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Topic: Medicare- what to do??

Forum: Employment, Insurance, and Other Financial Issues —

Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Mar 7, 2021 12:26PM - edited Mar 7, 2021 12:27PM by Emmy0212

Emmy0212 wrote:

Hi everyone,

My mom was recently diagnosed with stage 2 triple negative breast cancer. As if the emotional impact of the diagnosis wasn't enough, we have no idea how we are going to pay for the cost of treatment. My mom is 58 years old and is on disability. This being the case, her insurance is Medicare and they will cover 80% of her treatment, but she has to cover the remaining 20%. There is no out of pocket maximum. By my calculations, she is going to be in an ENORMOUS amount of debt by the time this is all over. As a family who lives paycheck to paycheck, there is no way we can afford this. Do we have any options? It looks like medigap isn't an option unless you are 65.



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Mar 7, 2021 12:51PM MelissaDallas wrote:

Emmy0212, sorry about your Mom.

I would make an appointment with a social worker at the hospital. They are really good at helping line up assistance or discounted billing.

As far as Medigap policies, they are available in my state for people on disability but under regular Medicare age, but they are very expensive. My cousin had to drop his because he would have been spending almost all his disability payment for the insurance. These policies are priced very differently than “regular” Medigaps

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor. Dx 5/20/2012, LCIS, Stage 0, 0/0 nodes
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Mar 7, 2021 02:52PM Moderators wrote:

Hi Emmy0212, MelissaDallas's suggestion to talk with the social worker is excellent. Please take a look at our section also on Paying for Your Care. For instance, most pharmaceutical companies have programs to help with costs. Please keep us posted, and let us know if we can help guide you or your mom.

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Mar 7, 2021 04:57PM AliceBastable wrote:

If your mother gets treatment at a teaching hospital or one affiliated with a religious organization, they may have sliding scale fees. MelissaDallas' suggestion is excellent.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Boring. Hope it stays that way. Dx 5/2018, ILC, Left, 2cm, Stage IA, Grade 1, 1/1 nodes, ER+/PR+, HER2- Surgery 7/11/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/8/2018 Radiation Therapy 10/29/2018 Whole-breast: Breast, Lymph nodes
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Mar 7, 2021 06:31PM Emmy0212 wrote:

Thanks for your responses everyone! I have reached out to the social worker and am waiting on a response. I really hope they can help in some way, or unfortunately we may not be able to continue with my moms treatment. Treatment is slated to include AC+T, lumpectomy and radiation.

Another question. My dad gets health insurance through his job and his open enrollment period is coming up. My parents were thinking of adding my mom to his plan, but could she be denied because of her pre-existing condition?

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Mar 7, 2021 08:54PM MelissaDallas wrote:

More than likely she cannot be declined for a group plan during open enrollment

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor. Dx 5/20/2012, LCIS, Stage 0, 0/0 nodes
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Mar 17, 2021 03:26AM sbelizabeth wrote:

I second MelissaDallas. I would be very surprised if his employer was allowed to deny her enrollment based on her pre-existing condition.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIB, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Mar 17, 2021 04:01AM illimae wrote:

Could you try an ACA plan for supplemental insurance? Perhaps they have a specific department that can provide assistance or other options? Also, check with her oncologist and hospital’s financial dept., they may have financial aide or prescription programs to help with those costs.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/2/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/2/2017 Herceptin (trastuzumab) Targeted Therapy 1/2/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/20/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/23/2019 External: Brain Surgery 1/22/2020 Radiation Therapy 2/17/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)

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