How to Triage Cancer Podcast


How to Triage Cancer is a cancer rights podcast presented by Triage Cancer in partnership with ArmorUp For Life. In terms you can understand, each episode breaks down the legal and practical issues that impact people navigating a cancer diagnosis, from patients and caregivers to advocates and health care professionals.

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What's Legal About Cancer

Episode No. 1

In our inaugural episode, hear real-life examples of how knowing your rights can help you navigate a cancer diagnosis, including health insurance, employment, and finances. We also break down financial toxicity, how it happens, and how to avoid it. And we introduce you to Triage Cancer and its hundreds of free resources to educate and prepare patients, caregivers, advocates, and health care professionals.

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Loriana Hernandez-Aldama: Welcome to our podcast series, “How To Triage Cancer,” in partnership with “ArmorUp for Life.” My name is Loriana Hernandez-Aldama. I'm a former news anchor, medical reporter, two-time survivor, speaker, author, and the proud founder of “ArmorUp for Life.” We are a nonprofit organization. We help cancer patients amplify their voice by preparing, presenting, prevailing, the three P's to really being possible. And so it's really my honor to be in partnership with Triage Cancer, to shine the light on the great work that they are doing, and the two amazing attorneys behind this organization. You might say to yourself, what is legal about cancer? Let me tell you firsthand, and if you're a cancer survivor, if you've been through it, you understand. After a year-long stay in the hospital battling leukemia, a bone marrow transplant, and five years later, breast cancer, there is a lot that is legal about cancer. So, let me introduce to you, the two rock stars, I think they're rock stars and you will too, Joanna Morales and Monica Bryant, to talk about this very topic, and how that relates to some of the financial issues, and burdens that might arise after the diagnosis. So first, let me tell you about Joanna Morales. She is a cancer rights attorney, and also Co-Founder and Chief Executive Officer of Triage Cancer. Joanna has spent more than 26 years working on behalf of individuals fighting cancer. Monica Bryant is also a cancer rights attorney, and helped co-found Triage Cancer too. So together, they educate, and help people really understand how to cope with cancer, help the caregivers and health care professionals about ways to introduce and reduce the financial burden of cancer. So the goal of this podcast is really to educate you, and share very practical information, and help everyone navigate a cancer diagnosis, which is so important. And in this first episode, we have three big goals, and we want to take a few minutes to talk to you about who is Triage Cancer, what is legal about cancer, and how can we minimize the financial burden of a cancer diagnosis, the financial toxicity. So, Monica and Joanna welcome, both of you. I'm so excited to talk to you, you know I adore you, and am so in awe of the work that you're doing. So, let's start with who is Triage Cancer.

Monica Bryant: I am, as you mentioned, a cancer rights attorney, and together in 2012, Joanna and I co-founded Triage Cancer, which is a national nonprofit that provides education on the practical and legal issues that arise after a diagnosis, and we do that through events, materials, and resources.

Hernandez-Aldama: And Joanna?

Joanna Morales: Well, Monica and I, both came to this work from very different places. I went to law school thinking that I was going to work in policy and legislative advocacy, and while I was in law school, I was also working at a cancer center for a Psychosocial Care Program, and I also took a class in law school on Cancer Rights Law, and it was the only class at the time on that topic across the country. And so, I learned some really interesting things in school that was coming up on a daily basis in my work. One of the things I was responsible for was to actually fit patients for mastectomy bras and prostheses in the cancer center's boutique, and in doing that process, I also billed insurance companies for those items, and often insurance companies would deny coverage for those prostheses and mastectomy bras, and I would get them on the phone, and I would say, “Well, this is supposed to be covered by insurance, why is it being denied?” And they would say, “That's not a covered benefit,” and I would say, “Well, what about WHCRA,” which stands for, the Women's Health and Cancer Rights Act, which was the law passed in 1998, that requires private insurance companies to cover those mastectomy bras and prosthesis, and so all I would have to do is say, “Well, what about WHCRA?” And then they would say, “Oh, okay, we're going to cover it,” and so all we had to do was show minimal knowledge of the rights of the patient I was calling on behalf of, and they would back down, and actually pay for something they're responsible for paying for, and it really demonstrated to me that if you don't know what your rights are, then so many systems that we have to navigate on a daily basis are in a better position to walk all over us, and that really drove me into this work. I want people to understand what their rights are, and what their options are so that they don't get walked all over, and they get access to the care and support that they need.

