An Update From the States

An Update from the States

In an ongoing effort to keep you up to date on the many proposed and approved changes to our health care system and how they might impact the cancer community, this week, we bring you updates from around the country. If you don’t live in one of these states, be aware, these changes could come to your state next. 

Medicaid News:

Do you have Medicaid coverage? You can now access the services included in Amazon Prime for a discounted fee of $5.99 a month, less than half the regular cost of $12.99 a month. Access to Prime services, including free expedited shipping, can be particularly useful for someone who is treatment. Instead of having to go grocery shopping or running other errands for household items, Amazon Prime can deliver those items to your doorstep for free. Amazon also now offers electronic benefit transfer (EBT) cards, which are used for food stamp benefits.

Other National News:

In the recent Bipartisan Budget Act of 2018, passed by Congress on February 9th, there were several changes made to our health care system that may be helpful and challenging for the cancer community:

  1. It provided two additional years of funding to State Health Insurance Assistance Programs (SHIP) and Area Agencies on Aging, which are two valuable resources that help seniors manage their Medicare coverage and get access to other programs and services.
  2. It eliminated the Medicare cap on access to outpatient physical, occupational, and speech therapy services as of January 1, 2018.
  3. It closed the Medicare Part D donut hole one year earlier in 2019, lowering the cost of prescription drugs for people with Medicare.
  4. It also changed the way that Medicare pays for home health services beginning in 2020. The home health coverage will be reduced from 60 days to 30 days and therapy thresholds will be eliminated. Beginning in 2019, Medicare will be allowed to base eligibility for home health services on a review of a patient’s medical record, including a home health agency’s record.


The Hawaii House has approved a bill that would allow physicians to prescribe life-ending medication to terminally ill patients. The bill now moves to the Senate, which approved a similar bill laws year. If approved, Hawaii would join California, Colorado, Oregon, Vermont, Washington, and the District of Columbia, which have death with dignity laws. Click here for more information about state laws.


A few weeks ago we shared that the Idaho Governor announced that he will allow insurance companies to sell plans in violation of the Patient Protection and Affordable Care Act (ACA). The ACA required health insurance plans to meet certain minimum requirements in order to protect consumers from pre-existing condition exclusions and annual and lifetime limits, while ensuring coverage of essential health benefits.

This past week, the Trump Administration did reject Idaho’s plan to sell plans in violation of the ACA.  Many other states had been closely watching this decision, as they also were looking at allowing plans without the ACA consumer protections. The cancer advocacy community was pleased to see that these consumer protections wouldn’t be ignored. However, the Administration did suggest to Idaho that they instead promote the sale of short-term insurance plans. Click here for more information on these plans.


The Iowa Senate voted last week to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans that don’t comply with the ACA, allowing people with pre-existing conditions to be denied or charged more for coverage.  Given the Administration’s rejection of Idaho’s plans, it is likely that Iowa will not be able to move forward with the sale of these plans.


There was a question as to whether or not Arkansas’ legislature was going to keep their expanded Medicaid program. However, lawmakers did vote to keep the program that covers 285,000 people in Arkansas another year.

In addition, the Trump Administration has approved Arkansas’ request to add a work requirement to their Medicaid program, joining Indiana and Kentucky as states that have added this new requirement. There are seven other states that have submitted applications for a Medicaid work requirement and 14 other states that are considering it.

Stay tuned for the latest news  . . .

Medicare Enrollment Periods – Do You Know the Difference?

More than 58 million people in the United States are enrolled in Medicare. But there is still medicare
a significant amount of confusion about how and when to make Medicare coverage choices. For information about the basics of Medicare and its different parts of coverage, read our Quick Guide to Medicare.

There are 4 separate enrollment periods that are important to getting access to Medicare coverage.

