- Children Diagnosed With Cancer: Financial and Insurance Issues
- Covering the costs of cancer treatment
- Private health insurance options
- Types of private health plans for children
- Getting answers to insurance-related questions
- Keeping records of your child’s insurance and medical costs
- Handling a health insurance claim denial
- Keeping employer-sponsored health insurance coverage
- Government-funded health plans
- Who regulates insurance plans?
- Options for uninsured children
- What sources are available to help with treatment costs if my child doesn’t have insurance and there’s no public assistance available?
- Financial issues for families: Getting help with living expenses
- To learn more
Government-funded health plans
What is Medicaid?
Medicaid is a state and federal government program that covers much of the cost of medical care for people with income below a certain level – the level varies from state to state. Not all health providers accept Medicaid.
In past years, Medicaid covered specific groups of people, including:
- Low-income families with children
- Supplemental Security Income (SSI) recipients
- Children under age 6 from low-income families may be eligible in some states (even if other family members are not)
- Pregnant women whose income is below certain federal poverty guidelines
- Infants born to Medicaid-eligible pregnant women
Several states still limit Medicaid to the above groups of people, but the health care law now gives states the choice to cover more low-income people through Medicaid. States that take this option (see the Kaiser Family Foundation website for updates) have extended Medicaid coverage to everyone earning up to a certain amount, whether or not they fall into one of the specific categories listed above. The law offers federal money to pay all of a state’s costs to increase Medicaid coverage at the start, with the federal share slowly going down to 90%.
Medicaid pays only a percentage of the direct cost of medical care to hospitals and doctors, but families are not billed for the rest.
Children that Social Security determines to be disabled are usually eligible for Medicaid.
Having insurance coverage does not make a person ineligible for Medicaid.
Some children who are not eligible for Medicaid when they are diagnosed become eligible after the family’s medical debt affects their income and assets.
In some situations, being eligible for Medicaid can help a child or family, even if it’s not used to pay direct medical costs. For example, most medical centers make their own determination of a family’s ability to pay medical bills. A family with an income low enough to qualify for Medicaid may get special consideration that could result in a discounted hospital bill. Medicaid funds may also be used in some states to help pay the cost of transportation to hospitals and clinics and for food and lodging if a family has to travel for treatment or follow-up care.
In the states that have decided not to cover more people through Medicaid, many low-income people still won’t qualify for Medicaid. Some very low-income people who don’t qualify in these states won’t qualify for help paying for a private insurance plan in the marketplace either. But you may want to keep checking, because states can decide at any time to extend Medicaid coverage as allowed under the health law.
For details on whether you or your children qualify and for how much, visit www.healthcare.gov, or find your state marketplace by calling 1-800-318-2596. Your team social worker can also give you more information on applying for Medicaid, or you can contact your county social service or health department. These numbers can be found in the blue pages of your local phone book, or you can get them from your state Medicaid office (see the “To learn more” section).
If you live in a state that has broadened its Medicaid coverage, it’s a good idea to re-apply in 2014, even if you or your children have been turned down before.
State-sponsored children’s health insurance programs (CHIP)
There’s a special state and federal partnership that pays for medical services for children called the Children’s Health Insurance Program (CHIP). CHIP offers some type of low-cost health insurance for uninsured children and pregnant women in families with incomes too high to qualify for state Medicaid programs, but too low to pay for private coverage.
Within federal guidelines, each state sets up its own CHIP program, including eligibility guidelines, benefits offered, and cost. The program covers doctor visits, medicines, hospitalizations, dental care, eye care, and medical equipment. It’s funded by state tax dollars. People enrolled in Medicaid usually are not eligible for state-sponsored health insurance programs.
To find out more about CHIP, call 1-877-543-7669 (1-877-KIDS NOW). You can also go to the CHIP website, www.insurekidsnow.gov, to learn more about the program in your state.
Can Medicare help with medical care costs for children?
Medicare is a federal program funded through the Social Security system. It offers insurance for US citizens and qualified legal immigrants who meet certain criteria. Young people with cancer who are disabled may get Medicare benefits after collecting Social Security benefits under the Supplemental Security Income (SSI) program for 2 years.
For your child to get SSI, you must apply for it on behalf of the child, complete with household income and the child’s medical and school information. Social Security will then determine if the child is disabled. A lot of confusing information and rumors about how Medicare benefits change (or don’t change) under the new health care law have been going around. But don’t let this keep you from exploring this possibility if your child has been getting Social Security. You can get up-to-date information on SSI and Medicare from the Social Security website (www.ssa.gov); click on “Disability.” If you have Medicare questions, talk with your team social worker, call Medicare directly at 1-800-633-4227, or contact your local Social Security office.
Medicare plus Medicaid: People on Medicare who have a low income and limited resources may get help paying for their out-of-pocket medical expenses from their state Medicaid program. For more information, contact your state or county Medicaid office (see the “To learn more” section).
