FAIR Health Consumer Access

Coverage for Cancer Care

A cancer diagnosis can change your life. While cancer care will differ by individual circumstances and the type of cancer, identifying ways to cover the costs associated with cancer can help you plan. This guide will help you to understand your options to pay for cancer care. It will explain the costs of cancer care, describe commercial and government coverage, and give you some tips on other ways to plan for the costs of your cancer care.

This article doesn’t provide medical advice. Speak with your doctor or healthcare team to help guide your healthcare decision making.

Costs of Cancer Care: What to Think About
People with cancer typically have higher out-of-pocket costs than people without it. This is because there may be many treatments, you may be hospitalized and you may have more appointments. You may need to travel to find a cancer center that best meets your needs. And you may need to meet with multiple specialists. New treatments for cancer are coming out all the time. Some of these may be pricey. Even if your cancer has been treated successfully, you may be taking medications for an extended period of time. And you may need regular follow-up tests to check on your health. In addition, having cancer might make it hard to do your job. If you need to stop working or cut your hours, your income could suffer.

Commercial Coverage
A commercial health plan is one you get through your (or a family member’s) job or from the Health Insurance Marketplace. Most plans cover routine cancer screenings, often at no cost. But many commercial plans need a pre-authorization for cancer services. This means your doctor needs to get approval from your health plan to say that a service, treatment, drug or medical equipment is medically necessary.

If you have a cancer diagnosis, check to see if your commercial plan covers the following:

• Cancer tests, such as scans and blood tests.
• Cancer therapies, such as chemotherapy, radiation and infusion.
• Genetic screening.
• Nutritional supplies.
• Diagnostic cancer screening (some plans may have different coverage for routine versus diagnostic screening).
• Cancer pain management, such as medications, physical therapy and injections.

The Affordable Care Act (ACA) states that your current health plan can’t be canceled because you have cancer. Also, you and your children can’t be denied coverage if you or they have cancer.

Commercial plans have a network of providers (such as doctors and hospitals) that agree to accept their contracted rates. If you go to an out-of-network provider, you usually have to pay more, so it makes sense to stay in network. With a cancer diagnosis, however, you may wish to see the providers with the most experience with your condition. And if your cancer is rare or serious, those providers might not be in your health plan’s network. Be sure to ask your health plan about any out-of-network benefits they have. Some health plans will give you approval to see an out-of-network provider at in-network prices if you ask. Learn more in our article here.

Cancer-specific insurance plans. Several health plan companies offer a supplemental cancer policy that can help with medical bills and other costs related to cancer. You must buy this policy before you get a cancer diagnosis. This kind of policy won’t pay for all your care, but it’s possible to get a lump-sum cash benefit with some policies. The lump sum can be used for anything. Cancer insurance can be useful if you have a high risk of cancer but don’t have any symptoms or a diagnosis. Talk over the options with a healthcare provider and/or a trusted friend or family member.

Private disability insurance. Ask your employer if they offer short- and long-term disability insurance. These policies can cover part of your income while you’re out of work due to cancer.

Government Coverage
Medicare. Medicare is insurance for people 65 or over, or who have certain illnesses or disabilities. Medicare covers cancer screening. It also covers some oral cancer drugs and chemotherapy. However, your doctor might recommend you get services more often than the amount Medicare covers. In that case, you may have to pay some or all of the costs. Search for whether and how often your test or treatment is covered by Medicare here.

Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid and CHIP are state and government health insurance for people with low income. Medicaid covers screening for breast, cervical and colorectal cancer. If you qualify for Medicaid/CHIP in your state, it will typically cover all medically necessary cancer treatment too. It will also often cover nonemergency medical transportation. If you’re diagnosed with cancer and are eligible for Medicaid but don’t have coverage yet, Medicaid may cover the costs of your healthcare for up to three months before you’re found officially eligible. This is called retroactive eligibility and can help you get cancer care right away. Contact your state Medicaid/CHIP agency to find out if you and/or your children are eligible.

Dual eligibility for Medicare and Medicaid. If you’re eligible for both Medicare and Medicaid, both can work together to cover more of your cancer care and keep your out-of-pocket costs lower. If Medicare won’t cover a service, Medicaid often will. Find out more here.

Veteran Healthcare. If you or a loved one with cancer are a veteran, the US Department of Veterans Affairs (VA) can help. Veterans who have cancer due to exposure to burn pits, Agent Orange and other toxic substances can get expanded VA healthcare through the PACT Act. The Act states that brain cancer, head cancer, lymphoma, melanoma, kidney cancer, pancreatic cancer and some others are covered under VA healthcare if you were exposed to burn pits/toxins during your service. Apply for VA healthcare here.

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). If you can’t work due to your cancer, you may be able to get SSDI or SSI payments to help manage living expenses. You can get Medicare two years after you become eligible for SSDI. To get SSI, you need to have low income. Find out more in our article on disability coverage here.

Other Ways to Plan for the Costs of Cancer Care
Preventive care. Getting cancer screening can help find cancers early, which could reduce your costs overall. Read our article on preventive services here.

Decision aids. When you and your doctor make decisions together, it’s called shared decision making (SDM). On our SDM page, you’ll find links to decision aids with clinical and cost information for early-stage breast cancer and fast- and slow-growing prostate cancer. Our printable checklists, available on our Older Adults page, can also help you navigate healthcare decisions and costs.

Clinical trial participation. A clinical trial is a research study using humans. Clinical trials can test how well a new cancer treatment works. If you want to take part in a clinical trial, your health plan should cover some costs that may be standard of care. And trial sponsors, such as drug companies, often cover the cost of the new treatment. To find out more about coverage for clinical trials and experimental treatments, check out our article here.

Self-advocacy. Ask your doctors about the costs of your treatment and if there are any programs that can help you save money. If an out-of-network provider sends you a bill you can’t afford, don’t be shy about speaking up. Call the provider and ask for a discount or payment plan. You may also be able to use our medical and hospital cost estimates to compare with what your provider is charging and use that to try to negotiate a lower rate. See more about that in our article here. If your insurer won’t pay for a healthcare service, you can appeal their decision. Find out how to do that in our article here. Make sure you keep good records of all your healthcare costs.

Crowdfunding. Check out some websites that allow you to raise money for medical and other expenses. Family, friends and other members of your community can contribute.

Financial assistance programs. Check out some programs and resources to help with cancer costs here. Ask your healthcare team if there’s a financial counselor or navigator you can talk to. Also, look up your type of cancer to find organizations that can help. For example, the Leukemia & Lymphoma Society offers funds to help patients with blood cancer expenses.

Resources
Family Reach is a nonprofit that provides financial support for families facing cancer.

The American Cancer Society is a nonprofit that has information about cancer care and cancer costs, as well as a 24-hour helpline. You can also find online patient support groups for different types of cancer.

The National Cancer Institute is a federal agency that conducts cancer research and training. Their site has information about the latest cancer research and ways to find clinical trials in the United States.

Find clinical trials happening anywhere in the world at ClinicalTrials.gov.