Hernandez-Aldama: And absolutely, and I really raised that point. Having had to get new bras after a double mastectomy, and tried to fight with insurance companies saying, “Well, I need a bra and I need a special bra,” and so I understand that, and I also always say, “Listen, I'm well-educated, and I don't know these laws.” And you make me feel better saying, it doesn't matter how well educated you are, you're not expected to know the laws to fight cancer.

Morales: What do you know about that random law? And even though that law was passed in 1998, so, how many decades are we past that law? Monica and I still talk to patients today where their insurance companies are denying coverage for reconstruction, and mastectomy bras, and prostheses, even though they're supposed to be paid for.

Hernandez-Aldama: When I had to leave my career anchoring, when I had leukemia for a year, it took me an entire year to get a wig approved, by then I had hair back, and I couldn't understand, I said, “I've lost my DNA, lost my identity, why would you do this to me?” It was traumatizing, and I would sit in bed, and I'm getting chemo treatment, fighting with insurance, and I wish I'd met you both sooner. And I kept saying, “How is this possible?” It's really sad that cancer patients, it adds to the burden, to the stress, and everything else that we're already going through, and so I really appreciate you giving that insight. I was looking up some numbers that just in 2021, 1.9 million people will be diagnosed with cancer in the United States, and as far as survivors, we have nearly 17 million cancer survivors. By 2030, that number is expected to jump to 22.2 million. So, thankfully, we're saving more people, and those we're saving, we have to move on with life, but we need to know our rights, and we can't go down a downward spiral because we can't afford to get through our cancer treatment.

Morales: Absolutely, and wigs are actually a great example of where there isn't a law that requires insurance companies to cover wigs, and so, that's an example of where there's a gap in the law, even though there's a serious need by patients, and it's also is an example of a great advocacy opportunity.

Hernandez-Aldama: Well, we'll have to talk more about that then after our podcast. Okay, well, Monica, let's talk about what else is legal about cancer? Can you tell us what you mean about the legal issues?

Bryant: Well, we get asked a lot, “What's a cancer rights attorney? What could possibly be legal about cancer?” And my answer is, “Almost everything.” From what drugs are approved to treat cancer, to what insurance companies are required to pay for, to what are your rights to take time off from work, or to work through treatment, or to return to work after treatment. If you do need to take extended time off, how do you replace that lost income? And that's where disability insurance comes into play, and there are laws around that. Certainly, managing medical bills, and finances, and estate planning, all of these things that people are asked to grapple with in addition to their cancer diagnosis are actually rooted in the law.

Hernandez-Aldama: Well, and there are many people like myself, who had to leave our careers, but maybe we weren't educated well enough from our own Human Resource Department to say, “Hey, you can continue your life insurance policy because you're still within that window.” I didn't know that. Now I can't get life insurance, nobody wants to insure me. I didn't know the rights. So, tell me more about some of what your rights are, if you have to leave your job. I know we'll get to the third thing, but you're giving me so much great information. If you have to leave your job because of a cancer diagnosis, what are your rights?

Bryant: Well, I get to give my favorite answer, which is, ‘it depends,' because there's no one size fits all to many of the questions that we get asked. And Joanna and I say, we always break the rule of answering a question with more questions because, in order to effectively explain what somebody's rights are, we need to know things, like what type of employer do you work for, how big are they, what state do you work in, do you work under an employment contract, or as a member of a union? Because all of those details are going to define what rights you have. Again, either to work through treatment, or to return to work, or if you have to leave.

Hernandez-Aldama: Okay, so, we'll move on to the third point that we talked about, and I mentioned at the beginning, and then we'll chit chat because I could talk to both of you for hours. What is financial toxicity, and how do legal issues relate to it? Explain the concept of financial toxicity, and how it relates to the problem. Joanna, do you want to start with that?

Morales: Sure, so when we're talking about financial toxicity, this is a term that was actually coined by some researchers from Duke in 2013, and it really focuses on the financial burden of a cancer diagnosis, and how that financial burden can also have an impact on a patient's health. Whether it be physical health, or emotional health, or psychological health, we know that the financial burden has real practical impacts for patients beyond just the cost, and we want to make sure that patients not only get help addressing those costs, but avoid some of those other factors that can impact their health and their quality of life. But part of the challenge around financial toxicity is that it isn't just one thing, it's not an easy problem to solve, because there are actually a lot of contributors to financial toxicity, and it's some of the things that Monica mentioned. So, having adequate health insurance coverage is what we think is the biggest contributor to avoiding financial toxicity, and then it's other things, like if you do have to take time off work or leave your job, that loss of income is going to have a huge impact on your finances.