  1. The initial enrollment period happens once – when you are first eligible for
    Medicare. And, generally, it lasts 7 months (the 3 months before your 65th birthday, the month of your 65th birthday, and 3 months after your 65th birthday). If you are eligible for Medicare because you have received SSDI benefits for 24 months, your Medicare will begin in your 25th month of receiving SSDI benefits.
  1. And, each year, from October 15 to December 7, you can make changes to your Medicare coverage, which will begin on January 1. This is called the open enrollment period.
  1. If you are over the age of 65, but are still working, you have a special enrollment period of 8 months after your employer-sponsor group health plan or your retirement plan coverage ends.
  1. And finally, if you do not sign up for Medicare when you are first eligible during your initial enrollment period or your special enrollment period, then you can still enroll in Medicare, but you have to wait until the general enrollment period. The general enrollment period occurs each year from January 1 to March 31. Individuals can sign up for Part A and B during this time frame. Once enrolled in Part A and Part B, between April 1 and June 30, individuals can add a Part D plan or move to a Part C plan. However, even if you sign up for coverage on the first day of the general enrollment period, you still have to wait until July 1, for your coverage to begin.


And, because you didn’t sign up for Medicare when you were first eligible, you will likely have to pay a late enrollment penalty:

  • Part A: you must pay a 10% penalty for twice the number of years you were eligible, but didn’t sign up.
  • Part B: you must pay a 10% penalty for each full 12-month period you were eligible, but didn’t sign up. You must pay this penalty on your Part B premium for life!
  • Part D: you must pay a penalty of 1% of the national base monthly premium, times the number of full months you were eligible, but didn’t sign up. You must pay this penalty on your Part D premium for life!

Part B Penalty Example:

David’s initial enrollment period ended August 31, 2015, but waited to sign up for Part B until the general enrollment period in February 2018. David waited 30 months to sign up, but this only included 2 full 12-month periods. (2 full 12-month periods x 10% = 20% penalty). David will pay a 20% penalty, in addition to his monthly Part B premium, for life!

Waiting to enroll in Medicare coverage can cost you a lot over time, so it is important to understand your options. For more information about Medicare enrollment and penalties, visit

Is Short-Term Insurance the Solution?

Last week, we shared a number of changes that states are looking to make to our health Short term health insurance policy on a table. care system. This week, we bring you a major change that has been proposed nationally.

Short-Term Insurance Plans

First, the U.S. Department of Health and Human Services (HHS) has released a proposed rule to allow the sale of short-term health insurance plans with coverage for any period less than 12 months.

Short-term health insurance plans are plans that only provide coverage for a certain period of time, less than a year. These plans were only intended to provide coverage for people who were between jobs or needed temporary coverage for other reasons.

These plans are not required to comply with the ACA’s consumer protections, which means that they can deny people with pre-existing conditions, can require people to complete medical questionnaires on the application, can charge people more because of an individual’s health history, and do not have to cover essential health benefits.  For example, a plan could exclude mental health care, preventive care, substance abuse treatment, or maternity care. They also are not required to have an out-of-pocket maximum, which means that people with serious medical conditions like a cancer, will pay significantly more for their medical expenses.

Because they don’t have to comply with these consumer protections, these plans are often referred to as “junk insurance.” These plans generally appear cheaper than other individual health insurance plans. The lower monthly premiums make them attractive for people who are healthier.  However, cancer is unpredictable.

The other challenge with these short-term plans, is that when they end, they do not have ‘guaranteed renewability.’  This means that an insurance company does not have to offer an individual a new policy when the term of coverage ends.  Furthermore, because these plans do not comply with the ACA, they are not creditable coverage. So when they end, it does not trigger a special enrollment period to buy a plan in the Health Insurance Marketplace. If no other coverage is available (e.g., going on a parent’s plan if they are under 26 years old), someone who has been diagnosed with cancer may have to wait for coverage until the next open enrollment period.

HHS’s previous rule from 2016, limited these short-term insurance plans to a maximum of three months. HHS is now allowing these plans to last for any time period up to 12 months, meaning that they can last up to 364 days.

