Coverage Issues - Prescriptions and Medical Care

Prescription drug coverage

Medicare part D

• Kaiser Family Foundation Prescription Drug Costs and Medicare
• AARP Medicare Part D
• Kaiser Family Foundation Medicare Low-Income Assistance Under the Medicare Drug Benefit

Wisconsin Programs

• BadgerRx gold program: What is Badger Rx and who should apply?
• SeniorCare: What is SeniorCare and what are the eligibility requirements?
• SeniorCare Prescription Drugs for WI Seniors; includes program information, eligibility requirements and application form and instructions.

Prescription Assistance Programs

• Patient Services Incorporated: PSI assists persons with chronic medical illnesses in accessing health insurance and pharmacy co-payment assistance. Information on eligibility, programs and services.
• Patient Advocate Foundation: Patient Advocate Foundation Co-Pay Relief Program provides direct do-payment assistance for pharmaceutical products to insured Americans who financially and medically qualify. Link to information on illnesses, resources and how to help.
• Partnership for Prescription Assistance: Help for qualifying patients who lack prescription coverage. Help in getting the needed medicines through public or private programs. Mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. Single point of access to 475 public and private patient assistance programs including 180+ programs offered by pharmaceutical companies.
• Health Well Foundation : Organization helps individuals afford prescription medicines. Provides financial assistance to eligible patients to cover certain out-of-pocket health care costs.
• Patient Access Network Foundation: Foundation supports the needs of patients who cannot access the treatments they need due to out-of-pocket health care costs.
• NeedyMeds : NeedyMeds is a 501(c)(3) non profit with the mission of helping people who can't afford to pay for their medications. Website links to patient assistance programs, government programs, Needy Meds brochure and information on assistance with the cost of healthcare.

Selecting comprehensive medical insurance coverage

Many people experience medical debt or financial stress because of inadequate health insurance. Know your current coverage and select the coverage that is right for you.

• CPP Checklist for Diagnosing your Coverage: It is important to know your health insurance coverage and appeal rights - this checklist will help in reading and understanding your health insurance policy.
• FamiliesUSA What Consumers Need to Know about Purchasing Health Insurance as an Individual: Comprehensive consumer information on how to find, choose and use quality health coverage. Available at: http://www.familiesusa.org/assets/pdfs/Consumer-Info-Individual-Market.pdf
• Georgetown University Health Policy Institute A Consumer's Guide to Getting and Keeping Health Insurance in Wisconsin: This comprehensive guide outlines protections and rights afforded under Wisconsin and federal law available to consumers who seek to buy, keep, or switch health insurance, regardless of health condition. It also outlines financial assistance for health insurance. Also available at: http://www.healthinsuranceinfo.net/statecoverageguides/
• Kaiser Family Foundation/eHealth Insurance Update on Individual Health Insurance
• What Cancer Survivors Need to Know About Health Insurance: This publication is produced by the National Coalition for Cancer Survivorship (NCCS). Topics include getting and keeping private health insurance, regulations and rights, public coverage and where to turn for help.

Resources for the uninsured

• HIRSP Outline of Coverage: Comprehensive health insurance for high risk individuals -Wisconsin Health Insurance Risk Sharing Plan offers health insurance to Wisconsin residents who are either unable to find adequate health insurance coverage due to medical conditions or who have lost their employer-sponsored group health insurance. Outline provides general information and an eligibility overview.
• Patient Advocate - Help! I'm uninsured : Tools to help the uninsured and underinsured: strategies to deal with unpaid medical bills, information on clinical trials, insurance policy issues and an overview of Medicaid programs.
• WI Medicaid Program: U.S. Department of Health and Human Services information on enrollment, coverage and forms. Also see the US Medicare and Medicaid website.
• WI Medicaid and BadgerCare Fact Sheet: This fact sheet deals with eligibility, benefits and applying for Medicaid and BadgerCare. BadgerCare Hotline is also available at 800-362-3002.

Cost Issues

Paying for Care

• National Coalition for Cancer Survivorship, Cancer Survival Toolbox, Finding Ways to Pay for Care Module: Audio module which discusses the effect of insurance on cancer care, what to do when you have no insurance and Medicare benefits.
• Georgetown University Health Policy Institute A Consumer's Guide to Getting and Keeping Health Insurance in Wisconsin: This comprehensive guide outlines protections and rights afforded under Wisconsin and federal law available to consumers who seek to buy, keep, or switch health insurance, regardless of health condition. It also outlines financial assistance for health insurance.
• How to Create a Flexible Payment Plan. This section of "Managing Your Medical Debt: Know Your Rights" by the Legal Aid Society of the District of Columbia outlines tips and traps in creating a workable payment plan for medical expenses.

