Transcript Transplant Plan

Financial Requirements for
Transplant Medications
Laurie Shore, MSW, LCSW
Transplant Social Worker
(813) 251-8017 X1162
Medication Coverage &
Insurance
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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
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Patients need to know the terms of their
policy
 Review insurance manual
 Call insurance company
Insurance Policy Inquiry
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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
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Most patients with ESRD are eligible for
Medicare Part A beginning
 Hemodialysis – 4th month of treatment
 Peritoneal Dialysis & Transplantation – 1st
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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
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Patients must have Medicare Part B for
anti-rejection medications to be covered
at a percentage
Medicare Part B covers 80% of antirejection 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
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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
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Patient options when lacking 20%
coverage:
 Self pay
 Spousal Insurance
 Medicaid
 Medicare Supplement
 Employee Group Health Plan
Questions