Living Well With Myeloma: Understanding Medicare Changes in 2024 and Beyond

Webinar Video Replay & Slides

As follow up to today's webinar, we will have the speaker slides and a video replay available.

They will be provided shortly after the webinar concludes and posted to our website.

Audience Q&A

• Open the Q&A window, allowing you to ask questions to the host and panelists. It will be sent to our moderator and panelists for discussion.

• If you have a question that does not get answeredtoday, you can contact our Infoline at 800-452-CURE (2873) US & Canada, 1-818-4877455, or email infoline@myeloma.org.

We Want to Hear From You!

Feedback Survey

At the close of the meeting a feedback survey will pop up.

This will also be emailed to you shortly after the workshop.

Please take a moment to complete this survey.

#MyelomaActionMonth: Take Action During March!

WHAT IS #MYELOMAACTIONMONTH?

Myeloma Action Month is a global social awareness campaign that takes place every March to raise awareness of multiple myeloma. Every March, we urge you to champion Myeloma Action Month to make an impact on those living with the disease. Will you take action for the myeloma community?

Advocacy at the IMF

How We Advocate for Bills Like the Inflation Reduction Act

Danielle Doheny Director, U.S. Policy & Advocacy

The Role of Advocacy

To advance the mission of the IMF… the Patient Engagement & Advocacy Function collaborates with multiple stakeholders including patient groups, the medical community, industry and policy makers to inform and influence decision-making.

The U.S. Policy and Advocacy team advocates for equitable access to timely diagnosis, innovative treatments and research funding on Capitol Hill, with key regulatory agencies and coalition partners.

The team advocates both alongside of and on behalf of the patient community that we serve.

Advocacy in Action

How We Work

IMF Advocacy Team

Elected Officials & Policy Makers

Patients & Care Partners

Congress & Government Agencies

Our Top Policy Priorities

Access to Care & Medicines

• Prior authorizations, Medicare Part D out-of-pocket costs, step therapy, copay accumulators

• Oral Parity: advocatingat the Federal level

• Drug shortages, access to & diversityin clinical trials

Coalition Partners Physicians & Key Opinion Leaders

Pharmaceutical & Diagnostics Industries

Biomedical and Programmatic Research Funding

• Federal research dollarsfor myeloma research and awareness, includingfrom the NIH/NCI, FDA, CDC

Reduce Disparities

• CDC multiple myeloma program focused on underserved populations

• Increased federal fundingfor cancer centers

Supply Chain

• Lowering drug prices within supply chain reform.

The IMF’s U.S. Policy Priorities in 2024

IMF advocatingfor increased cancer research funding with Rep. John Moolenaar

We inform and influence decision-making on the critical healthcare policies that directly impact myeloma patients.

Our 2024 Policy Priorities include:

1. Increased Federal Myeloma Research Funding

2. Increasing Access & Diversifying Participation in Clinical Trials

3. Insurance Reform: (Private Insurance)

• Oral Parity

• Copay Accumulators

• Improving Step Therapy Protocols

4. Access to Emerging Cancer Drugs (including CAR-T Cell Therapies)

5. Implementation of the Inflation Reduction Act (IRA)

As we were looking to influence the implementation of the Inflation Reduction Act the question became… …what can we do to help myeloma patients on Medicare?

Understanding Medicare Changes in 2024 & Beyond

Joanna Fawzy Doran, Esq.

Cancer Rights Attorney & CEO, Triage Cancer

This presentation provides general information on the topics presented. The authors and presenters are not engaged in rendering any legal, medical, or professional services by its presentation or distribution. Although this content was reviewedby a professional, it should not be used as a substitute for professional services.

No part of this presentation may be reproduced, distributed, or transmitted in any form or by any means, without the prior writtenpermission of the author, except properly attributed, noncommercial uses permittedby copyright law. For permission requests, contact the authors at info@triagecancer.org

Terms: Costs

Cost to Have Health Insurance

• Premium – each month (fixed $ amount)

Costs When You Use Your Health Insurance

• Deductible – each year (fixed $ amount)

• Co-Payment – each time you get care (fixed $ amount)

• Co-Insurance or Cost-Share – each time you get care (%)

• Out-of-Pocket Maximum (fixed $ amount) =

deductible + co-payments + co-insurance

Dan’s Plan: Deductible = $2,000 Co-insurance= 80/20 plan

OOP Max = $8,000

Meet Dan

If Dan has a $102,000hospital bill, what does he pay?

1. His deductible of $2,000 $102,000-$2,000= $100,000left

2. His co-insurance amount of 20% 20% of $100,000= $20,000

But OOP max is $8,000.So, he would only pay the $2,000 deductible + $6,000 of the $20,000 co-insuranceamount, for a total of $8,000.

Medicare

As of September 2023: covers more than 66 million people (~20% of U.S. population)

• Eligibility

• U.S. Citizen or legal resident

• And be:

• 65+ years old; or

• Receiving SSDI 2+ years; or

• Have ESRD or ALS

Medicare Part A - 2024

• Hospital Insurance

• Hospital stay

• Hospice

• Skilled nursing facility stay / home health care

• Nursing home care (very limited)

• Costs

• Premium: $0 – if at least 40 work quarters

• $278 – if 30-39 work quarters; $505 – if less than 30 work quarters

• Deductible: $1,632 per benefit period

• Co-payments: 1-60: $0; 61-90: $408/day; 91+: $816/day until lifetime reserve days used, then patient is responsible for 100% of costs

Medicare Part B - 2024

• Medical Insurance

• Services from doctors

• Outpatient care

• Preventive services

• Lab and imaging tests

• Durable medical equipment

• Cost

• Premium: $174.70/month (most people – based on income)

• Deductible: $240/year

• Cost Share: 80/20%

• No out-of-pocket maximum!