Advocates have three main concerns about this change:

  1. Unsuspecting consumers who are healthier will leave the Marketplace to buy these cheaper plans, which will drive up the costs of plans in the Marketplace
  2. If these healthier individuals are diagnosed with serious medical conditions, they may find they are not adequately covered by their short-term plan and may lose access to insurance when their term ends
  3. People with pre-existing conditions won’t be able to purchase these cheaper short-term plans, which means they will be stuck in the marketplace with more expensive plans

While expanding access to these short-term plans does increase the number of options available to consumers, there is a concern that the expansion of these plans allows insurance companies to do another end run around the consumer protections laid out in the ACA, ultimately leaving consumers with less coverage and more cost.

People have until April 23, 2018, to comment on this proposed rule, and then HHS will release a final rule at some point after that. We will keep you posted. Stay tuned.

Heart Health After Cancer

In February, we celebrated American Heart Month and as part of our core values, we’re happy to raise awareness not only about heart health, but how issues with your heart can affect life after cancer treatment.

Did you know that heart disease is the leading cause of death for men and women in the hearthealthUnited States? Every year, 1 in 4 deaths are caused by heart disease.

Living a heart-healthy lifestyle can be incredibly important when you’re faced with difficult traumas like treatment for cancer. According to a new report from the American Heart Association, certain cancer treatments may take a toll on the heart, but there are certain precautions you can take to protect your heart before treatment. “From the start, women [and men] should have their cardiovascular health evaluated,” Dr. Richard Steingart, chief of cardiology service at Memorial Sloan Kettering Cancer Center said. “Then, they and their doctors should try to get any heart disease risk factors under the best control possible.” It’s incredibly important to talk with your health care team if you’re concerned about how treatment may affect your heart.

“When it comes to chemotherapy, any effects on the heart typically show up in the short term and can be detected during treatment,” said Steingart. The report also suggested that in some cases, women might need a break from their cancer treatment to see whether any heart effects reverse. If they don’t then the treatment plan may need to be changed.

It’s important not only to focus on your heart health during treatment, but after as well. Side effects from treatment can arise long after treatment has been completed.  You should talk with your oncology team and your primary care team to ensure that you are receiving appropriate health screenings moving forward.

On March 13, Triage Cancer is hosting a free webinar on Cancer Survivorship Care Plans & Late Effects. Cancer Survivorship Care Plans can be valuable tools to understand the cancer treatment you have received and how it impacts your ongoing follow up care after cancer treatment is completed. The webinar discusses the elements of an effective care plan, shares ways to access plans, explains long-term and late-term side effects that some cancer survivors may experience, and provides information on screening options related to those side effects.

You can also take steps towards living a heart-healthy lifestyle by joining the American Heart Association’s national movement in support of healthier communities and healthier lives.

You can watch these Triage Cancer webinars on nutrition and exercise.

Putting plans into action for caring for your heart after treatment is essential to your health.

How States are Changing Health Insurance Rules

In an ongoing effort to keep you up to date on the many proposed and approvedhealth insurance
changes to our health care system and how they might impact the cancer community, this week, we bring you updates from around the country. If you don’t live in one of these states, be aware, these changes could come to your state next.

National News:

Two weeks ago, we reported that 11 states have applied for waivers to make some individuals work, in order to get access to health care through Medicaid. Since then, Kentucky and Indiana’s waivers have already been approved by the Center for Medicare and Medicaid Services and those states are moving forward with implementing plans for a Medicaid work requirement. Click here to learn more about the impact of the Medicaid waivers and to see what the states are asking for in their waivers.

In addition to work requirements, five states have also asked the U.S. Department of Health & Human Services if they can place a lifetime cap on how long an individual can receive Medicaid coverage. For example, Arizona, would like to place a 5-year lifetime cap on coverage. Kansas, Utah, Maine and Wisconsin are also seeking to impose lifetime caps.

This would be a substantial change to the Medicaid program, since signed into law under President Truman in 1965.  More than 68 million people receive Medicaid coverage, including children, seniors, and people with disabilities.  HHS has not released any guidance on this issue, to date.


Ohio has now joined Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi (still in process), New Hampshire, North Carolina, Utah, and Wisconsin, in asking for permission to add a work requirement to their Medicaid program. The work requirement would begin July 1, 2018, if approved in time.