Hernandez-Aldama: Well, and I'll add to this, and Monica, I'll let you jump in, and I've been very transparent about it, because I feel like I have an obligation to speak up for those who aren't used to being on camera and talking about their problems. But I went from living the life as a news anchor to fighting for my life, and then my husband nearly losing his job. We found him another job, we were losing our house. He had to move. It was a big mess, but I went from living the life, to fighting for my life, to wanting to take my own life. And I thought, “How am I suicidal after fighting for so long?” But the bills were this high, and it was a full-time job for maybe two years. Because when you spend a year in the hospital, the bills just mount, and it was all day, every day I was like, do I make memories with my son in case I die? Do I spend all this time on the phone in case I live, because I have bills? And I just wanted to give up, and it started to take a toll on me, and I thought, “Well, how do other people do this?” I have a husband who finally found a job, but it is, that can take a toll on your psychological well-being, where you just don't want to be here.

Bryant: Absolutely, and unfortunately, your story, it's certainly unique, but it's not the only time we hear stories like that. We have mountains of anecdotal evidence that illustrates how financial toxicity really does impact somebody's overall quality of life, but we also have lots of scientific research to back that up. And the rates of stress, and anxiety, and depression, in individuals who've been diagnosed with cancer, and face financial burdens, skyrocket.

Hernandez-Aldama: Absolutely, you were saying with the impact of the caregivers, the family members and the caregivers have to be fit enough, mentally, physically, financially. That's part of the whole fitness wheel, I say, when you armor up to be able to get through this process because it can increase the stress. And what I advocate on our side with “ArmorUp for Life” is stress causes inflammation. Inflammation is a fertilizer for cancer. So, you're just causing more, and could potentially lead to secondary cancer, and put us at risk for more. So, it really does behoove anybody who could step in and help reduce the financial impact for cancer patients, could save lives and improve patient outcomes. So, what practical suggestions do you have on how people can avoid the financial toxicity, and who we can reach out to, to minimize that?

Morales: Well, at Triage Cancer, we have an endless number of resources that are intended not just to help patients in dealing with all of these issues related to insurance, and employment issues, and finances, but also to help caregivers, because caregivers also have rights in these circumstances. So, whether it's employment rights, or access to paid leave, depending on the state that you're in. So, caregivers can also be prepared with information about their rights and their options, so that we can help try and prepare the entire family for dealing with some of these issues, and minimizing that financial toxicity for everybody.

Hernandez-Aldama: Can you give me some examples? I love the word prepare, because it's part of my three P's, and we're all preparing ourselves for illness, so we could present well, and position ourselves to prevail, and that's preparing financially. So, how can we prepare? If someone's watching this and they have not been affected by cancer, and they don't have a loved one affected, there's still one in two chance that in their lifetime they will be affected by cancer. How can we get ready so we're financially prepared for an illness like this?

Morales: Well, ideally, if we could reach every patient when they're first diagnosed, we could give them the information that they need to make decisions throughout their whole course of treatment, and into post-treatment survivorship. But unfortunately, there are two problems with that. One, we know that when patients are first diagnosed, it's incredibly overwhelming, and so focusing on many of these practical and financial issues aren't top of mind. Top of mind is focusing on medical care, but we also know that not everybody is being connected to the resources that can help them navigate these issues like Triage Cancer. And so that's also why we work with healthcare professionals to train them about what we provide, and some of these issues that their patients might be experiencing, so that they're appropriately connecting patients to us. And when we're talking about preparing, it really is understanding all of your rights and options. And I know that sounds like just one more thing we're asking patients to do, but if someone understands all of their options, they can actually make educated decisions about the best option for them, so they can find their best path forward, because often, someone will only find out about one thing, like FMLA, or COBRA, because someone's more familiar with those things because they come up in lots of other circumstances. But knowing all of your employment rights, and all of your health insurance options might actually lead you to a better option for you.