Hospital Community, Charity Care, or Financial Assistance Programs

Most hospitals offer financial assistance programs to low-income patients who face extraordinary medical costs. Even if a patient does not technically meet eligibility criteria, the Center for Patient Partnerships encourages any patient with overwhelming medical debt to apply for assistance. General information about these programs in Wisconsin is made available by the Wisconsin Hospital Association as part of their billing and collection guidelines at: http://www.wha.org/financeAndData/billingCollection.aspx.

Selected Community Care applications can be found at:

• Meriter - http://www.meriter.com/mhs/patient_center/billing/financial_asst.pdf.
• UW-Health - http://www.uwhealth.org/page.asp?contentid=10185.
• St. Mary's - http://www.stmgb.org/Pages/VisitorInfo/ComCare.aspx

Appeals and the grievance process

• Kaiser Family Foundation A Consumer Guide to Handing Disputes with your Employer or Private Health Plan 2005
• Patient Advocacy Foundation Your Guide to the Appeal Process
• Wisconsin Office of the Commissioner of Insurance Consumer's Guide to Grievances and Complaints "How to appeal your health plan's coverage decision." This includes a process overview, general tips and OCI contact information.

• Office of the Commissioner of Insurance Complaint Form - English
• Office of the Commissioner of Insurance Complaint Form - Spanish

Financial Planning

• Financial Education Center Brochure: Overview of financial management classes and services offered by the Financial Education Center, a program of the UW-Extension - including one-on-one financial coaching and a Volunteer Income Tax Assistance program. The Financial Education Center is located at 2300 S. Park Street, Madison, WI 53713. Phone: 608-261-5077. Email: deb.neubauer@ces.uwex.edu. Web: http://fec.uwex.edu
• Money 2000 Organizing your Financial Records: A publication of the UW-Extension which outlines how to track spending to stay within a spending plan - offers various tracking methods and suggestions.
• Cancer Society Booklets (Available at: http://www.cancer.org/docroot/MIT/mit_3.asp?sitearea=MIT&level=1 in the "Taking Charge of Money Matters" section.)

• Can I be Prepared if Cancer Occurs?: Financial guidance for those with concerns about cancer. Answers to questions such as "How would I cope if I got cancer?" and "What can I do to protect myself financially?" Includes information about medical, disability, life and credit life insurance coverage as well as tips on saving money and organizing your financial future.
• Coping Financially with the Loss of a Loved One: Financial guidance for families-help in identifying what tasks need to be done immediately and what can wait. Includes resources, worksheets and tips for survivors.
• How to Find a Financial Professional Sensitive to Cancer: Addresses how a financial planner can help and includes tips and resources for finding the right financial planner.
• In Treatment Financial Guidance for Cancer Survivors: Suggestions on how to face tough issues, tips for preparing a financing plan/budget, estate planning considerations, list of general resources and a glossary of financial terms.
• Off Treatment Financial Guidance for Cancer Survivors: Topics includes embracing survivorship, returning to work, looking for a new job, medical plan features, living without benefits, rebuilding your finances and basic estate planning considerations.

Options to address medical debt

• CPP Medical Debt Brochure: Created by a law student at the Center for Patient Partnerships, this brochure provides tips to avoid debt and address health care expenses: billing tips, preventive tips and resource information.

• Financial Help for People with Cancer: by CancerCare, also available at: http://www.cancercare.org/pdf/fact_sheets/fs_financial_en.pdf. Excerpt: "Being diagnosed with cancer can be a tremendous financial burden, on a patient as well as on a family. Besides hospital bills, cancer treatment can include many expenses that insurance doesn't cover, such as medications, transportation, or child care. If lost wages compound this situation, then the diagnosis of cancer can also become a financial crisis. Some relief is available, but it will take effort to piece together what is out there. This checklist was developed to help guide you in finding options."

  CancerCare also provides small grants for medical related expenses and tip for finding financial guidance at http://www.cancercare.org/get_help/assistance/index.php.

• Federal Trade Commission for the Consumer Focus on Credit Knee Deep in Debt: This publication provides self help tips, information about credit counseling and debt management plans, warning signs regarding credit counseling organizations, and an introduction to debt consolidation, bankruptcy, and debt negotiation programs.
• Federal Trade Commission Fiscal Fitness: Provides tips on how to choose a credit counselor and explains debt management plans (DMPs) and debt negotiation programs.
• Patient Advocate Foundation A Greater Understanding: Financial Assistance and Debt Crisis Intervention: This publication by the Patient Advocate Foundation provides strategies to address illness-related debt. Also available at: http://www.patientadvocate.org/pdf/pubs/GU-Financial_Assistance.pdf.
• Money 2000 Using Power Payments to Pay off Debt: This UW-Extension document explains "power payments" as a method to get out of debt. Also available at: http://learningstore.uwex.edu/pdf/B3709_4.PDF.