Financial Requirements for Transplant Medications

Laurie Shore, MSW, LCSW

Transplant Social Worker

(813) 251-8017 X1162

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

Commercial, Private &Supplemental

Patients need to know the terms of their policy Review insurance manual Call insurance company

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?

Medicare Eligibility

Most patients with ESRD are eligible for Medicare Part A beginning Hemodialysis – 4th month of treatment Peritoneal Dialysis & Transplantation –

1st 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

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

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

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

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 $200-500 per month

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.

                   

Financial Options

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

Questions