Hernandez-Aldama: Yeah, and how to argue and be your own best advocate, and I liked that when you said that you could help us find different options. When I went through my transplant, I had to stay in an outpatient housing connected to Johns Hopkins. It was not covered. My transplant was covered, but my housing wasn't. So, how am I supposed to get here? I had to be attached to the hospital, and so we spent, just in 100 days, $10,000 cash that we charged, but then the patient next to me would say, “Oh, my insurance covered it,” and so you meet people and you're like, “Well, how did you fight for it?” So, I think these are very practical questions that patients go through. Can they just call Triage Cancer, or could they email, and say, “I need somebody to help me navigate this?” Or what would a patient who's watching do right now?

Bryant: Well, I think that the very first step is to go to triagecancer.org. We have so many resources and materials, and we present the information in multiple formats. So we have hour-long webinars that somebody could watch on-demand. We have quick guides, which are one- to four-page documents that explain a particular topic, down to a five-minute animated video. And so, we say, pick whatever medium makes the most sense for you at that moment. Another tool that we have is a tool called Cancer Finances, and this is a tool that has modules on all of the different topics that could potentially impact somebody's finances. Now, what's really unique about this tool is that it's in a choose your own adventure format, where the website will ask the user questions, and then based on how the user answers those questions, it takes them to targeted information. And we thought this was really important, because as Joanna said, people were overwhelmed. There's already too much to figure out and to deal with, and the emotions on top of it, and so we really want to be able to help people find the information that they need, and not really worry about the things they don't need to worry about, or maybe can deal with later. Which of course is the very definition of triage, and it's how we got our name.

Hernandez-Aldama Okay, that sounds great, but if after going to your website and reading that information, if patients still have questions, what do they do?

Bryant: Well, we actually have a new resource called the Legal and Financial Navigation Program. And so individuals who've been diagnosed or caregivers, or even healthcare professionals can fill out an intake form on our website. And then they'll get a link to schedule a 30-minute phone call with one of our staff, because as I mentioned earlier, sometimes the answers to the questions really do depend on somebody's specific situation. So, we're always happy to try to help provide answers to somebody's specific situation.

Hernandez-Aldama: Well, it's been great talking to both of you. We have many more episodes to do. And in our next episode, we're going to give some key steps to help you pick the best health insurance plan for you. We've talked about COBRA, we've talked about plans, we're going to dive much deeper into that in the next episode. And there are some exciting new ways that you can get help paying for your coverage, so we hope that you tune in. In the meantime, you can get more information about these very topics we discussed and what we're going to discuss, as Joanna and Monica mentioned, triagecancer.org and cancerfinances.org.

How to Pick a Health Insurance Plan

Episode No. 2

Picking the right health insurance plan could save you thousands! In this episode, we introduce you to key terms that are critical when comparing insurance options. We’ll also teach you how to figure out how much your health insurance and medical care will actually cost. And, you’ll learn how and when to pick a plan that meets your specific needs. How to Pick a Health Insurance Plan is the one class you wish you could’ve taken in high school!

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Loriana Hernandez-Aldama: Welcome back to our series, “How To Triage Cancer.” I'm Loriana Hernandez-Aldama, the proud founder of ArmorUp for LIFE. We are a nonprofit organization that amplifies the patient voice to make more patients possible. And joining me, we are doing this whole series in partnership with Triage Cancer, and the two rockstar attorneys that I adore, they're doing amazing work with Triage Cancer. They are the founders. We have Monica Bryant and Joanna Morales joining us again. Last time we talked to you about how having adequate health insurance coverage is the most effective way to minimize the financial burden of a cancer diagnosis. But health insurance is confusing. So, today we're going to talk about how one figures this out because the financial toxicity, when you go through cancer is so much, and it can take a toll on your financial wellbeing, but also your mental wellbeing, your physical wellbeing. And so, they are here to help. So, Monica, I want to start with you. How does the average person figure this out and navigate it?

Monica Bryant: It is so confusing. It is like learning a new language, but nobody but us is actually teaching what this language is. We often joke that there should be a class in high school, on health insurance and finances. Stuff we all need to know, but no one ever teaches us. And then now you're faced with a cancer diagnosis, and having to learn this new language. And so, there are some key terms that are really useful for everybody to understand. And we certainly have lots of resources at triagecancer.org to help people understand these different terms. But for today, I really just wanted to highlight two of them. So, the first is your monthly premium, and this is what you're going to pay every single month, just to have health insurance. And you pay that amount, whether you go to the doctor or not. It's like having car insurance all year, but never getting into an accident or filing a claim.

