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  • About Arthritis
    Common Topics
    woman holding her wristWhat Is Arthritis?

    Arthritis is not one disease. Learn about the different types of arthritis, how they differ and why it’s important.

    microbesInflammation and the Immune System

    Body-wide inflammation is at the root of most chronic diseases — and you may have more control over it than you think.

    Patient talking with nurseNewly Diagnosed With Arthritis

    A new arthritis diagnosis can be overwhelming. These tips can help.

    • Understanding Arthritis
    • Arthritis Types
    • More About Arthritis
    • Where it Hurts
    • Related Conditions
  • Treatments
    Common Topics
    Woman holding shoulderWebinar: Touch Therapies for Pain Management

    Learn the evidence behind popular touch therapies for arthritis, including what to try and what to avoid, for how long and when.

    Managing Arthritis Care Costs

    Learn the basics about health care costs and financial tools available to you.

    Man with head in hands on bedWebinar: Arthritis Fatigue Causes and Solutions

    Learn the various causes of arthritis-related fatigue and strategies to combat weariness.

    • Treatment Plan
    • Drug Guide
    • Joint Surgery
    • Complementary Therapies
    • Insurance Management
  • Healthy Living
    Common Topics
    Woman with upset stomachMicrobiome, Gut Health & Arthritis

    Microbiome, microbes, microorganisms – these terms may be confusing, but the types of bacteria living in and on our bodies can impact arthritis. Learn what helps or harms the microbiome and the health of your gut and discover dietary changes that can make a difference. This episode was originally released on January 19, 2021.

    man exercisingStairs Workout Demo

    Strengthen your leg muscles and improve your stability to make going up and down stairs safer and easier.

    woman consoling anotherArthritis and Mental Health

    Learn about the connection between arthritis, depression and anxiety and how these conditions can make your arthritis worse.

    • Ease of Use Products
    • Managing Pain
    • Recipes & Nutrition
    • Physical Activity
    • Emotional Well-being
    • Daily Living
    • Family & Relationships
  • Juvenile Arthritis
    Common Topics
    2023 JA Family Summit

    Learn about the National Juvenile Arthritis Conference, a place for families to connect, share and learn.

    JA Camps

    The Arthritis Foundation’s JA camp programs give kids with arthritis and related childhood rheumatic diseases the chance to make lasting memories.

    Juvenile Arthritis Volunteer

    • About Juvenile Arthritis
    • Treatment
    • Managing Pain
    • Medical Decisions
    • Nutrition
    • Emotional Well-being
  • Professionals
    Common Topics
    Transforming Clinical Interactions

    The Live Yes! Arthritis community connects patients with others online and in-person for support and education, and encourages patients to play an active role in their health care.

    Partners 4 Patients with Arthritis

    The Arthritis Foundation recently launched an initiative to build stronger relationships and increase recognition of our most engaged practices. 

    Fellowships

    See how we're aiming to address the growing shortage of arthritis specialists, especially in under-served parts of the country.

    • Better Living Toolkits
    • Our Issue Briefs
  • Science
    Common Topics
    OACS Forum Series

    The Osteoarthritis Clinical Studies Forum Series features OA thought leaders from across the globe discussing the future of how the disease can be treated to improve patient outcomes.

    man bandaging boy's kneeConquering Childhood Arthritis

    The Arthritis Foundation is mobilizing patients and their families to engage in studies comparing the effectiveness of treatments for juvenile arthritis and funding research for more options.

    Focus

    • Awards
    • Funding Opportunities
    • OACS Forum Series
    • Osteoarthritis Focus
    • Participate in Clinical Trials
    • Partnerships
    • Publications
  • Get Involved
    Common Topics
    Capital hillAction Center

    Take action today - use the resources here to learn who your elected officials are, what opportunities we have to advocate from the comfort of your own home, federal and state legislation, and more!

    LiveYes! Insights thumbnailLive Yes! INSIGHTS

    Share your experience in a 10-minute assessment to be among those changing the future of arthritis.

    woman listening to podcastLive Yes! Podcast

    You may have arthritis, but it doesn't have you. The Arthritis Foundation’s one-of-a-kind podcast. Hosted by patients, for patients.

    • Advocacy
    • Ways to Give
    • Fundraising
    • Volunteer
    • Partnership
    • Live Yes! Arthritis Community
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Managing the Cost of Arthritis Care: Terms You Should Know

Learn the basics about health care costs and financial tools available to you.

