Nearly three million Americans are diagnosed with rheumatoid arthritis (RA) every year. RA is an autoimmune disease meaning the immune system appears to attack the synovium that lines our joints. The disease causes pain and inflammation, usually confined to the joints, but can also be found in other parts of the body. If RA is not treated, it can cause permanent disability and organ damage.
Researchers have come up with therapies that can put the disease in remission. These therapies involve injections or infusions. And, for many RA patients, the infusions can help in relieving pain, preventing progression of the disease and possible deformation, and maintaining an independent lifestyle.
For those who have Medicare Parts A and B supplemented with a Medigap policy, there is no problem adhering to the infusion treatment schedule (usually every six to eight weeks). This is because Medicare covers 80 percent of the infusion cost under Part B and the supplemental Medigap plan would handle the remaining 20 percent not covered by Medicare.
However, it’s a different story with Medicare Advantage plans. They are only required to provide the benefits available through Medicare, or 80 percent of the cost. Patients need to handle the remaining 20 percent of the cost since Advantage plans cannot be combined with a supplemental Medigap policy.
The foundations that had been established to provide financial assistance have already exhausted their funds this year, so about 36 percent of Medicare Advantage RA patients lost their foundation support and were unable to get treatment. This break in therapy can result in disease progression that can lead to permanent damage. There is also an increased risk of infusion reactions if the therapy is interrupted for more than four weeks and then resumed. This can really be life threatening and could require finding another treatment regimen that worked for the patient.
Even though Medicare Advantage plans typically offer low premiums, they may not be right for you if you suffer from RA. Lower premiums are of little benefit if you can’t get the health care you need. If you’re suffering from RA, combining original Medicare with a Medigap plan may save you money in the long run because you wouldn’t have to pay for 20 percent of the cost of RA treatments.
Jim McFadden has over 11 years of executive-level experience in the health insurance industry, is a youth baseball, softball and football coach, and has one of the worst fantasy football records in the world.