Choosing the right Medicare options for your infusion or specialty therapy

As we’re getting well into the Medicare Open Enrollment period, which closes Dec. 7, 2023, now is the time to ensure you have all the information to make these important and potentially life-altering decisions and elections for the 2024 coverage year. 

It is incredibly important to evaluate the effectiveness and appropriateness of current insurance benefits to determine if a change or adjustment is needed or warranted going forward. 

Did your benefits serve your healthcare needs well? And, most importantly, how did this plan impact your wallet and budget? 

Each year, a thorough re-evaluation should be completed because insurance companies make changes to Medicare plans that can impact your out-of-pocket costs significantly. These changes can include monthly premiums, deductibles, drug costs, and provider or pharmacy networks. 

Unfortunately navigating the complex and often disjointed healthcare and insurance system can be overwhelming. With all of the different choices, it can be confusing to understand what type of insurance you have, how it works in new and different situations–like infusion therapy–and how to go about making better choices and changes when anticipating the new year. 

“An informed patient is an empowered patient, and when people know better, they can do better.”
– Patient Advocate Chrissie Jenkins, LISW-CP 

Prioritizing healthcare literacy is crucial for enhancing healthcare outcomes, satisfaction, and overall well-being. Often, healthcare plans do not cover all expenses associated with infusion and specialty drug therapy, leaving individuals in distressing and alarming situations due to unforeseen additional costs. 

So, how should you determine what coverage you need this year for your specialty or infusion therapy? 

Assess Current Health Status: 

• Reflect on your health over the past year and any changes in your condition requiring infusion therapy. 
• Evaluate the frequency and type of infusion therapy you received, along with any new medications. 

Review Previous Medicare Coverage: 

• Examine your Medicare coverage from the previous year. Identify any gaps or limitations in coverage for infusion therapy. 
• Understand how Medicare Part B (Medical Insurance) or Part D (Prescription Drug Coverage) covers your specific medications and treatments. 

Consult Healthcare Providers: 

• Schedule a discussion with your healthcare providers, including those administering infusion therapy, to discuss the anticipated treatments for the upcoming year. 
• Inquire about any changes to your treatment plan and how it aligns with Medicare coverage. 

Understand Treatment Costs: 

• Research the costs associated with your infusion therapy, considering Medicare copayments, deductibles, and any potential out-of-pocket expenses. 
• Explore if you qualify for any assistance programs for additional financial support. 

Check Network Providers: 

• Confirm that healthcare providers involved in your infusion therapy accept Medicare assignment to maximize coverage benefits. 
• Understand any requirements for pre-authorization or referrals. 

Seek Assistance: 

• Seek guidance from a Medicare counselor, insurance professional, or healthcare navigator to help you understand and choose the most suitable coverage for your infusion therapy needs. 
• Jenkins provides insurance optimization information, as well as refers patients to State Health Insurance Assistance Programs (SHIP) where Medicare-certified staff provides unbiased help to Medicare beneficiaries, their families, and caregivers so they can elect the qualified plan that best serves their individual healthcare needs and budget. 

Additionally, Palmetto Infusion’s Patient Advocate and Patient Services team work diligently to seek out potential funding through various sources to offset some of these costs when applicable. Unfortunately, the demand for these limited funds and grants through CPAP (Charitable Patient Assistance Programs) are outpacing the supply, so it is not a guarantee from year to year. 

We strongly encourage patients to arm themselves with crucial knowledge about their insurance options going into this new year so that they can be better prepared to address healthcare needs and combat costs that may unpleasantly and unexpectedly arise. 

WATCH BELOW: Palmetto Infusion Patient Advocate Chrissie Jenkins, LISW-CP and Medicare Benefits Counselor and Pharmacist Jerilyn Arneson, PharmD, BCOP break down the complexities of Medicare options, offering essential tips and tools specifically tailored for those undergoing infusion or specialty therapy treatments in this webinar.