If a client wants to be completely covered by Medicare without any extra out-of-pocket costs, what should they do?
It depends. Each client should be assessed individually, as the answer depends on the client’s unique life circumstances, the assistance that RWHAP and ADAP provides in the client’s state, Medicare Advantage and Medigap plan availability, and the eligibility criteria for financial assistance programs such as Medicare Savings Programs in the area.
Medicare-eligible clients should first compare the pros and cons (including costs, coverage, and provider networks) of Original Medicare vs. Medicare Advantage plans in the area. If the client opts for Original Medicare, they should consider adding on a Medigap policy and Medicare Part D prescription drug coverage.
After enrolling in Medicare coverage (Original Medicare or Medicare Advantage), the client should review the eligibility criteria for additional financial assistance programs, including but not limited to:
- State Medicaid programs
- Program of All-Inclusive Care for the Elderly (PACE)
- State-administered Medicare Savings Programs
- The federal Extra Help program (i.e. the Part D Low Income Subsidy)
- State-administered State Pharmaceutical Assistance Programs (SPAPs)
- Locally available Pharmaceutical Assistance Programs (PAPs) to reduce the cost of specific brand-name medications
Case managers should also stay up-to-date on the RWHAP and ADAP policies in their jurisdiction, including allowable costs and payor of last resort requirements.