Health Care Costs Support
If you or someone you care for has heart disease, it’s easy to feel overwhelmed. You need to focus on managing your condition and living a healthier life, while also juggling life’s other demands. Living with a chronic condition also means you must take steps to make sure your health care needs are being met. This includes getting access to the right treatment and follow up care. You’ll also need to keep up with medical bills and deal with your health plan (if you have insurance coverage).
If you need help paying for your care or navigating the health care system, there are resources available. This page will help get you started.
Patient Assistance Programs – Helping Cut Medication Costs
Medications are an important part of managing many cardiovascular conditions. But these medications can be expensive. Even though many prescription drugs are now available in lower cost generic forms (as opposed to brand names), the costs can still add up.
Prescription Assistance Programs (PAPs) and other discount programs are offered by pharmaceutical companies to provide free or low cost prescription drugs to those who qualify. PAPs may require approval from your doctor, details about your current financial situation and health insurance coverage, or other information to help determine if you qualify.
TIP: Do not skip or stop taking a medication because of the cost . Even though you may feel uncomfortable talking about your finances, ask your health care provider about lower cost options and look into prescription assistance programs.
To find out more or to search for available PAPs for your medications, visit any of the following sites or go to the manufacturer’s web site.
Partnership for Prescription Assistance
Patient Assistance Program Center
Hope for Everyone
Helping Patients Get Medication
TIP: If you have Medicare (Part D), watch out for gaps in prescription drug coverage (called the “donut hole”). After total prescription drug costs reach a certain amount, Medicare requires you to pay for medicines out of pocket before drug coverage kicks in again.
Heart Failure Patient?
The Patient Access Network (PAN) Foundation has launched a new patient assistance fund for Medicare patients being treated for heart failure. Qualifying patients will be eligible to receive up to $1,500 per year to help cover the out-of-pocket costs associated with their prescribed heart failure medications. To qualify, patients must:
- Have Medicare insurance and it must cover the medication for which they seek assistance
- Reside and receive treatment in the United States
- Have a household income at or below 500% of the Federal Poverty Level (for example, $79,650 or less for a family of two).
Patients, or advocates and caregivers applying on their behalf, can apply for assistance using PAN’s online patient portal or by calling 1-866-316-PANF (7263), 9 a.m. to 5 p.m. Eastern Standard Time, Monday through Friday. To learn more about PAN’s heart failure program, visit www.panfoundation.org/heart-failure.
Free or Low-Cost Options for Health Insurance
There are a number of free or low-cost health insurance options to help certain individuals and families pay their medical bills. Medicaid and the Children’s Health Insurance Program (CHIP) are two examples.
These government-sponsored or “public” programs are available only if you meet certain requirements, mostly related to your income. For example, to be covered by Medicaid, it may depend on:
- Your income and resources
- Your age
- Whether you are pregnant, disabled or blind
- Whether or not you are a U.S. citizen
Because each state has its own rules about who and what services are covered, you need to check with your state office for more information. To learn more about the programs in your state and what options might be right for you, visit http://finder.healthcare.gov/.
Community Health Centers may be another place to turn. Certain hospitals, health centers and clinics provide free or low-cost health care. Anyone can use these centers regardless of whether they have health insurance. However, the amount you pay will depend on your income.
Patient Navigators – Your Personal Guide
If you have heart disease, you know it can be a lot of work to manage your condition and keep up with medical appointments and bills. Patient navigators can be a very useful resource. Think of them as your personal advocate. They help answer questions and can be a guide to you throughout your journey, helping to ease the burden of living with your condition. Some studies have shown navigators can actually help shorten the time to diagnosis, and perhaps result in better outcomes and overall care.
Patient navigators are usually nurses or social workers. You can typically find them working in hospitals or major medical centers.
A navigator can:
- Guide you through the hospital process
- Help you better understand your diagnosis and treatments, reasons for medical tests, etc.
- Advocate for you to receive timely, appropriate medical advice and care
- Coordinate your medical care by making sure your health care providers are talking to one another
- Facilitate communication between you, your family and members of your health care team
- Answer insurance questions
- Find information and support
- Help you feel more in control and prioritize your concerns
Find out if your hospital or health care system has a patient navigator available.
6 Quick Tips
- Find out if you qualify for certain programs. There are free or low-cost health insurance options, as well as “high risk” pools, prescription assistance programs and other programs to help certain people pay health-related costs.
- Know your health plan. In order to get the best care possible—and avoid unpleasant financial surprises—it’s important to know your insurance policy inside and out and what is covered and what isn’t. If you have questions, call your insurance company or ask a patient navigator for help.
- Take advantage of resources offered by your insurance carrier. Many insurance companies have online tools and phone support to help answer questions about treatment options and provide tips for maintaining health and wellness.
- Be your own advocate. Few things are more important than your health. Taking an active role in your health care includes knowing what health insurance options are available to you and making sure you are getting the most from your coverage.
- Ask for help. Navigating the health care system – even your insurance plan and following up on claims – can be difficult. Patient navigators, social workers and other health advocates can help. Find out if your hospital has one.
- Prioritize your health needs. You know better than anyone what your health needs are.