insurance Medicaid Medicare Supplement Employee Group Health Plan

12 Questions


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