Hernandez-Aldama: And then we have this magical phrase that I heard so many times during leukemia and breast cancer battles, out-of-pocket maximum. So, let's talk about that because cancer patients, we know, we cringe when we hear that.

Bryant: Generally speaking, the out-of-pocket maximum is the most that somebody's going to have to pay for their healthcare in the year. And the way that you get to that is by adding up everything you pay out of pocket for your co-payments, and your co-insurance, and your deductible. So, it's everything except those monthly premiums. Now, it is so valuable to understand what your out-of-pocket maximum is, and how your policy defines out-of-pocket maximum because it then allows us to plan for a worst-case scenario.

Hernandez-Aldama: Joanna, I want to send it to you, how do you actually pick a plan?

Joanna Morales: Well, you need to know what the monthly premium is going to be for a particular plan option. And you also need to know what the out-of-pocket maximum is for that particular plan. And the way that you figure out what a plan is actually going to cost you by the end of the year, is that you take the monthly premium and you multiply it by 12, for 12 months, because that's how much it's going to cost you to have the plan for the year. And then you add that to the out-of-pocket maximum because that's the most that you're going to pay out of pocket for your medical cost during the year. And that final number is what your actual cost for your medical care and your health insurance is going to be for the year. Now the problem is that most people don't understand out-of-pocket maximums. So, when they're shopping for health insurance coverage, they're often just focusing on that monthly premium, but oftentimes plans that have higher monthly premiums actually have lower out-of-pocket maximums. And so sometimes those plans that appear to be more expensive based on their monthly premium can end up saving you thousands of dollars by the end of the year because of that lower out-of-pocket maximum.

Hernandez-Aldama: So, you're saying to somebody that, and I just explained this to someone going through cancer, you might have to pay more upfront, but long-term, and I'll just pick a random number, but let's say it's going to be a thousand dollars a month upfront, but long-term, you may pay less in the out-of-pocket maximum. If you choose to pay less, then it could keep adding and adding and adding. And long-term over that course of the year could be a lot more of a financial burden for yourself.

Morales: Absolutely. That's exactly the problem. And so, we want people to understand how to actually do this math because the math matters in any type of plan that they're looking at. So, you could be using this math problem to actually figure out your options if you're shopping in the marketplace, you can use this example. If you're comparing different options that your employer gives you, you can also compare what your employer gives you to what's available to you in the marketplace. Or if you have Medicare, you can compare your Medicare plan options using the same type of math problem.

Hernandez-Aldama: I also say to people, when you're choosing your plan, nobody ever thinks that they're going to get cancer. I walked around thinking I was invincible. And so, when you're choosing that, you're like, oh, I don't, I'm in great health, I eat clean, nothing's going to happen to me. So, you're not thinking about crunching those numbers, but the reality is, as I say, it's not always a matter of if something's going to happen. It's a matter of when. And we're really preparing ourselves so we could present well, physically, financially, mentally when we, when our world turns upside down with something. So, I think it's important to take these great facts that both of you are providing and think about it, even if you're not affected by cancer and you're watching and think to really think about that, right? When you're looking at, how would this impact you if you had cancer?

Morales: Exactly. I think part of the thing that we forget about is insurance is for something that might happen, we're preparing ourselves in case something was to happen. So oftentimes people who are healthy think, oh, I'm just going to buy the lowest cost insurance because I'm never going to reach my out-of-pocket maximum because I don't get any medical care. But we don't usually get advanced warning before a cancer diagnosis. And so, the idea of having insurance is in case something were to happen. You have that coverage. And that's really where we see so much financial toxicity is the people have plans that are not adequate for their medical care. And so, they end up having to pay so much more money out of pocket for those high out-of-pocket maximums.

Hernandez-Aldama: Well, being a journalist and literally living at Johns Hopkins while battling leukemia, I filed reports from my bedside and I've talked to so many patients and they would always say, well, I always said to myself, well, I never get sick. It was such a common theme and people didn't plan ahead. So, I encourage people who are watching to go check out all the information on TriageCancer.org, because you don't know when something may happen to you, small or large, and it is best to be prepared. It is my whole mantra for ArmorUP for Life. There are other things, Monica, if you want to jump into considering about the deductibles, the networks, the formularies.

