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By StateCoverage for Cancer Care
Summary
A cancer diagnosis can change your life. 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.
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. 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
The Affordable Care Act (ACA) states that your current health plan can’t be canceled because you have cancer. Most commercial plans cover routine cancer screenings, often at no cost. But many plans need a pre-authorization for cancer services. Check to see if your commercial plan covers cancer tests, therapies, genetic and diagnostic screening, nutritional supplies and pain management.
Government Coverage
Medicare covers cancer screening. It also covers some oral cancer drugs and chemotherapy. 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.
If you can’t work due to your cancer, you may be able to get Social Security Disability Insurance or Supplemental Security Income payments to help manage living expenses.
Other Ways to Plan for the Costs of Cancer Care
Preventive care, decision aids, clinical trial participation, self-advocacy, crowdfunding and financial assistance programs can help you plan for and reduce the costs of cancer care.
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.
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.
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.
Your Action Plan: Paying for Cancer Care
- Check what your health plan covers for cancer care.
- Speak with your doctor about staying up to date on cancer screenings.
- If you’re at high risk of cancer, consider taking out a cancer-specific health plan.
- If you have Medicare or Medicaid, check to see if you’re eligible for both.
- If you’re a veteran with cancer, check to see if VA healthcare will cover your cancer care.
- Check out our shared decision-making tools if you have early-stage breast cancer or prostate cancer.
- Check out our printable checklists, which can help you ask questions to guide your care and treatment.
- Think about whether you want to take part in a clinical trial that offers treatment for your type of cancer. If interested, speak to your doctor about your options.
- Ask questions about medical costs up front.
- Ask about financial assistance programs where you’re receiving care.
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