The Basics 

  • Allowed Amount: The maximum amount that a health plan will pay for a covered health care service. Also called “negotiated rate,” “allowed charge,” “eligible expense,” or “payment allowance.” If the provider charges more than the plan’s allowed amount, you will have to pay the difference. Even if your provider charges the allowed amount, you may still need to pay a percentage of the cost depending on your health plan (see coinsurance below). 
  • Co-insurance: The percentage of costs of a covered health care service that you pay after you have satisfied your deductible.  Coinsurance levels will vary depending on your type of plan. For example:  Your health plan’s allowed amount for a doctor’s visit is $100 and your coinsurance is 20%. If you’ve paid your deductible (see below), you pay 20% of $100 or $20. The health plan pays the rest. If you haven’t paid your deductible, you will owe the full amount.
  • Co-payment: A fixed amount that you pay for a covered health service (for example $20 for a general physical).  Also called a copay.
  • Co-pay assistance: These programs help you save money on medical care and prescriptions, regardless of your income or ability to pay. You may get a debit card (also known as a copay card)  the money is deposited in an account that you draw from or the provider is paid directly. Funds are provided by drug manufacturers, non-profits, state health departments or the federal government. The funds from some private programs cannot be used if you have Medicare, Medicaid or other federal- or state-funded insurance. 
  • CPT code: A Current Procedural Terminology (CPT) code is a five-number code that providers use to bill for a medical procedure. It’s always included on the bill from the provider or in the explanation of benefits from your insurer.
  • Deductible: The deductible is the amount you pay for medical services or products before your health plan starts paying either a percentage (e.g. 70%) or 100% of an expense. A plan may pay for certain services, like an annual checkup, before a person meets the deductible. Some plans have separate deductibles (e.g. a medical care deductible and a drug deductible). Some family plans have an individual deductible and a family deductible. For example: The individual deductible for in-network coverage is $600 and the family deductible is $2800. If the family meets the $2800 deductible, the health plan will cover the expenses of family members who have met their $600 individual deductible. Family members who haven’t met the individual deductible must still pay out-of-pocket until they reach $600.
  • Explanation of Benefits (EOB): This is an insurer’s explanation of the charges from a medical procedure and how it will be paid.  It shows what the provider charges, what is the allowed amount, how much the insurer will pay and how much the patient will pay.
  • Formulary: A list of prescription drugs covered by your health plan. The list has groups or “tiers.” The higher the tier for the drug the more you will pay for it. While tiers vary among insurers, a typical drug benefit includes three or four tiers:
    • Tier 1 usually includes generic medications.
    • Tier 2 usually includes preferred brand name medications.
    • Tier 3 usually includes non-preferred brand name medications.
    • Tier 4 usually includes specialty medications, such as biologics.
  • High Deductible Plans: These plans have lower premiums and higher deductibles. They are combined with a health savings account (HSA) (see below). The funds put into the HSA are tax-free and can be used to pay medical expenses.
  • Premium: This is the amount you pay monthly for your health coverage.

Insurance Plan Processes

  • Accumulator Programs: These policies prohibit the use of drug manufacturer co-pay cards from being used for a patient’s deductible or out-of-pocket maximum.
  • Donut Hole: Also known as a coverage gap. Most Medicare prescription drug plans (Part D) have a limit on what’s covered during a plan year, and you may need to pay some costs out of pocket.  Not everyone will have this issue and some people qualify for financial assistance to cover the gap.
  • Prior Authorization: A decision by your health plan that a health care service or product is medically necessary. Also called “preauthorization,” “prior approval” or “precertification. Prior authorization doesn’t mean that the health plan will cover the full costs. It may not be required in an emergency. .
  • Step Therapy: A policy by your health plan that requires patients to use a safe lower-cost drug or service before permitting the use of more expensive options. Also known as “fail first.”
  • Gag Clauses: These policies prevent some pharmacists from telling consumers about less-expensive price options.  Many states are outlawing these clauses, but be sure to self-advocate and always ask about prices if you use your insurance or not.
  • Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.

