Financial instability leads to stress, which can affect your health as well as your mental well-being. When a person becomes disabled, they are faced with so many uncertainties in regards to their future. Without the knowledge of what resources may be available, the thought of the long road ahead can oftentimes be unbearable. This publication has been designed to provide you with the necessary information to provide a smoother transition from being in a work environment into an unplanned retirement or extended period of disability. Any incident, inquiry or issue may vary according to the specific and unique circumstances surrounding each individual.
You have been diagnosed with an illness that is going to, or already has, interrupted your ability to work, provide for yourself and your family and robbed you of your independence. You are now going to be faced with issues that you never thought you would have to face. Patients can deplpete an entire life's savings in a short amount of time. What will you do? How will you keep your home? How will you buy food, pay for your utilities and other bills? Will you be left with no income for a period of time? How can you access the benefits that you may be entitled to? Are you uninsured and do not know how you are going to afford your treatment?
Through research conducted by the Patient Advocate Foundation's Patient Services Department, we have identified resources that may be helpful to you. Having knowledge of the disability process will empower you as a patient and hopefully leave you feeling less overwhelmed. Patient Advocate Foundation hopes to assist you with avoiding a financial crisis by giving you the resources and information to plan ahead. If you have any questions that are not answered in this guide, please contact Patient Advocate Foundation at 1-800-532-5274.
Are You Uninsured?
How can you get the care you need?
If you are in need of medical care, but do not have insurance, don't panic. There are facilities that offer charity care and/or financial assistance programs. You will have to find a hospital/provider that offers such assitance, by calling and speaking with a social worker, patient advocate or financial counselor. Ask for an application for charity care/financial assistance. The determination will be based on the area they assist individuals in, your income/assets and household size. Each facility will have their own specific eligibility requirements for charity care, but these are the main demographics that will be evaluated. Some may offer 100% charity cre and others might use a sliding fee scale based on your income.
When applying for charity care, keep in mind that any hospital charges will be covered, but there will be providers that bill separately. You will need to make separate arrangements with them. Occasionally, if the hospital is doing a charity write-off for your care, the physicians will follow suit. If charity care is not available, discuss making reasonable payment arrangements with the provider.
Most states have Hill-Burton facilities. These facilities provide care to uninsured Americans. To locate a Hill-Burton facility in your area, call 1-800-638-0742 or visit their website at www.hrsa.gov.
How will you get your medications?
There are many programs available to assist you with getting your medications. Most medications are available through patient assistance programs offered by pharmaceutical companies. Each company has their own eligibility requirements to obtain your medication free of charge or at a discounted rate.
A very user friendly website, www.needymeds.com, is available to find out if your medications are available through a patient assistance program. they are not able to accept calls, so the internet is the only way you can access this information. If you do not have the internet, a friend, family member or healthcare provider may be able to assist you with obtaining the information.
Pharmaceutical Research and Manufacturers' of America (PhRMA) publishes a "Directory of Prescription Drug Indigent Programs." This is a list of drug manufacturers that offer medications to people who are unable to afford them. You must submit a written request to receive a free copy. The request must be received on a physician, healthcare professional or agency letterhead. Their address is:
Manufacturers' Indigent Drug Program
1100 15th Street, NW
Washington, DC 20005
Or you can visit them online at www.phrma.org. PhRMA also offers www.helpingpatients.org, which allows the patient to answer a series of questions and automatically fills out the appropriate applications for programs offered by one of the 48 participating pharmaceutical companies.
You may also qualify for assitance with obtaining your diabetic supplies. Call Crystal Home Health care & Medical Equipment at 1-800-493-4902 for more information. They provide assistance with obtaining other types of medical equipment/supplies as well.
How can you get Medicare?
