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Leann Reynolds

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How to Navigate Medicare/Medicaid With Cancer

Posted: 05/08/2012 6:11 pm

When someone is diagnosed with cancer, they are so deluged with information about their health and how to treat the disease so that managing their Medicare or Medicaid coverage gets overlooked.

"The paperwork becomes overwhelming for people," said Cheryl Berger-Israeloff, who works as a volunteer patient navigator for the American Cancer Society at Nassau University Medical Center. "They have to figure out what is covered, what they need, what is not covered."

Ms. Berger-Israeloff is not just working with people who are over age 65 and therefore automatically eligible for Medicare, but also indigent people, illegal immigrants, and what she calls the "working-class poor."

"A lot of people don't know that if they get a life-threatening disease, like cancer, that they can apply for emergency Medicaid," she said. One patient she met was a young woman who discovered a lump in her breast, but since she had lost her health insurance when she lost her job, she did not seek immediate treatment and waited until she was very sick to come to a hospital.

Susan Olivera-Pepin, director of the patient and family services for the American Cancer Society in the Bronx, recommends that people diagnosed with cancer connect with their hospital's social worker for help in navigating their Medicare and Medicaid coverage.

"People should also delegate a friend or family member to handle the paperwork as they deal with their surgery, chemotherapy and radiation," Ms. Olivera-Pepin said.

One reason for this is that people can sometimes overlook renewing their own coverage when they are preoccupied with treating their cancer. "We had a patient who it didn't on them to renew their coverage and they were paying out of pocket," she said. "They were concerned with going to the doctor and they last thing on their mind was making sure their insurance was still active."

Another challenge is not only determining what is and isn't covered under Medicare and Medicaid, but also filling out more paperwork to access to what is covered. For example, transportation to and from treatments is covered, according to Ms. Olivera-Pepin, yet the processing time is prohibitive.

"Some people have passed away before getting approved," she said. "That's how long the paperwork can take."

She also recommends calling the American Cancer Society to find local resources for additional coverage and assistance. In addition to their 800 number for anyone to call, their website has a section titled, "Managing Insurance Issues," that has a wealth of detailed information for every possible question and financial assistance data.

Ms. Berger-Israeloff said that the population she works with is primarily using Medicaid, which is more limited that Medicare in terms of who will accept it. "They may be really limited in where they can go for their care," she said.

An option for those who can afford it is to get supplemental coverage, which does require premiums and other costs.

"With Medicare, there are so many holes," said Dawn Vigil, an agent with American Republic Insurance.

She recommends plugging the holes Medigap, which can lead to complete coverage. With Medicare Advantage, the newer Medicare plan, there is often a percentage of costs to be paid out of pocket too. All of the Medicare plans are outlined in great detail at www.medicare.gov, and those with Medicaid can go to the website to learn about who is eligible and coverage.

Ms. Berger-Israeloff is a breast cancer survivor who had private health insurance during her illness and treatment. "I was fortunate to go to whatever doctor I wanted to," she said. "With Medicaid it can be a disparity between the haves and have-nots."

When the insurance does not cover all the costs of cancer treatment and people do not have the funds to pay out of pocket, Ms. Berger-Israeloff said that there are charities to help cancer patients too. "Even when someone is paying 20 to 30 percent of his or her medical costs, it can a huge and unbelievable amount of money," she said. "A catastrophic diagnosis can really set people back."

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