What other public assistance programs might help pay for my child’s medical care?
Children’s Special Health (Care) Services (CSHS or CSHCS)
This is a state-run program, financed by state and federal money. It may help pay some health care costs for children, usually those 21 and younger with certain chronic conditions, including cancer. In many states these programs have different names. To find out if such programs can help you, talk to a hospital or clinic financial counselor or talk with the team social worker. Or you can try calling your state health department.
A few hospitals and other non-profit medical facilities get Hill-Burton funds from the federal government so they can offer free or low-cost services to those who can’t pay. Each facility chooses which services it will provide at no or lowered cost. Medicare and Medicaid services aren’t eligible for Hill-Burton coverage. But Hill-Burton may cover services that other government programs don’t.
Eligibility for Hill-Burton is based on family size and income. First you’ll need to find out if there’s a facility in your area that has any Hill-Burton obligation for which you may qualify. If your child is cared for at such a facility, you may apply for Hill-Burton help at any time, either before or after care is received. Call the Hill-Burton Program for more information at 1-800-638-0742 and leave your address to request a packet of information. You can also visit their website, www.hrsa.gov/gethealthcare/affordable/hillburton/facilities.html, for a listing of Hill-Burton-obligated facilities, eligibility criteria, and frequently asked questions about the program.
Can children who are not US citizens get Medicaid or Children’s Special Health Services?
There are situations in which children who are not citizens of the United States, but are legal immigrants, may be able to get Medicaid, CHIP, or Children’s Special Health Services (CSHS) to pay for some of their treatment. All questions about Medicaid eligibility rules and regulations should be discussed with your county Medicaid specialists. Talk to the hospital or clinic financial counselor about CHIP or CSHS coverage. The services of an interpreter can usually be arranged if speaking or understanding English is a problem.
Will children covered by Medicaid, CHIP, or Children’s Special Health Services be treated the same as children covered by private health plans?
Children and teens should get the same quality of care, the same state-of-the-art treatment, and any other services available – no matter who pays for it. If parents have any questions or concerns about this, they should speak with the pediatric oncologist in charge of their child’s care or with another member of their child’s cancer care team.
Veterans’ and military benefits may help children
What if the child’s parent has TRICARE?
TRICARE is the Department of Defense’s health insurance program for those in the military, as well as some family members, survivors, and retirees. It offers a number of different plan options to cover people in the US and overseas, and includes family plans as well as plans for certain reservists. Pharmacy plans, dental plans, and other special services are available for some beneficiaries. If the parent is a veteran who retired from the military, their child, teen, or young adult may be eligible for TRICARE.
Unlike insurance plans that are governed by the new health care law, TRICARE has its own set of rules about young adults. It only covers children as dependents on their parent’s plans up to age 21, or age 23 if they are full-time students who are financially supported by their families.
If the sponsor-parent is on active duty, in reserves, or is retired from the military, individual coverage may be available through TRICARE for unmarried adults up to age 26 if they don’t qualify for coverage at work. However, this is a separate policy with its own premium. Check with your TRICARE office about signing up.
The service member must register eligible family members, including children, in the Defense Enrollment Eligibility Reporting System (DEERS) to get health coverage for them. Records can be kept up to date by the service member or the family members through the nearest military personnel office or ID card-issuing facility, or online at www.military.com/benefits/tricare/tricare-eligibility.html.
Each TRICARE plan has its own limits and requirements. Choose your plan carefully and know how it works. You can find more on TRICARE at www.tricare.mil, including a way to compare different plans to find one that best suits your family and children.
What if a parent is a military reservist who has been called to active duty?
Members of the military reserve units who are called up for active duty from private employment have certain rights about the health care coverage they get from their employers. They are allowed to pay the full cost of their health plan, very much like COBRA, during their time away. When they return to work, their health coverage must be re-instated without any waiting period. See “To learn more” for US Department of Labor contact information to find out more about this.
What if the child’s parent died in the military or became permanently disabled due to military service?
A program called the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is available for certain spouses, widows, or widowers and their children who are not eligible for TRICARE. CHAMPVA can cover the spouse or widow(er) and the children of a veteran who:
- Is permanently and totally disabled due to a service-connected disability as determined by a VA regional office
- Was rated permanently and totally disabled due to a service-connected condition at the time of death
- Died of a service-connected disability
- Died on active duty and the family members are not eligible for TRICARE benefits
CHAMPVA is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by the VA Health Administration Center. You can find out more about CHAMPVA, including things like eligibility, benefits, finding a provider, and filing claims by calling 1-800-733-8387, or visiting their website, www.va.gov/hac/hacmain.asp (select CHAMPVA under “Special Programs”).
Last Medical Review: 01/14/2014
Last Revised: 01/14/2014