Ohio has also asked the federal government for permission to not comply with the individual mandate. This will likely have no actual impact, as Congress reduced the penalty for not purchasing health insurance to $0, in the latest tax bill. The $0 penalty will begin in 2019, which means that those who don’t have health insurance in 2018 will still be responsible for the penalty!

Rhode Island:

Rhode Island is also making cuts to its Medicaid program, which covers more than 300,000 people. Individuals will be required to pay co-pays when receiving health care services or prescription drugs.  However, there will be an annual cap on co-pays equal to 6% of an individual’s income.


Idaho announced last week that they will allow insurance companies to sell plans in violation of the Patient Protection and Affordable Care Act (ACA). The ACA required health insurance plans to meet certain minimum requirements in order to protect consumers from pre-existing condition exclusions and annual and lifetime limits, while ensuring coverage of essential health benefits. Insurers argue that providing this quality coverage is more expensive and that is why plans sold in the Health Insurance Marketplace can be more expensive.

Idaho’s approach to bring down the cost of insurance is to allow plans to offer less coverage and to exclude people with pre-existing conditions. This directly violate the law. It will be up to HHS to enforce the law or allow Idaho to continue offering these illegal plans. There are many other states waiting to see how HHS will react.

Blue Cross of Idaho has already unveiled five new plans that don’t comply with the ACA, including having annual caps on coverage and pre-existing condition exclusions for up to 12 months.

Advocates have three concerns about this approach:

  1. People who are healthier will leave the Marketplace to buy these cheaper plans, which will drive up the costs of plans in the Marketplace
  2. If these healthier individuals are diagnosed with serious medical conditions, they will find they have inadequate coverage
  3. People with pre-existing conditions won’t be able to purchase these cheaper plans, which means they will be stuck in the marketplace with more expensive plans

This turn of events is very concerning for the cancer community, as it allows insurance companies to do an end run around the ACAs protections for people with pre-existing conditions.

Congress Takes Steps to Undermine the ADA

Many have heard of the Americans with Disabilities Act (ADA), but may not know all of the details. The ADA is the federal law that protects people with disabilities from discrimination in a variety of ways.

The ADA was passed by Congress in 1990, more than 28 years ago.  Congress improved protections in the ADA in 2008 by passing the ADA Amendments Act.  Most people are familiar with its physical access requirements, such as having accessible parking spots, ramps into buildings, and accessible restrooms. However, despite its age, many who are protected by the ADA, don’t know it.

In addition to physical access requirements, the ADA also provides protections for people with disabilities in the workplace.  Title I of the ADA requires that covered employers provide eligible employees with protection against discrimination and rights to privacy, as well as access to reasonable accommodations. For more information about these protections and how they apply to individuals diagnosed with cancer AND their caregivers, visit:

The ADA also provides protections for children, adolescents, and young adults with disabilities in school, including those diagnosed with cancer.

Approximately 36% of adults ages 65 and over have some type of disability. Learn 7 facts about Americans with disabilities.

This month, Congress took a step to erode the protections in the ADA.  The U.S. House of Representatives passed (252-192) the ADA Education and Reform Act, which forbids individuals with disabilities from suing a business for violating their rights under the ADA, unless they first:

  1. Provide written notice to the business that they are in violation of the ADA
  2. Wait 6 months to see if the business fixed the violation

Opponents of the bill argue that this allows businesses to refuse to comply with the ADA, until an individual with a disability sends them a written complaint and then they get another 6 months to comply. Meanwhile, the individual with a disability is unable to access that hospital, doctor’s office, restaurant, store, movie theater, hotel, or other public place.

Advocates for people with disabilities are skeptical that businesses need more time to comply with a law that was enacted almost thirty years ago.

In what other area of society do we allow a business to ignore a law until someone sends them a written complaint?

Oh, wait.  That sounds a lot like health insurance appeals.

The bill now awaits a vote in the U.S. Senate. For more information about how to be an effective advocate, visit Stay tuned.




Triage Cancer Joins the Metastatic Breast Cancer Alliance!

