5 ways to reduce Medicare out-of-pocket costs

| Katherine Southwick

More than 1 percent of the 8.3 million Americans living with psoriatic disease have Medicare as their health insurance. 

Needless to say, NPF's Patient Navigation Center receives many questions about how to navigate Medicare. People come to us for help understanding their coverage, to find plan options and for help affording their prescriptions. In fact, more than 35 percent of our insurance-related work involves helping people who have Medicare health plans.

One of their top concerns is the amount they have to pay for their treatments (called “out-of-pocket costs”). For a number of reasons, people with Medicare are likely to have high out-of-pocket costs, which many are unable to afford.

Here are five ways we help people with Medicare reduce their out-of-pocket costs:

1. Conduct a benefits investigation

If your out-of-pocket treatment costs are high, the first thing we do at the Patient Navigation Center is investigate your benefits so that we can better understand how your prescriptions are being billed to your insurance. By assessing the relationship between your insurance coverage and your out-of-pocket costs, we’ll be able to make an effective game plan to reduce your costs.

2. Explore eligibility for Medicare assistance programs

We’ll then explore your eligibility for a number of assistance programs within Medicare that can help lower your treatment costs, like Medicare Extra Help and Medicare Savings Programs.

3. Explore other assistance programs

If you don’t qualify for a Medicare assistance program, the next thing we can do is find the patient assistance program offered by your treatment’s manufacturer. Each program has its own qualifying criteria. If we identify one that can help you, we’ll send you the application and help you complete it. We’ll also let you know if any private foundations or funds are currently offering grants to help people with psoriatic disease lower their treatment costs.

4. Locate state resources

Some U.S. states run special State Pharmaceutical Assistance Programs (SPAPs), which help people with Medicare obtain additional assistance when paying for their prescription treatments. If you live in a state that has an SPAP, we can help you apply.

5. Help you switch plans or purchase supplemental insurance

Finally, if the Medicare plan you are currently enrolled in is not adequately covering your health care and treatment costs, it’s time to make a change. How exactly do you change to your coverage? Well, you’re in luck! The Open Enrollment period for Medicare began on Oct. 15 and ends on Dec. 7. This is the only time during the year when you are able to make changes to your Medicare plan and your prescription drug coverage.

If you are planning on making changes to your Medicare coverage, the first thing we can help you do is calculate your real out-of-pocket costs for the coming year. This will help us determine which options, whether it’s switching plans or purchasing a supplement, are best for you.

To get started, request a free Health Insurance Quick Guide. This guide outlines specific information to help you assess your health care needs for the upcoming year, compare Medicare plans and select the best Medicare plan to reduce your out-of-pocket costs.

You can also ask us a question, email us, or call 1-800-723-9166 (option 1) to talk to a Patient Navigator.

Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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