- Children Diagnosed With Cancer: Financial and Insurance Issues
- Insurance is complicated
- Private health plan coverage for children
- How to manage your child’s health insurance
- 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 when you leave your job
- What if my child’s medical care is covered by more than one insurance company?
- Government-funded health plans
- Who regulates insurance plans?
- Options for uninsured children
- State coverage and health insurance options for the hard to insure
- 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
Options for uninsured children
What if my child is not listed as a beneficiary under either parent’s health insurance?
Sometimes even if a parent has group insurance coverage through an employer, family members are not covered because the premiums cost too much. You will want to talk about this with the team social worker, who should know more about financial resources that may offer help.
If possible, the insured parent should talk with their employer (or their employee benefits person at work) about how to enroll their child. Many plans have annual or semi-annual “open enrollment” periods that allow you to sign up for family coverage despite current medical problems.
Cancer treatment can go on for long time and cost a lot. Insurance issues can be very complex and many families need help not only in finding answers, but even in knowing the right questions to ask.
What can we do when work does not offer us group health insurance?
Families that do not have health insurance through an employer can explore several options:
- Under the new health care law, people looking for health coverage will be able to compare plans and select the best one for their family on new health insurance marketplaces in each state. Your state’s marketplace will collect information from you to find out if you qualify for Medicaid or financial help to help pay for coverage. For a list of state marketplaces, visit www.healthcare.gov or call 1-800-318-2596. Or, you can watch for your state’s marketplace information starting in October 2013. The health marketplace starts covering people on January 1, 2014, but open enrollment ends March 31, 2014.
- If you need help before the end of 2013, look into buying individual health insurance to cover your child. Although this is costly, rates have become more competitive with private insurance companies who see this as a business opportunity.
- Some states have health insurance options for low-income residents, in which the state pays for part of the coverage.
- Decide if one parent should look for a job with a large company that offers health insurance.
- Find out if there are health maintenance organizations (HMOs) or health care service plans in your community. You can sometimes get very good coverage through these plans. Many offer a period of open enrollment each year during which applicants are accepted regardless of past health problems.
- If a parent and child have recently been covered under an employer-sponsored plan for at least one day, and the employer still offers insurance coverage, the parent should be able to keep their medical insurance (or just the child’s, if the parent went part time, lost or left the job, died, got divorced, or became eligible for Medicare) through COBRA. The employer should tell you, in writing, about this COBRA option. For more information, please see “COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986)” in the section called “Keeping employer-sponsored health insurance coverage when you leave your job.”
- Look into your child’s eligibility for Medicare, which covers people who are permanently disabled and have been getting Social Security (SSI) for 2 years.
- See if your child is eligible for state or local benefits such as Medicaid if you are in a low-income bracket or are unemployed.
- If you have insurance at work and want to leave the job, find out if you can convert your group insurance to an individual plan for your family. Some group plans have a clause that allows people to convert, but premiums may be much higher. You usually must apply for individual plans within 30 days of leaving a job. (This is different from COBRA, which allows you to stay with the group insurance but only for a limited time.)
When looking into insurance options, find out about differences in coverage. The health care law requires plans to provide a Summary of Benefits and Coverage (SBC). The SBC is an easy-to-understand document with details on the benefits and the costs you will be responsible for. It includes specific disease examples to help compare which plan may be right for you. Look into these things:
- Choice of doctors
- Protection against cancellations
- Increases in premiums
- What the plan really covers, especially in the event of catastrophic illness (a serious illness, like cancer, that can add up bills quickly)
- What are the deductibles and co-pays? (Sometimes higher deductibles go along with better or more complete coverage.)
Be wary of ads or agents offering what they might call “government-issued insurance” or other low-cost health insurance. See “Fake health insurance” in the “Private health plan coverage for children” section for more on this.
If you feel an insurance company has treated you unfairly, contact your state insurance commission for more information. See the “To learn more” section to find your state insurance department.
Last Medical Review: 10/07/2013
Last Revised: 10/07/2013