What Is The Cost of Treatment For Rheumatoid Arthritis? An autoimmune condition known as rheumatoid arthritis (RA) causes swelling, discomfort, stiffness, and soreness in the joints of the body. The lining of the joints is the focus of rheumatoid arthritis. Rheumatoid arthritis is more prevalent in women and typically affects the hands, knees, and ankles. Around middle age, rheumatoid arthritis typically first manifests.
This article discusses how to handle with insurance and financial aid programs while living with rheumatoid arthritis.
Financial Assistance Programs
There are several ways to get financial assistance for rheumatoid arthritis treatment.
Affordable Care Act
According to the Patient Protection and Affordable Care Act (ACA), insurance companies are required to cover people with rheumatoid arthritis and maintain that coverage without increasing premiums.
Coverage requirements under this law include:
- Hospitalization for surgery
- Disease management
- Prescription drugs
- No coverage limits
- An out-of-pocket spending limit of $8,150 for an individual and $16,300 for a family
- 80% of premium payments spent toward care
The government’s healthcare marketplace can be found at healthcare.gov.
NeedyMeds
NeedyMeds is a nonprofit organization and network that connects people with programs that can help them manage healthcare costs, including:
- Prescription medication costs
- Low-cost healthcare centers
- Diagnosis-based assistance
- Federal and state government programs
For rheumatoid arthritis specifically, NeedyMeds links patients to the rheumatoid arthritis branches of national organizations like The Assistance Fund, Patient Access Network (PAN) Foundation, and the Patient Advocate Foundation. State-run programs, like Florida’s Specialty Therapeutic Care and North Dakota’s Division of Special Health Services (SHS), are also featured.
Good Days
Good Days is a national healthcare nonprofit that helps patients cover the costs of:
- Navigating the healthcare marketplace
- Co-pays
- Prescription drug coverage
- Traveling to medical appointments
- Diagnostic testing
- Paying for premiums
Good Days assistance is income based, and the application can be filled out online or printed and mailed.
Medicare and Medicaid
Medicare is the federal health insurance program for people over age 65, some people with disabilities, and people with end-stage kidney disease.
In addition to coverage for health care and prescription drug costs, Medicare also gives people the right to:
- File a quality-of-care complaint
- Appeal coverage decisions
- See a specialist as many times as needed
If your Medicare plan does not provide complete coverage, a Medigap plan from a private insurance company can help with those costs.
Medicaid is a low-income health insurance program financed by both the federal government and state governments. Medicaid eligibility and benefits can depend on state, and people can qualify for both Medicaid and Medicare at the same time.
If you are not a U.S. citizen or have been a permanent resident for less than five years, you might not be eligible for Medicaid in your state.
To apply for Medicaid in your state, you can use the healthcare marketplace at healthcare.gov or apply through your state’s Medicaid agency website.
Drug Company Programs
Drug companies can assist with prescription costs via pharmaceutical assistance programs (PAPs) and co-pay cards.
You can speak to a healthcare provider or pharmacist about programs available for your prescription, or use online tools like RxAssist and CreakyJoints to search for your prescription. Drug manufacturers also provide contact information for assistance programs on their websites.
State Programs
Most states have state pharmaceutical assistance programs (SPAPs), including for people who do not qualify for other cost-saving programs like Medicare or Medicaid.
Which conditions and prescriptions are covered in an SPAP can depend on the state. You can find your state’s SPAP through the Medicare website.
Other Assistance
Other organizations that can help with healthcare costs and navigating coverage include:
- Healthwell Foundation
- Rx Outreach
- Caring Voices Coalition
- CreakyJoints
- Patient Access Network (PAN) Foundation
How to Find Financial Help
You can also find financial help by asking your healthcare provider or pharmacist about patient assistance programs, co-pay cards, and manufacturer coupons for prescription medications.
It is also recommended that people with arthritis:
- Track expenses by keeping reading and understanding billing statements.
- Compare rates when looking for a provider.
- Appeal claims denials: The healthcare marketplace website provides guidance on how to file health insurance appeals. Non-profits like NeedyMeds and Good Days can also help with appeals applications.
Treatment Costs: What to Expect
A study found that for RA patients, total healthcare costs could range from about $7,000 to $ 21,000. Yearly out-of-pocket prescription costs can depend on the treatment method. The following are some estimates:
- Conventional (not including biologics) treatments: $1,500—$,2000
- Disease-modifying antirheumatic drugs (DMARDs): $70—$100
- Non-steroidal anti-inflammatory drugs (NSAIDs): $40—$65
- Corticosteroids: $20—$ 40
- Biologics: $1.000—$5,0001112
Treatment costs for rheumatoid arthritis can be direct, as in insurance premiums and co-pays, or indirect, as in mobility devices. Here are some other expenses that might occur:
- Prescription drugs
- Physical therapy
- Assistive devices ranging from jar grips to canes and chair lifts
- Supplements
- Anti-inflammatory foods14
- Exercise routines and equipment15
- Ambulance services
- Loss of income from missing work
Summary
Rheumatoid arthritis is an autoimmune disorder when the body’s immune system attacks its joints, causing stiffness, swelling, and pain. Treating rheumatoid arthritis can be costly, but there is financial assistance available.
In addition to private insurance, Medicare, and Medicaid—all of which are required to cover arthritis under the Affordable Care Act (ACA)—organizations like NeedyMeds and Good Days link patients to resources that can help with costs. Drug companies also offer copay cards and pharmaceutical assistance programs (PAPs).
FREQUENTLY ASKED QUESTIONS – What Is The Cost of Treatment For Rheumatoid Arthritis?
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Rheumatoid arthritis is considered for disability claims.16 Getting disability coverage requires meeting strict requirements, including an expectation of not being able to work for at least a year and not more than $1,350 a month in income in the year before applying. Your arthritis must also be debilitating to the point of mobility issues for at least a year, and you must also be unable to find other work because of your condition.17
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What if I can’t afford rheumatoid arthritis treatment?
There are many options for people who can’t meet the costs of rheumatoid arthritis patients. If you can’t afford insurance, the ACA and/or Medicaid can provide financial assistance. Other paths to getting help with rheumatoid arthritis treatment include community health centers (which can be found through findahealthcenter.hrsa.gov), nonprofits like NeedyMeds and the Patient Advocate Foundation, patient assistant programs through pharmaceutical companies and non-profits, and additional state and federal assistance programs.
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Is rheumatoid arthritis curable?
Rheumatoid arthritis is not curable, but patients can reach remission, which is when inflammation is very low and only affects one or no joints. Remission can be achieved with powerful anti-inflammatory drugs called biologics or disease-modifying antirheumatic drugs (DMARDs).18
Final Note
Rheumatoid arthritis can be a painful condition, but maintaining your well-being and minimizing pain is possible despite the costs. There are many opportunities for finding financial assistance for your care, whether that be from a co-pay discount, a federal or state program, or a nonprofit organization. It’s important to remember you’re not alone in needing help navigating healthcare costs, and there are others waiting to help.
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