Bryant: Well, Joanna walked you through how you figure out what the total annual cost is going to be by understanding your annual amount for premiums and your out-of-pocket maximum. But you also have to make sure that you've checked that the policy you've chosen covers the providers that you want to see. So, the doctors, and the hospitals, and the labs. And that's important for two reasons. The first is that many policies won't cover providers that are out of network at all. And if they do cover them, they're going to cover them at a lower rate. It's also important because many policies, when they're figuring out an out-of-pocket maximum, they're only going to count payments towards in-network providers. So, this is so key. And I think for those of us that work in this space every single day, sometimes it sounds like everyone would know this information, but I think honestly the average consumer of health insurance doesn't stop to think, “I need to check that my existing providers are in this plan's network.”

Hernandez-Aldama: That is great advice. So, you're saying if, so, if you could make the time to call some of those doctors that you want to continue care with and say, “Hey, this is what insurance plan I'm going to have going forward, do you, are you on this list?” So, you're going to have to do some research, or somebody will, if you can't do it because you're busy fighting cancer.

Bryant: Yeah. I mean, it definitely takes some leg work. There are some tools on the online marketplace that can be useful, but ultimately, we think it is always good to check with the provider and to use the exact plan name when they are calling their provider. But, you know, I sometimes talk to people and they say basically what you're saying, right? Like that it's an added thing to do when you're in the middle of fighting cancer and I agree, it's a lot. It's a lot even if you're not in the middle of finding cancer, but I often find people will spend more time researching their next washer and dryer than they do their health insurance policy. And when we think about how many people in America utilize health insurance, that's a little bit scary. But the good news is that picking a health insurance policy, you don't just get one shot at this. We actually have the opportunity to change our plans every single year. And so the time of year that you're allowed to do that is going to depend on whether you have an employer policy or a marketplace plan or Medicare, but every single year, we get to make choices. And well, that could be seen as an additional chore we have to do every single year. I think it's also an opportunity, especially for those people who maybe didn't pick the best plan for them because they didn't think they were going to need it and now do.

Hernandez-Aldama: Absolutely. And it is worth the time and the effort, especially if you can do it while you're healthy, before anything happens. And while you're of sound mind and you have the time and the energy do it then, so you are well-informed when it happens. So, if someone picks a plan with the lowest out-of-pocket cost that covers their providers and their prescription drugs, then they're set right? And they can stop worrying is what most people would like to say, “Okay, I can just kick back and hopefully nothing happens.”

Bryant: I mean, assuming that they watched this and looked at all of our other materials and knew exactly how to pick the most appropriate plan for them, then sure. But it's still worth the time to look every single year and make sure that the plan they're choosing for the next year still meets their needs. And this can go both ways. So, it could be that somebody now has a cancer diagnosis. And maybe they want to pick a different plan that covers different providers or different prescription drugs because now they're taking drugs for their cancer, or it could be maybe that somebody's out of active treatment for cancer and maybe they need different things now. That’s what I was talking about in terms of the flexibility every single year that we can now look to the year ahead and make different choices.

Hernandez-Aldama: I'll jump in with a few scenarios. If I did not lose my job during the pandemic, can I just switch insurance right now? Because I want to, because I need to save money. Times are tough.

Morales: If you have an employer plan, there are some different rules about how you can get access to the marketplace and qualify for that financial assistance. But we're never required to take the health insurance coverage that our employers offer us. So, you can choose not to accept that coverage either because it's more expensive or maybe it doesn't cover your providers and then go to the marketplace and see if there's a plan that's available to you that does cover your providers, or is less expensive. So you're always able to do that. The question is just whether or not you actually qualify for the financial assistance. And we definitely have some information about how you figure that out on our website.

Hernandez-Aldama: Well so, does this apply to COBRA and we might be jumping ahead for the next episode, if you, if you're, if you or your spouse is between jobs and you're on COBRA, does that apply where you can say, hey, I need to go back and revisit the marketplace and try to get something cheaper or you can't pay that whole thing.

Morales: Normally, if you accepted COBRA and you decided you couldn't pay for it, you'd actually have to wait until the next open enrollment period to pick up a marketplace plan. And we're definitely going to talk about COBRA and other options for losing health insurance coverage, through an employer in our next episode, and the financial assistance that's available to help pay for COBRA.