Metastatic Breast Cancer Alliance

Triage Cancer is proud to announce that we are a new member of the Metastatic Breast Cancer Alliance! We are committed to providing education and support in an effort to ensure that the metastatic breast cancer community has access to crucial information about practical issues to improve their quality of life.

What is MBC?

Metastatic breast cancer (MBC) is cancer that originated in the breast but has spread to other parts of the body, such as liver, lung, bones and brain. MBC is the cause 40,000 deaths every year in the U.S. Learn more about MBC.

MBC Alliance Mission

Triage Cancer believes that collaboration is the key to providing valuable information and practical tools on the many issues that arise after a cancer diagnosis, particularly to underserved members of the cancer community. In alignment with our goals, the MBCA’s mission is to:

Unify the efforts of MBC Alliance members to improve the lives of, and outcomes for, those living with metastatic breast cancer and their families through increasing awareness and education about the disease and advancing policy and strategic coordination of research funding – specifically focused on metastasis – that has the potential to extend life, enhance quality of life and ultimately
to cure.”

One of the resources offered by the MBC Alliance is the Metastatic Trial Search, which is the first-ever clinical trial search engine designed specifically for people with MBC.

Metastatic trial search

Triage Cancer Resources & Tools

As a member of the MBC Alliance, we are committed to providing up-to-date and relevant resources to those coping with MBC. We offer a number of educational resources that have particular relevance to the metastatic community, such as our Quick Guides on disability insurance, clinical trials, and estate planning. Click here to watch our recent webinar on Taking Time Off Work & Disability Insurance.

Given the long-term treatment that many in the metastatic community receive, the financial burden can be significant. Triage Cancer hosts, which provides tailored information on topics that can have an impact on finances after a cancer diagnosis.

We also offer a number of free educational events throughout the year, which cover topics that pertain to the metastatic community:

Triage Cancer looks forward to working with the Alliance to continue to support the MBC community. For more information about the Metastatic Breast Cancer Alliance, visit

Medicaid Work Requirements & the Cancer Community

There has been discussion in the news over the last few weeks about the President’s decision to allow states to require that people “work” in order to receive Medicaid. This is referred to as the Medicaid work requirement. We want to break down these changes for you and how this might impact the cancer community.

If you live in one of the states that is about to make changes to its Medicaid program, you should definitely keep reading.

What is Medicaid?

Medicaid is the federal health insurance program that covers more than 74 million individuals who have a low income, low resources, and meet some other category of eligibility, such as being a senior, a minor child, or having a disability (receiving Supplemental Security Income (SSI)). In 2014, the Affordable Care Act expanded access to Medicaid to all adults with an income level up to 138% of the federal poverty level ($16,753 for an individual in 2018).  Eliminating the low resource requirement and the requirement to be receiving Supplemental Security Income, made it much easier for someone with a cancer diagnosis to get access to Medicaid coverage, and ultimately get access to care.

While Medicaid is a federal program, it is administered by both the federal government and states. Since 2014, 32 states have expanded access to their Medicaid program under the ACA.

There is a lot of discussion about the number of people who receive Medicaid, but don’t work, and whether or not that is fair. Those who are in favor of work requirements for Medicaid believe that “able-bodied” adults should be working if the federal government is going to pay for their health insurance coverage.

Those who are opposed to work requirements are concerned how they might impact people who are unable to work for a variety of reasons or who live in communities where work is difficult to find. Advocates are concerned that the additional administrative requirements will cause people to lose vital coverage, that people will be discouraged from applying for coverage, and that the number of uninsured people will start to rise again.  One of the many benefits of lower numbers of uninsured individuals was that it decreases the amount of uncompensated care that hospitals provide. When hospitals have high levels of uncompensated care, they are more likely to close, which impacts access to care for everyone.

Who Receives Medicaid?

According to an analysis by the Kaiser Family Foundation, most Medicaid and CHIP enrollees would be actually be automatically exempt from the requirement because of their age or disability status.

Medicaid Work Requirements & the Cancer Community

What are the New Medicaid Rules?