Medicare is a health insurance program for the elderly of disabled and is administered by the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services Department (DHHS). Most patients over 65 and some people who have been receiving Social Security disability payments are eligible for Medicaid benefits. Benefits vary and patients should determine, as early as possible, which benefits they are qualified to receive (HHA-SSA Publication No. 05-10029). CMS can explain coverage and eligibility requirements by calling the Medicare Hotline at 1-800-MEDICARE or 1-800-633-4227. You can speak to a Customer Service Representative in English or Spanish. TTY users should call 1-877-486-2048 (Medicare & You, 2004).
You will need to apply for Social Security Disability Income (SSDI) or Social Security Income (SSI) and Medicaid. Once approved, you will receive your first check five months later. Twenty-four months after receiving your first check, you will have the option of enrolling in Medicare. Check with your Social Security Office to determine what benefits you would qualify for and the length of your waiting period. The national number for the Social Security Administration is 1-800-772-1213. After you have been disabled for 24 months, you may qualify for Medicare. The Medicare phone number is 1-800-633-4227.
Were you a member of the armed forces?
If so, the Veteran's Administration may be able to help you with medical expenses. The VA provides hospital care covering a full range of medical services. Outpatient treatment is available for all service connected conditions, or a non-service connected condition in some cases. Questions regarding health care benefits should be directed to 1-800-733-8387 (HHA-SSA Publication No. 05-10029).
What is Medicaid and how can you find it if you qualify?
Medicaid is a federally funded, state regulated program to provide financial assistance in regards to medical expenses for children, the elderly and disabled and pregnant women. Individuals must qualify based on their household income, assets and other limits established by each state. Medicaid can act as a Medicare supplement as well as primary coverage. Information about coverage is available at your local public health or welfare office, State Medicaid Assistance or State Medicaid office.
Keep in mind that you may lose your Medicaid upon receipt of your first disability check. The amount of your disability may put you over the income guidelines. Check with your caseworker to see if a spend-down program is available. A spend-down will allow you to keep your Medicaid benefits, but you will have to pay an amount, deteremined by your caseworker, for your medical care.
If you are in need of assistance with daily activities such as bathing, dressing, light housekeeping, transferring, etc., contact social services to request a community based care screening. If approved you may be able to get an aide in your home to assist you with your daily needs. Depending on what is offered in your state, community based care participation might also include incontinence supplies, transportation and medications. Check with your local Medicaid office for state specific information.
Financial Assistance Programs
When applying for financial assistance, please recognize that many organizations have specific criteria that must be met in order to qualify for financial assistance in an area that you do not need. Be creative in your approach in how to utilize this assistance. For example, you may need financial assistance to pay your health insurance premium, and an organization will provide assistance for your utility bill. Take advantage of the financial assistance for the utility bill and reallocate your money to pay your health insurance premium, if the program permits reallocation.
What should you do about your secured debt?
In general, most organizations will not provide financial assistance for secured debt, such as a mortgage or an automobile. Your best option for this type of debt would be to work direct with the creditor and ask for alternative payment arrangements for the loan, such as refinancing, deferring payments or paying only for interest due. If you cannot get teh creditor to work with you, you may consider selling the item. A home mortgage is usually at risk of foreclosure after three months of delinquency. Typically, mortgage lenders are more cooperative when they are approached prior to foreclosure status.
Do you have credit card bills?
If you find yourself unable to pay your credit card bill(s), contact the creditor to make payment arrangements that involve the most minimal payment you can afford. Be specific in the amount that you are able to afford. If you are unable to establish payment arrangements, contact Consumer Credit Counseling Services for assistance. You can always give them more money each month, but want to make sre you are at least paying teh minimal amount due. Charitable organizations are not likely to assist you with making these payments.
It might be in your best interest to contact a credit counseling center for debt consolidation. They are able to negotiate lower interest rates and payment arrangements. Only contact those companies that are non-profit.
If you have mounting medical bills, do not allow them to go into collections. Contact the billing office of the provider that you owe money, and offer the most minimal payment you are realistically able to make. When negotiating a payment, keep in mind that you are making a binding agreement. You cannot default on your payments, so make sure the monthly amount is feasible for you and your family. You must also realize, when negotiating payment arrangements, that the facility/provider is a business and must be able to collect a reasonable amount. If you are able to make a lump sum payment, that facility may be willing to write a portion of thebalance off.