Hernandez-Aldama: And that was my next line. So, thank you, Joanna, for helping me out. Options when losing your health insurance is part of our next episode. So, in the meantime, if you want to check out more information about these topics we're discussing and what we're going to discuss, go to Triage Cancer, it's triagecancer.org, and cancerfinances.org.

Options When Losing Health Insurance at Work

Episode No. 3

In this episode, we dive into COBRA, one of the primary options for people who have lost their employer-sponsored health insurance. But COBRA isn’t the only option! You may be eligible for Medicaid, Medicare, or a private insurance plan with financial assistance through the Marketplace (think insurance shopping mall). We’ll break it all down in this episode of How to Triage Cancer.

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Loriana Hernandez-Aldama: Welcome back to our series, “How to Triage Cancer”. I'm Loriana Hernandez Aldama, founder of ArmorUp for Life. Our mission is to amplify the patient voice, to help people, more patients become possible by prepare, present, prevail. The three P's to armor up for life. I am joined in partnership with Joanna Morales and Monica Bryant. The rockstar attorneys and founders of Triage Cancer, with some great information. So, we want to continue our series. We're talking about options when losing your insurance. This year, during the pandemic, has been so tough on so many people. Millions have lost their jobs. They've lost insurance. So, you might be asking these questions like, where do I go from here? How do I get COBRA? I know I had to go through COBRA, and it was not pleasant this year. So, it's a very timely topic for so many people. Thank you so much, both of you for joining us. Monica, I want to start with you. How do you get COBRA? How do you navigate it?

Monica Bryant: It's really scary if you have been used to getting your insurance through an employer, and now you're faced with a situation where that's not an option anymore, you might be trying to figure out, well, what do I do now? COBRA is a federal law that allows eligible employees to keep the exact same health insurance policy when they would normally lose it. So, it's the exact same policy that you had when you working. Now, what's really, really useful about that is everything keeps going. So, everything you've paid towards your deductible, or your out-of-pocket maximum, keeps going. It's the same network of providers, the same prescription drug coverage. So, nothing changes, except what you pay monthly to have that policy, because, with COBRA, the employee is now responsible for 100% of the premiums, and so that can feel really daunting. I know Joanna often says most of us don't appreciate what our employer pays for our insurance until we're writing that check ourselves. Now, the other piece of this is that, well COBRA is a federal law, and does apply to people who work for employers with 20 or more employees. For someone who works for a smaller employer, they might have really similar rights, but it's actually going to be under a state law, instead. And, we have all of that information, because the laws vary state to state, on TriageCancer.org under our charts of state laws. So, you can check that out and see what's available in your state.

Hernandez-Aldama: Well, I didn't fully understand the whole complexity of COBRA, until I went through it this year, because it is easy to say, well… And, it is great information, that we have COBRA, it is a continuation of care, but… And, that's great, however having to know that you're going to have a new payer ID, trying to get coverage. I'm still getting bills, and we had no idea… We appreciated my husband's employer, but we didn't realize that his employer was paying 77% of his insurance cost. And, because we have the highest given… I've had leukemia and breast cancer, we said, oh, my gosh. So, for the month of February, for 28 days, we're going to pay $3,000. And, we just about choked on it. We couldn't believe it. And, then we said, “well, now what do we do?” Is COBRA our only option? And, what do we do from here? And, so that leads to my next question. Either one of you can jump in. We ended up paying it because we were too stressed. It was only a month. It was 28 days and I had surgery coming up, but what else can you do if you can't just charge that?

Monica Bryant: Thanks to the Affordable Care Act, there are some other options that people can now look to for health insurance coverage, if they're losing their coverage through work. Most people are familiar with COBRA, because that's what maybe their HR department sent them paperwork on. But if COBRA isn't a good option, either because your providers aren't covered, or your drugs aren't covered, or it's just too expensive, you could also now look at what your options are in the state health insurance marketplaces, which are available in every state. And, people can find all of the private insurance plans that are available to them as an individual, or a family, on the marketplace. And, not only do you have access to looking for that information on the marketplace, you potentially are going to qualify for financial assistance to help you buy your plan in the marketplace. So, that financial assistance is based on your income level, and it can lower what you pay for monthly premiums, as well as what you're paying for your out-of-pocket costs for those marketplace plans.