In January, the Trump Administration announced its decision to make significant changes to the Medicaid program, by allowing states to apply for waivers to impose work requirements on Medicaid enrollees in their state. The Centers for Medicare and Medicaid Services (CMS) released rules for the states who want to apply for those waivers.

The rules forbids states from imposing work requirements on certain populations, such as the elderly, minor children, individuals who are pregnant, and those receiving SSI.

CMS also requires states to exempt individuals who are “medically-frail.” CMS defines “medically frail” as those who have “disabling mental disorders; chronic substance abuse disorders; serious and complex medical conditions; physical, intellectual, or developmental disabilities that significantly impact the ability to perform one or more activities of daily living; and those who meet Social Security disability criteria.”

While CMS does remind states to consider how some communities have high unemployment rates due to economic factors, it gives states significant flexibility to design their own requirements. CMS also suggested that states could allow for “community engagement” alternatives to work, such as job search, job training, volunteering, community service, or education.

Work requirements are likely to have an impact on everyone receiving Medicaid in a particular state, because everyone will have to document that they meet the requirements. And, the CMS rules allow for states to ask enrollees to certify they are still eligible as often as monthly.

Which States Want Medicaid Work Requirements?

These eleven states have already applied for waivers to add work requirements: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi (still in process), New Hampshire, North Carolina, Utah, and Wisconsin.  Additional states are considering submitting requests.

Medicaid Work Requirements

Since the CMS announcement, Kentucky and Indiana’s waivers have already been approved and those states are moving forward with implementing plans for a Medicaid work requirement.

Click here to learn more about the impact of the Medicaid waivers and to see what the states are asking for in their waivers.

What is in Kentucky’s Waiver?

Kentucky’s waiver requires people to work 80 hours a month, or alternatively to engage in job searching, job training, community service, or education. Drug treatment and caregiving for a non-dependent relative or another person with a disabling medical condition are also considered work activities.

Kentucky Medicaid enrollees can obtain an exception to the work requirement if they can verify one of the following during their month of noncompliance with the work requirement:

  • Disability, hospitalization, or serious illness of enrollee or immediate family member in the home;
  • Birth or death of a family member living with the enrollee;
  • Severe inclement weather including natural disaster; or
  • Family emergency or other life-changing event such as divorce or domestic violence.

A primary caregiver of a dependent minor child or adult with disabilities per household is also exempt.

In addition to the medicaid work requirements, the waiver also establishes premiums, deductibles, benefit restrictions, and six-month coverage lock-outs, while eliminating non-emergency medical transportation.

Also included in Kentucky’s waiver is the elimination of the 3-month retroactive coverage for most adults, including those who are medically frail. This was very useful for someone diagnosed with cancer, so that they could start receiving care while their Medicaid application was being processed.

To read a breakdown of Kentucky’s waiver, click here. These changes are set to begin being phased in on April 1, 2018.

However, advocacy groups in Kentucky have filed a lawsuit to stop the implementation of Kentucky’s waiver. Kentucky Governor Matt Bevin has signed an executive order stating that if the court does stop the work requirements, that the Governor will eliminate the expanded access to Medicaid in Kentucky entirely. This would result in 48,000 people in Kentucky losing access to their health insurance coverage.

What is in Indiana’s Waiver?

Indiana’s waiver was approved on February 2, and requires adult enrollees to work an average of 20 hours a month and it is phased in over time. It also has a long list of exemptions and alternatives to employment. In addition to the work requirement, Indiana will also implement a “lockout” provision.  Medicaid enrollees who fail to submit their paperwork showing that they still qualify for the program, will be blocked from coverage for three months. Click here to read Indiana’s Medicaid waiver.

More Information

Triage Cancer will continue to follow the changes to state programs and how those changes might impact the cancer community and share that information on our blog.  Stay tuned.

Changes Coming to Medicare

There are a number of changes coming to Medicare. Individuals who are already enrolled and new enrollees should both be aware of these Medicare changes.

