According to the Milliman
Medical Index, in 2016 the cost of
healthcare for an average American family of four covered by a typical employer-sponsored
preferred provider organization (PPO) plan will be $25,826. The average family
will also spend $4,270 on prescriptions this year. However, the key word when
considering these statistics is this: average.
In reality, some families will spend significantly less, and some families –
like the ones where one or more family members live with a chronic condition –
will spend significantly more.
I am the mom of an actual
American family of four, and my diagnosis of rheumatoid arthritis has a
tremendous impact on my family’s finances. Because, unfortunately, only
patients who need to rely on specialty drugs have to figure out how to pay for
them.
As someone living with a
chronic illness, I know from personal experience that one of the most
stress-inducing questions concerning my health is this: how on earth do I afford the treatment I need?
Understanding Your Coverage
Step one in attempting to
answer this difficult question is to make sure you understand your health
insurance coverage. Insurance plans can vary a lot, but important components to
understand (if your plan has them) are the amounts of your co-pay, deductible, out-of-pocket
maximum, co-insurance, and annual drug benefit limit. If you are taking a
specialty medication, it may be covered by your medical benefits or pharmacy
benefits, depending upon how it is administered. You can get more help
understanding your coverage by watching the Joint
Decisions Webchat: Benefit From Your Benefits: How to Make RA Treatment
More Affordable.
If you still have questions
about your coverage, or if a medication your doctor recommends gets denied,
call your insurance provider and ask them about it. Part of their job is to
help you understand your coverage, so don’t hesitate to ask the same question
multiple times if you need a better explanation. I also find it useful to take
notes during a call, including the name of the person I am speaking to. That
way I will have something to reference if I need to call back about the same
issue.
Record Your Medical Spending
Keeping a careful record of
your medical spending can be useful for several reasons. A record can help you
figure out when your deductible has been met or spot errors in your bills – which
do occur! I keep a Google spreadsheet to keep track of my family’s medical
spending, and while it can be a bit overwhelming to see our healthcare spending
add up, knowing our expenses does help us create a more accurate budget for our
family.
A detailed record is also
potentially useful for tax purposes, as the IRS allows you to deduct qualified
medical expenses that exceed 10% of your adjusted gross income for the year –
and given the statistics above it is easy to see how that can happen! Qualified
medical expenses include premiums, preventative care, treatment, lab fees,
surgeries, doctor’s visits, and prescription medications. You can also deduct a
few things you may not have considered: acupuncture fees; mattresses bought
specifically to alleviate an arthritic condition; the cost of installing
special equipment like grab bars in your bathroom; and medical aids such as
wheelchairs, canes, or braces. Any travel expenses you incur attending medical
appointments should also be included, such as mileage on your car, parking
fees, bus fares, or lodging expenses if you have to stay overnight.
But keep in mind that any
expense you are reimbursed for – such as by your insurance or your employer –
does not count. Things like over-the-counter medications, vitamins, or health
club dues are also not deductible. The IRS maintains a complete list of
deductible health expenses, which you can look at here.
Support Programs
If you are still struggling
to pay for all your medical expenses, the good news is that there are many
types of programs available to help ease the burden. A co-pay assistance
program or pharmaceutical assistance program may help you cover the cost of an expensive
specialty medication. There are also patient assistance foundations available
to help. These programs can help patients access and pay for expensive
medications, provide direct financial support or travel assistance, or locate
appropriate assistance and support programs. CreakyJoints maintains an index of available arthritis copay cards and assistance, for easy reference.
With the help of these tips
and resources, hopefully it will be easier for patients living with RA to
access and afford the treatments they deserve.
This post is sponsored by Joint Decisions, an educational initiative developed
by Janssen Biotech, Inc. that empowers people living with RA to take a more
active role in the management of their disease and have more open and honest
conversations with their doctors. Janssen Biotech has compensated me for
this article. All thoughts and opinions expressed here are my own.
Check out the Joint Decisions Facebook page to connect
with others in the online RA community, and visit JointDecisions.com for RA resources and tools.
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