Financial Tools

  • Flexible Savings Account: This account allows you to set aside a portion of your income before taxes to pay for medical expenses and childcare expenses.  FSAs are offered through employers. If you don’t spend all your FSA in a year, you may lose the funds or carry over to next year, depending on your employer’s policy.
  • Health Reimbursement Account: This account is funded by your employer and the money can be used for IRS approved health expenses. It’s only available when your employer manages the health plan instead of an insurance company.  
  • Health Savings Account: This savings account that allows you to set aside a partition of your  income before taxes to pay for medical expenses. It is only available with a high-deductible health plan. HSA funds roll over year to year if you don't spend them.
  • Medical Tax Deduction: The IRS allows you to deduct qualified medical expenses that exceed 7.5% of your adjusted gross income. 

Learn about other health care and insurance terms in the glossary.

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Raise Your Voice
You can help pass laws that make arthritis care more accessible. It’s easy to be an Advocate!
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    Proud Partners of the Arthritis Foundation make an annual commitment to directly support the Foundation’s mission.

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Ways to Give

Every gift to the Arthritis Foundation will help people with arthritis across the U.S. live their best life. Whether it is supporting cutting-edge research, 24/7 access to one-on-one support, resources and tools for daily living, and more, your gift will be life-changing.

Make a Donation

Help millions of people live with less pain and fund groundbreaking research to discover a cure for this devastating disease. Please, make your urgently-needed donation to the Arthritis Foundation now!

Become a Member

Become an Arthritis Foundation member today for just $20 and you'll receive access to helpful tools..... and more. 

Make a Honor or Memorial Gift

Honor a loved one with a meaningful donation to the Arthritis Foundation. We'll send a handwritten card to the honoree or their family notifying them of your thoughtful gift.

Gift Planning

I want information on ways to remember the AF in my will, trust or other financial planning vehicles.
 

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Volunteer


Volunteer Opportunities

The Arthritis Foundation is focused on finding a cure and championing the fight against arthritis with life-changing information, advocacy, science and community. We can only achieve these goals with your help. Strong, outspoken and engaged volunteers will help us conquer arthritis. By getting involved, you become a leader in our organization and help make a difference in the lives of millions. Join us and become a Champion of Yes.

Become a Volunteer

More About Volunteering

  • Walk to Cure
  • Jingle Bell Run
  • Do it Yourself Fundraising
  • JA Camp
  • Start a Live Yes! Connect Group
  • Be an Online Community Moderator
  • Local Leadership Board

Live Yes! INSIGHTS


Give Just 10 Minutes.

Tell us what matters most to you. Change the future of arthritis.

By taking part in the Live Yes! INSIGHTS assessment, you’ll be among those changing lives today and changing the future of arthritis, for yourself and for 54 million others. And all it takes is just 10 minutes.

Your shared experiences will help:

- Lead to more effective treatments and outcomes
- Develop programs to meet the needs of you and your community
- Shape a powerful agenda that fights for you

Now is the time to make your voice count, for yourself and the entire arthritis community. 

Currently this program is for the adult arthritis community.  Since the needs of the juvenile arthritis (JA) community are unique, we are currently working with experts to develop a customized experience for JA families. 

How are you changing the future?

By sharing your experience, you’re showing decision-makers the realities of living with arthritis, paving the way for change. You’re helping break down barriers to care, inform research and create resources that make a difference in people’s lives, including your own.

Get Started

Partner


Meet Our Partners

As a partner, you will help the Arthritis Foundation provide life-changing resources, science, advocacy and community connections for people with arthritis, the nations leading cause of disability. Join us today and help lead the way as a Champion of Yes.

Trailblazer

Our Trailblazers are committed partners ready to lead the way, take action and fight for everyday victories. They contribute $2,000,000 to $2,749,000

Visionary

Our Visionary partners help us plan for a future that includes a cure for arthritis. These inspired and inventive champions have contributed $1,500,00 to $1,999,999.

Pioneer

Our Pioneers are always ready to explore and find new weapons in the fight against arthritis. They contribute $1,000,000 to $1,499,999.

Pacesetter

Our Pacesetters ensure that we can chart the course for a cure for those who live with arthritis. They contribute $500,000 to $999,000.

Signature

Our Signature partners make their mark by helping us identify new and meaningful resources for people with arthritis. They contribute $250,000 to $499,999.

Supporting

Our Supporting partners are active champions who provide encouragement and assistance to the arthritis community. They contribute $100,000 to $249,999.

More About Partnerships

  • Partner with Us
  • Ease Of Use Commendation
  • Let's Get a Grip On Arthritis
  • Promotions that Give Back