A New Medicare Card

Sometime between April 2018 and April 2019, you will be receiving a new Medicare card that will not have your Social Security number on it. The cards will have Medicare Changesa new Medicare Number on them, which will be unique to you. This change will keep your Social Security number more secure, and help protect your identity.

The Social Security Administration is asking you to make sure that your mailing address is up to date.  If you do need to update your address, you can do so by calling 1-800-772-1213 or at They are also warning you to be aware of anyone contacting you about your new card.  The Social Security Administration will never call you and ask you for private information to get your card.  And finally, don’t worry if your neighbor gets their card before you do.  It will take some time to mail our cards to every Medicare member.

2018 Medicare Costs

For 2018, the Medicare Part B Deductible will be $183.  The Part B Standard Premium will be $134 or higher, depending on your income (see chart).  However, most people who get Social Security benefits pay less than this amount ($130 on average). You pay the standard premium amount of $134 (or higher based on the chart below) if:

  • You enroll in Part B for the first time in 2018.
  • You don’t get Social Security benefits.
  • You’re directly billed for your Part B premiums.
  • You have Medicare and Medicaid, and Medicaid pays your premiums.
  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.
If your yearly income in 2016 was You pay (in 2018)
File individual tax return File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less Your plan premium
Above $85,000 up to $107,000 Above $170,00 up to $214,00 Not applicable $13 + your plan premium
Above $107,000 up to $133,500 Above $214,000 up to $267,000 Not applicable $33.60 + your plan premium
Above $133,500 up to $160,000 Above $267,000 up to $320,000 Not applicable $54.20 + your plan premium
Above $160,000 Above $320,000 Not applicable $74.00 + your plan premium


The 2018 standard Medicare Part D (the prescription drug benefit) Deductible is $405. Once that deductible is met, your costs break out as follows:

Deductible: $0-$405 100% paid by Participant until the deductible is met
Initial Coverage Limit $3,750 in total drug costs 75% Paid by Medicare 25% paid by Participant


Between $3,750 and $7,508.75 in total drug costs

Brand Name Drugs:

50% Manufacturer Discount

15% Paid by Medicare


Generic Drugs:

56% Paid by Medicare


35% Paid by Participant




44% Paid by Participant


Above $7,508.75 in total drug costs 95% Paid by Medicare 5% Paid by Participant


Medigap Plans C and F

One useful way to reduce your out-of-pocket Medicare expenses is to buy a Medigap Plan. These are supplemental Medicare plans that cover some of the costs that Medicare Parts A & B don’t cover, deductibles, and co-insurance amounts.  There are 10 different Medigap plans, each labeled with a different letter, each having a different level of coverage.  One of the most comprehensive plans is Medigap Plan F, which includes coverage of:

  • Part A hospital and coinsurance costs up to an additional 356 days after Medicare benefits are exhausted
  • Medicare Part A hospice care copayment or coinsurance
  • Medicare Part B coinsurance
  • Medicare Part B excess charges
  • Medicare Part A deductible
  • Medicare Part B deductible
  • First three pints of blood used in an approved medical procedure (annually)
  • Skilled nursing facility coinsurance
  • Foreign travel emergency coverage (80%, up to plan limits)

Another popular plan is Medigap Plan C.  Plan C covers almost everything Plan F covers.  The one difference is that Part C doesn’t cover something called “Part B excess charge”.  The definition of that is “If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.”

You can see why these 2 plans are so popular.  In 2015, Congress voted to close these plans to new people in 2020.  Meaning, if you are new to Medicare in 2020, you won’t have the option of choosing these plans or if you are a current Medicare recipient looking to change Medigap plans, these plans won’t be available.

Between now and 2020, seniors and people with disabilities need to think about this carefully.  Right now, people turning 65 or just switching to Medicare from an employer plan can be accepted into any Medigap plan they choose, regardless of their health.  If they want to switch Medigap plans later on, insurance companies can look at their health, and either turn them down for that reason, or charge them a hefty premium for a pre-existing health condition. So, your first choice is important.

That said, should you just jump and buy Plan F while you can?  Maybe not.  Experts expect the premiums on Plan F to rise after they close the plans because there won’t be any new, relatively healthy 65 years olds to offset the costs of the aging people already in Plan F.  So choosing a Medigap Plan F now could lock you into a very expensive plan in the future.