• Medicare A+B = Original Medicare = fee-for-service

Medicare Part D - 2024

• Prescription drug coverage added to Medicare

• Sold by private insurance companies

• Cost

• Premium: varies by plan (2024 Range: <$1-$108) and by income level

• Deductible: $545

• Co-payments vary based on plan

Medicare Part D – Donut Hole before ACA

Until total drug costs = $2,700

Beneficiary

Beneficiary pays 25%

Beneficiary pays 100%

After total out-of-pocket drug costs = $4,350

Beneficiary pays greater of 5% or $2.40 generic / $6 brand

Medicare pays 75%

Medicare pays 0%

Medicare pays 95%

ACA Medicare Benefits

1. Free Wellness Visit

2. Free Preventative Care

3. Lowers the cost of prescription drugs

Medicare Part D - 2024

Inflation Reduction Act of 2022

Beneficiary pays max of $545

When total out-of-pocket drug costs = $8,000

Beneficiary pays 25% Beneficiary pays $0

Drug plan pays 5%

Drug company discounts

70%

Note: patients who are taking brand name drugs, get credit for the 70% discount that drug companies pay, which helps them reach the total OOP drug costs of $8,000. This means their actual OOP costs = ~$3,333

Medicare Part D – 2025

• 2025: Caps out-of-pocket drug costs at $2,000

• Applies to both Part D plans and Part C plans with drug coverage

• If plan has a drug deductible, that will count towards the cap

• Cap could increase over time

TriageCancer.org/2024-Medicare-Changes

• 2025: Part D plans will allow out-of-pocket costs to be spread out through the year, rather than a lump sum payment

• Ex: $167/month vs. $2,000 in January

Medicare Part D – Other IRA News

• 2023: co-pay for 30-day supply of insulin will be capped at $35

• 2023: vaccines covered under Part D plans (e.g., Shingles) have $0

cost-sharing

Medicare Part C – 2024

• Medicare Advantage (MA) (1982)

• Must be enrolled in Part A and B; also ~90% include Part D (Rx coverage)

• HMO, PPO, Special Needs Plans (SNP), Medical Savings Account (MSA), Private Fee-forService (PFFS)

• Sold by private insurance companies

• Networks of providers

• Cost

• Premium: varies – average = $18.50

• In addition to Part B premium

• Deductible, co-payments, & co-insurance: varies

• OOPmaximum ≯ $8,850 for in-network services

• Eligible for both Medicare & Medicaid

“Dual Eligibles”

• More than 12 million individuals (2023)

• Medicare typically primary payer

• In most cases, Medicaid picks up Medicare Part A & B cost-sharing

• Medicaid can cover non-Medicare services (e.g., dental care in some states)

• States can pay premiums for MA plans

Help Paying for Medicare Parts A& B

Medicare Savings Programs (MSPs)

• Helps pay for premiums; and sometimes deductibles, co-payments, & cost-share

• Four types of MSPs:

1. QualifiedMedicareBeneficiary(QMB–“Quimby”)Program helpseligibleindividuals pay for PartA and Part B premiums,as well as deductibles,coinsurance,and co-payments

2. SpecifiedLow-IncomeMedicareBeneficiary(SLMB–“Slimby”)Program helpseligible individuals pay forPart B premiums.

3. QualifyingIndividual(QI) Programhelpspay the Part B premiumsforcertain individuals who are not eligibleforMedicaid.

4. QualifiedDisabledandWorkingIndividuals(QDWI)Programhelpseligibleindividuals pay their Part Apremiums.

TriageCancer.org/QuickGuide-MedicareSavings

Help Paying for Medicare Part D - 2024

• Low-Income Subsidy (aka Extra Help):

• Mostpeople pay $0 premium or deductible & have lower co-payments/cost-share

• Income limit = 150%FPL

• Pay no more than $4.50 for each generic/$11.20 for eachbrand-name covered drug

• State Pharmaceutical Assistance Programs (SPAP):

• Pays some premiums or drug costs

• Not available in everystate

Where to Go For Help

• Medicare & You: www.medicare.gov/medicare-and-you

• 1-800-MEDICARE (800-633-4227) and say “Agent”

• State Health InsuranceAssistance Program (SHIP): TriageCancer.org/stateresources

Triage Cancer Medicare Resources

Other Financial Assistance Options

Module: FinancialAssistance Options

• Local, state, county, & community organizations

• Cancer organizations

o American Cancer Society

o CancerCare

• Private programs

o Patient Services, Inc.

o Healthwell Foundation

CancerFinances.org

Free, one-on-one help for:

• Individuals diagnosed with cancer

• Caregivers

• Health care professionals

Health Insurance, Employment, Disability Insurance, Finances, Estate Planning, & More

Our Navigation services:

• Explain options

• Provide accurate information

• Empower you to take next steps

Start Online:

Audience Q&A

• Open the Q&A window, allowing you to ask questions to the host and panelists. It will be sent to our moderator and panelists for discussion.

• If you have a question that does not get answeredtoday, you can contact our Infoline at 800-452-CURE (2873) US & Canada, 1-818-4877455, or email infoline@myeloma.org.

We Want to Hear From You!

Feedback Survey

At the close of the meeting a feedback survey will pop up.

This will also be emailed to you shortly after the workshop.

Please take a moment to complete this survey.

Webinar Video Replay & Slides

As follow up to today's webinar, we will have the speaker slides and a video replay available.

They will be provided shortly after the webinar concludes and posted to our website.