Don't forget your medical bills while filing your taxes. Medical expenses are tax deductible. Keep all receipts and records of payment. Examples of tax deductible expenses include milege for trips to and from medical appointments, out-of-pocket costs for treatment, prescription drugs and/or equipment and the cost of meals during medical visits (http://usovinfo.about.com/library/weekly/aa061800b.htm).
Having trouble paying your utilities?
Check to see if your state has a Low Income Heating Energy Assistance Program (LIHEAP). Ask the utility company if they have any charity programs available. Call the Department of Social Services in your area to see if they have any information about a Community Action Agency, an organization who can usually assist when a shutoff or eviction notice is given. Ask your doctor to write a letter of medical necessity to the utility company, as they may be more willing to work with you relative toyour condition. Lastly, you may contact the State Utilities Commisioner to request their review of a compassionate appeal. For more information on the LIHEAP program, call 1-202-783-5594.
Your electric company may also have a fuel fund. This is the fund that your neighbors contribute to. Look on your electric bill for the number in your area.
HearShare is administered by the Salvation Army and provides emergency energy assistance on a year-round basis. Funds are used to natural gas, oil, propane, wood, electricity and emergency furnace repairs. For more information, call 1-800-842-7279.
Have prescription coverage, but still can't afford medications?
Managed RX is a program that accepts most major medical insurance as full payment for prescribed medications. If your prescription benefits pays a minimum of 70%, Managed RX accepts that as full payment for teh medication and waives the co-pay. Medications are shipped at no cost to you. Call 1-800-799-8765 for an application.
The PAF Patient Assistance Program provides financial assistance to patients who meet certain qualifications to help them pay for the prescriptions and/or treatments they need. This assistance lets patients who have chronic, life-threatening and/or dibilitating diseases afford the out-of-pocket costs for these items that their insurance companies require.
What is the PAF Patient Assistance Program?
The PAF Patient Assistance Program helps patients with insurance including Medicare and Medicaid. Once approved for the program and depending on the level of help needed, payments are made:
- To the doctor
- To the pharmacy
- To the patient directly
Who is eligible and how to apply?
The PAF Patient Assistance Program offers personal service to all patients through the use of program call counselors. These counselors screen for eligibility by collecting financial and medical information from everyone who calls to apply for the program. Once eligibility has been determined, a comprehensive application will be completed and processed. Patients will be assigned their own call counselorwho will be available to answer any questions during the process. For more information, please call 1-866-512-3861.
What type of assistance can your community offer?
Civic, religious, and fraternal organizations also might offer financial aid or services to assist the patient and family. Groups such as the Salvation Army, United Way, Lutheran Social Services, Jewish Social Services and the Associated Catholic Charities can be found in the yellow pages under "Social Service Organizations." Also, churches and synagogues sometimes provide financial help to their members; however, you do not have to be a member to qualify for assistance with many religious organizations (HHA-SSA Publication No. 05-10029).
If financial aid is not available, these and other organizations may be able to provide transportation to and from the treatment centers, babysitting services and special equipmint and dressings for home care. Services are sometimes available through organizations that are specific to your diagnosis (HHA-SSA Publication No. 05-10029).
Local charities are often willing to provide financial assistance for such needs as clothing, utilities, rent, furniture and other necessities while funding is available. Check your local listings for charitable organizations in your area.
Could you use help with getting food?
If you are having a difficult time affording an adequate amount of food, there are places to turn. Contact your local social services office to apply for food stamps. Food stamps will allow you to purchase food at the grocery store. The stigma of using food stamps has been removed by the implementation of the food stamp debit card program. Those who are eligible for the program will receive a plastic card that is swiped just like a debit or credit card. Almost every community in America has a food bank program. Check your phone book for a list of local food banks.