Experts are recommending people look at Plan G.  This is a plan that is almost as comprehensive as Plans F and C, but it does require you to pay the Medicare Part B annual deductible.

Will Medicare Plan F premiums go up too much?  Will you develop a medical condition that makes moving from Plan F to another Medigap plan too expensive? These are things to consider.  Medicare offers a really helpful grid comparison of the different Medigap plans at Without a crystal ball, these choices are really hard, but know this, the clock is ticking.

How Medicare Covers Chemotherapy

Throughout our lifetimes, we enroll in health insurance for a variety of reasons. Medicare-ChemotherapyIt gives us access to doctors and provides preventive care and screenings for early detection of medical conditions. There’s no question, however, that the main reason we buy health insurance is to help us pay for major treatment if we are diagnosed with a serious illness such as cancer.

Many people who are new to Medicare or have been recently diagnosed wonder how Medicare covers various cancer treatments, such as chemotherapy. The good news is that Medicare provides extensive coverage of cancer treatment and cancer-related services.

Medigap supplemental coverage is also available to round out that coverage, help pay for your deductibles, and protect you from catastrophic out-of-pocket medical spending. Let’s look at how Medicare’s coverage of chemotherapy and other cancer treatments works:

The Parts of Medicare

Original Medicare has two parts. Part A is your inpatient hospital coverage, and this provides for your hospital room and some skilled nursing care. Part B is your outpatient coverage, which includes physician services, lab work, diagnostic imaging, preventive care, durable medical equipment, and much more. Part D provides prescription drug coverage. Click here for an explanation of Part C.

Although chemotherapy is often administered in a hospital or clinic setting, it generally falls under Part B, since chemotherapy is a treatment administered by a physician. Radiation treatment and some anti-nausea medications are covered under Part B as well, if the doctor prescribes them to you within 48 hours of a chemotherapy session. Otherwise, these would be covered under a Part D drug plan. Click here for a complete chart comparing drugs covered by Parts B vs. Part D.  In terms of chemotherapy coverage, this is how it breaks out:

  Covered by Part B Covered by Part D
Infusion drugs Drugs administered by an implantable infusion pump




Drugs administered by an external infusion pump that you use at home and your local DME contractor covers them under Part B.

Drugs administered by an external infusion pump outside of the home (i.e., in a skilled nursing facility or hospital) and your stay is not being covered by Part A or you do not have Part A.


Drugs administered by an external infusion pump that you use in the home, but your Durable Medical Equipment contractor does not cover them under Part B for use in the home.


Infusion drugs administered at home without an infusion pump at home. One example of this is an IV push.

Injectable Drugs The drug generally cannot usually be self-administered and your doctor provides and administers the drug to you. You can buy the drug at the pharmacy and it is either administered by your doctor or you administer the drug yourself.
Oral Anti- Cancer Drugs It is an oral anti-cancer drug that was once available only in an injectable form that was covered by Medicare. You or your doctor can administer the drug. It must be used to treat cancer. You use the drug to treat a condition other than cancer.
Oral Anti-Nausea Drugs (antiemetics) Must be related to cancer, used as a full replacement for intravenous treatment, and administered within 48 hours of cancer treatment. It can be administered by yourself or by a doctor. The drug is used for conditions other than cancer.


It is used more than 48 hours after cancer treatment or is not a full replacement for intravenous treatment.

Part B has a small annual deductible that you must pay. That deductible is $183 in 2018. Then, Part B pays for 80% of covered services that you receive. You are responsible for the other 20%. This is called your Part B co-insurance. There is no out-of-pocket maximum for Part B, so your expenses could be high.

That is why a Medigap plan can be helpful to pay for that co-insurance and other Medicare-related out-of-pocket costs, such as deductibles and copays. You can find out more information about Medigap plans here.  You may also find a Medicare Advantage plan helpful to lower your out-of-pocket costs.  For more about Medicare Advantage, click here.