Avoid Double Financial Jeopardy for New Medicare Enrollees
Rae
State: Colorado
Congressional District:
Diseases
Blood Disease, Immune Disease, Rare Disease
Issues and Challenges
Rae has encountered: Access to Expert Providers, Access to Medicine, Copay Issues, Insurance Issues, Medicare / Medicaid Issues, Rare / Underserved Disease, Financial Assistance, Invisible Illness, Transparency in Health Care, Underserved Community
My Story
A fix is Needed to Avoid Double Financial Jeopardy for New Medicare Enrollees
People with chronic and rare diseases often rapidly sail past their health plan deductible and reach
maximum Out Of Pocket (OOP) expenses within the first few months of the plans’ annual renewal. This
happens year after year depleting precious financial resources many are not able to replenish because of
ill health, caregiving responsibilities and fixed incomes.
Through my involvement with the International Myeloma Foundation and Patients Rising community I
have met more than a few fine people who feel overwhelmed by their financial responsibilities and the
complexity of the system. It is no wonder that exorbitant medical bills account for 40% of personal
bankruptcies and are the leading cause of filings in the US. While a sliver bullet to solve this issue
remains elusive I have discovered an opportunity to fix one problem that would allow welcome financial
relief and correct an issue related to fairness.
In 2024, at age 65, I qualified for Medicare and duly signed up with my plan set to start on May, 1st.
Because of regular laboratory tests and expensive medication of $17,000 every 28 days, I anticipated
meeting my market place insurance maximum OOP expenses, of $8,700, by the end of April. Then, in
May, I would get the opportunity to do it all over again by meeting the Medicare Part B Deductible of
$240 and the Part D maximum OOP expenses of $8,000, taking me to the Catastrophic Coverage phase.
All for standard care to monitor and maintain my multiple myeloma remission.
As it happened, the silver lining from a bout of pneumonia at the beginning of the year, resulted in taking
a break from Revlimid, the expensive drug used for maintaining remission. A dispute over reimbursement
between my insurer and our rural healthcare facility eventually resulted in forgiveness of some pending
bills. Once on Medicare, my first prescription was covered, in part, by a foundation grant then the
manufacturer chipped in 70%, due to one time legislation for 2024. This year, after all of the concern, I
ended up paying about one quarter of my potential financial liability. Through a stroke of luck, the
kindness of others, and an obscure piece of legislation, I came through relatively unscathed.
How is it that people transferring to Medicare are exposed to serious financial jeopardy twice in one
year? A simple solution to this unfair practice would be for new Medicare enrollees to get credit for
payments already made to their previous health insurer in the year of Medicare enrollment. Insurer’s are
already alerted when when patients make this change. Automatic reporting by insurers directly to
Medicare by sharing of Explanation of Benefit statements (EOBs) would be one way of achieving this
and creating parity with market place healthcare plans.
My Motivation and Inspiration
Fairness and compassion with an eye toward realistic financial goals.
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