Hernandez-Aldama: And, so I was trying to explain to someone how I perceived the marketplace, so please correct me if I'm wrong, but I've never had to go to a marketplace. I've been fortunate enough to find my insurance through my employer, but I said, when you call and you’re looking for car insurance, and you're calling this company and that company, you have like a broker who says, well, I can get you this company for this price, this for this price, and you're like, you know what, I want this car insurance company. Is it very similar to that?

Morales: Yeah, so we often refer to the marketplace as an insurance shopping mall. So, it's one place that you can go to look for all of the private insurance plans that are being sold in your state. And, there's a lot of confusion about the marketplace. So, people think they're buying a government-sponsored health plan, and they're not. They're buying a plan from a private insurance company. It's just that the government created the shopping mall for those companies to come and sell their plans, and then added some benefits like making sure that all of those plans are providing a base level of benefits. So, you're not getting inadequate health insurance coverage. And, then it also required those plans to be standardized. So, that you can compare apples to apples, and oranges to oranges across all of those companies as a consumer. And, then of course the financial assistance, it added the financial assistance for people based on their income level.

Hernandez-Aldama: And, you can do that, like I could have done had I had time, and didn't have surgery, and I was rushing, but you can do that whether you need COBRA for a month, or three months, four months, or a year, but my question… My follow-up question is to you about the financial part, if you can't pay that full amount, if you can't find something affordable in the market, what do you do?

Morales: You might actually qualify for Medicaid in your state, as a result of the Affordable Care Act, Medicaid was expanded for anyone with a household income up to 138% of the federal poverty level, which is a little more than $17,000 this year for an individual. So, if you're making under that amount, if your state expanded Medicaid, you can actually get access to Medicaid, as well. And, we have a great deal of resources on our website about whether or not you qualify for the marketplace or Medicaid.

Hernandez-Aldama: Okay, so there is help out there. You just have to figure out how to navigate it. Monica, is there anything else you want to jump in on, that I may have overlooked, because I could talk about this financial toxicity, and the stress of COBRA. Months later, I'm still trying to get through bills, and tell a particular hospital, that shall remain nameless, that I don't owe them $10,000, that they need to rerun my new group number, and that was only for a month, and then in a period of three months, I had three different insurance group numbers. And, so I have bill collectors calling, and it's very stressful. So, if there's any advice you want to give, before we close out this episode, let me know. Jump in.

Bryant: A lot of people don't have those types of issues with COBRA, so I don't necessarily want to scare people off from considering COBRA as an option. One of the things that we stress really strongly at Triage Cancer, is that if somebody's facing a situation where they're going to lose their employer-sponsored insurance, or they're trying to figure out what their options are, they have to do the math. And, we talked about doing the math in our last episode together, because we think of it as, you could potentially have four different lanes to drive in. So, you could be able to keep your exact same policy through COBRA or state COBRA. You could potentially pick up a totally new policy through the state health insurance marketplaces, maybe, based on your situation, there's another group plan you can join. So, if you're under the age of 26, potentially you could go on your parents' plan, or if you're married, maybe your spouse has a plan at work. And, then as Joanna mentioned, based on your income, you might be eligible for Medicaid. Certainly, also based on circumstances, or your age, you might also be eligible for Medicare, and so making sure that you don't, sort of, jump to a decision, because you think that's the only option, but to look at all the possible lanes you could drive in, and then do the math to figure out which is the best lane for you. Because once you make that choice, you don't get to change lanes, until the next open enrollment period. So, it really can be a big financial impact if you choose the wrong lane to drive in.

Hernandez-Aldama: I love that analogy. I love analogies. Great one. To pick that lane and you'll be staying in it, so choose it wisely. Well, Joanna and Monica, thank you so much. It's been great to talk to both of you. We will continue to have more episodes on more topics that Triage Cancer covers, and you could find more information about what we discussed in our prior episodes at TriageCancer.org and CancerFinances.org.

How to Triage Cancer Hosts

How to Triage Cancer, a cancer rights podcast, is hosted by Triage Cancer CEO Joanna Morales, Esq., COO Monica Bryant, Esq., and ArmorUp for Life Founder Loriana Hernandez-Aldama. Morales and Bryant have a combined 40 years of cancer rights legal experience, and they are authors of the first and only book on the topic. Hernandez-Aldama is a two-time cancer survivor, patient advocate, inspirational keynote speaker, and an award-winning journalist with more than 20 years of on-air television experience.

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