How will I pay for all this?
ACS Answer
The cost of treatment varies with the type of treatment, how long it lasts, how often it is given, and whether you are treated at home, in a clinic, office, or in the hospital. Most health plans, including Medicare Part B, cover at least part of the cost of many treatments. In many states, Medicaid may help pay for certain treatments. Before you begin treatment, find out whether your insurance company or Medicare will pay for your care. Find out also what part of the expense, if any, will be your responsibility.
Check to see if you qualify for state or local benefits such as Medicaid if you are in a low-income bracket or are unemployed. If you are currently employed and are thinking about leaving your job, find out about conversion options through your current plan. (Conversion options may allow you to switch from your employer's insurance plan to an individual plan with similar coverage.)
Many group plans have a clause for switching to individual plans, although you may have to pay higher premiums (what you pay for insurance). You usually must apply for these individual plans within 30 to 60 days of leaving your job. For additional information, please see "What is COBRA?"
If you are looking at insurance options, look closely at differences in coverage between plans. Ask about your choice of doctors, as well as protections against cancellations and increases in premiums. Find out what the plan really covers, especially if you have a catastrophic illness (generally defined as an illness that prevents you from working). What are the deductibles? (Remember that many health insurance plans have different deductible amounts for different services.) Sometimes higher deductibles go with better comprehensive coverage.
Most managed care plans should pay for participation in a clinical trial if a patient's doctor recommends the treatment and if the clinical trial is approved by a trustworthy agency. These plans typically supply case managers or other personnel with whom your doctor can argue for the need for drugs not typically covered. Health maintenance organizations (HMO) commonly provide preventive care and routine doctor visits; however, access to state-of-the-art cancer care is sometimes difficult to obtain through these organizations.
Learning about your health insurance will help you be prepared not only for the expense of treatment, but also for the process of communicating with the many people involved in administering your health insurance plan. Patients who understand their insurance and know how to communicate with the insurance company are more likely to be successful in getting the coverage they need. Sometimes it is necessary to go outside the plan for the cancer care that is best for you. Knowing in advance exactly what your health insurance will cover can give you some peace of mind as you make treatment decisions.
If you have a dispute with your health plan, there are ways to handle it. Always keep records and documents from all aspects of your care and interaction with health plan staff and clinicians. Your doctor is your ally and advocate. In cases of denied care, it is your doctor who may go to the proper administrator within the health plan, such as a medical director, to give him or her additional information about your case.
If you do not already have insurance, there are several options to consider in seeking coverage, such as an independent insurance broker who may be able to help you locate a reasonable benefits package. Find out if you can apply for group insurance through professional organizations (such as those for retired persons, teachers, social workers, or realtors).
Related Resources
Get more information about medical insurance.
Get more information about your eligibility for benefits.
Get more information about Medicaid and Medicare.
Get more information about COBRA.
Request a copy of the American Cancer Society document "Financial Guidance for Cancer Survivors and Their Families."
Recommended Consultation
You should consider discussing this topic with your employer’s human resources or benefits department, or with the patient representative at your hospital or doctor’s office.
