Understanding Government Health Plan Options

Transcription

1 Understanding Government Health Plan Options including Patient Information, for RADICAVA, also 1

2 Understanding Your Options We can help you review information about government health plan options. Visit Medicare.gov for more information or contact a Medicare insurance plan representative with questions about coverage. You may be eligible for Medicare: Age 65 or older You may enroll in Original Medicare Part A (hospital costs) and Part B (outpatient and doctor fees) health plans Prescription drug coverage (Part D) is also available Under age 65 If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you can apply for Social Security Disability Insurance (SSDI) benefits, and subsequently, for Medicare coverage.1,2 Apply as soon as possible to avoid a gap between your commercial insurance and Medicare coverage. To apply for SSDI benefits, visit your local Social Security Administration office The application process for SSDI benefits can take 3-5 months and payments usually start in your sixth month of disability Once you apply for SSDI benefits, you may qualify to apply for Medicare almost immediately. Visit or to learn more about Medicare, SSDI, and to apply online. Infusion with RADICAVA (edavarone) IV infusion is typically covered under Medicare Part B. For home infusion treatment, only the RADICAVA medication is typically covered under Medicare Part D. If you are eligible for Medicare, you are not eligible for any Searchlight Support cost support programs. See back cover for a helpful glossary of health insurance terms. including Patient Information, for RADICAVA, also 2 2 3

3 Medicare Part B Coverage 20% After your deductible is met, you typically pay 20% of medication and infusion costs. 80% Medicare Part B covers 80% of medication and infusion costs. Supplemental coverage and plans may be available to help with premiums and the 20% of costs for treatment with RADICAVA (edaravone) IV infusion not covered by Medicare Part B. A Medicare Supplement plan (Medigap) may be able to cover most or even all of your Original Medicare out-of-pocket costs A Medicare Advantage plan (Medicare Part C) may be available as an alternative to Original Medicare coverage. Some limitations apply If enrolled in a Medicare Advantage plan, you cannot enroll in a Medigap plan Medigap and Medicare Advantage plans vary in coverage benefits and cost of monthly premiums. Visit Medicare.gov or your State Health Insurance Assistance Program (SHIP) at ShipTACenter.org for help with additional Medicare-related questions. including Patient Information, for RADICAVA, also Call us to learn more or visit us online at Medicare Part D Coverage Medicare Part D prescription drug plans typically cover the cost of home infusion medications such as RADICAVA. It is important to note that this coverage applies only to the medication, and not to any related services, equipment or supplies.* Contact your insurance plan representative with questions about your plan s coverage. Here s How It Works in 2017: Before the In the After the On average, you pay 25% You pay 40% You pay 5% You pay annual deductible On average, Medicare pays 75% Medicare pays 95% Supplemental coverage may be available. Part D Program covers 60% Medicare Extra Help Low Income Subsidy (LIS) may be available to help pay for prescription drug plan costs, including deductibles and out-of-pocket expenses A Medicare Advantage plan (Medicare Part C) may include prescription drug coverage and may be available as an alternative to Original Medicare coverage. Some limitations apply Medicare Advantage plans vary in coverage benefits and cost of monthly premiums. Visit Medicare.gov for more information or contact your Medicare insurance plan representative. * Coverage may be different for Medicare beneficiaries who are homebound. Based on Medicare Part D plan information for

4 Additional Resources Other government-funded health plans Medicaid Benefits vary by state and some have programs for people with catastrophic or high monthly out-of-pocket healthcare costs. TRICARE/DoD/Veterans Administration Veterans with ALS who spent at least 90 continuous days in the military may be eligible for 100% disability compensation benefits. 3 This is not a complete list of government health plan options. For other government-funded health plans not listed, please visit Alternative resources for cost support and coverage Need help paying Medicare premium costs? If you have limited income and resources, you may qualify for a Medicare Savings Program. Visit for more information. If you need supplemental assistance If you have a government health plan, we can refer you to independent foundations that may provide assistance. Contact Searchlight Support for more information. including Patient Information, for RADICAVA (edaravone) IV infusion, also Call us to learn more or visit us online at For questions about your coverage with Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), Puerto Rico Government Health Insurance Plan ( La Reforma ), or other government-funded health plans not listed, speak with a Care Coordinator at Searchlight Support. The Department of Veterans Affairs (VA) assigns benefits based on a percentage of the disability that can be associated with your military service

5 Glossary Co-insurance: A percentage of the cost of your medications and healthcare services that you are responsible for paying. Typically, this is a lower percentage amount than what your health plan pays. 4,5 Co-pay: A set amount, determined by your health plan, that you pay for medications and healthcare services at the time such services are rendered. 4,5 Deductible: The out-of-pocket amount you must pay before your health plan begins to pay. 4,5 /Coverage Gap: A limit on the amount that a Medicare Part D prescription plan will cover after your out-of-pocket prescription costs reach a certain level. After your costs pass the higher limit of this range, you pay just 5% of all your prescription medication costs for the rest of your coverage year. 4,6 Medicaid: A joint federal and state program that helps with medical costs for some people with limited income and resources. 4 Medicare Advantage (Medicare Part C): Health plans approved by Medicare but offered by private insurance companies. 4 Medicare Extra Help Low Income Subsidy (LIS): A Medicare program to help people with limited income and resources pay for prescription drug plan costs, including deductibles and out-of-pocket expenses. Offered at full and partial levels. 4,7 Medicare Savings Programs: State Programs that help eligible, low-income Medicare beneficiaries with their out-of-pockets costs. These may include premiums for Medicare Part A and Medicare B, deductibles, co-insurance, and co-pays. 4 Medigap (Medicare Supplement): Supplemental policy sold by private insurance companies that may cover some health care costs that Original Medicare doesn t cover, like co-pays, co-insurance, and deductibles. 4 Original Medicare: Federal health insurance coverage that includes Medicare Part A (hospital costs) and Part B (outpatient and doctor fees). 4 Social Security Disability Insurance (SSDI): A Social Security program that can pay monthly benefits if you become disabled with a long-term medical condition before you reach retirement age and aren t able to work. 1,2 References: 1. Disability Benefits. Social Security Administration website What You Need to Know When You Get Social Security Disability Benefits. Social Security Administration website. pubs/en pdf. 3. Department of Veterans Affairs. Presumption of Service Connection for Amyotrophic Lateral Sclerosis. Federal Register. 2009;74(212): Codified at 38 CFR Part Medicare & You Centers for Medicare & Medicaid Services website. You.pdf. 5. Glossary. Blue Cross Blue Shield Association website. learn/glossary. 6. The Medicare Part D Prescription Drug Benefit. Kaiser Family Foundation website If You Get Extra Help, Make Sure You re Paying the Right Amount. Centers for Medicare & Medicaid Services website. Pubs/pdf/11324-If-You-Get-Extra-Help.pdf. RADICAVA and the RADICAVA logo are trademarks of Mitsubishi Tanabe Pharma Corporation. Searchlight Support and the Searchlight Support logo are trademarks of Mitsubishi Tanabe Pharma America, Inc Mitsubishi Tanabe Pharma America, Inc. All rights reserved. U.S. only. CP-RC-US /17 5