- Thinking about the costs of cancer treatment
- Private health plans
- Types of private health plans
- Other things to know about health insurance
- How to manage your health insurance
- Getting answers to insurance-related questions
- Keeping records of insurance and medical care costs
- When you have problems paying a medical bill
- Handling a claim denial
- Keeping employer-sponsored health insurance coverage when you leave your job
- COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986)
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- The Family and Medical Leave Act of 1993
- The Americans With Disabilities Act of 1990
- The Affordable Care Act
- Government-funded health plans
- Who regulates insurance plans?
- Health insurance options for the uninsured
- State coverage and health insurance options for the hard-to-insure
- Financial issues: Getting help with living expenses
- Getting money from life insurance policies
- Other sources of financial help
- Disability benefits
- To learn more
The Affordable Care Act
Many people with cancer are afraid they will lose their health coverage if they lose their jobs. Others worry about having their coverage canceled because they got sick. Some face dollar limits on the amount of care their health plan will cover. The Affordable Care Act (ACA), a federal law passed in 2010, changes health care in ways that help people with cancer. For instance, the law:
- Removed life-time dollar limits and restricted yearly dollar limits on health benefits. It will remove all yearly payout limits beginning in 2014.
- Does not allow insurance companies to deny coverage for pre-existing conditions (such as cancer) in children. Pre-existing condition exclusions will not be allowed in adults starting in 2014.
- Does not allow insurance companies to charge patients a fee for cancer screening tests, such as mammograms and colonoscopies.
- Does not allow insurance plans to cancel coverage just because a patient gets sick.
- Created a Pre-Existing Condition Insurance Plan (PCIP) in every state as a way to insure seriously ill people until 2014, when they could buy insurance through exchanges. People who are already in PCIPs can stay in them until 2014, but they’re closed to new enrollees.
- Makes coverage available for patients who take part in clinical trials.
- Allows young adults to stay on their parents’ health insurance until age 26.
Beginning in 2014, the ACA does several important things:
- It requires each state to set up an online health insurance marketplace where people can compare health plans and decide which one is best for them.
- It provides financial help to low- and middle-income people and families who can’t afford to buy health coverage through their state’s health insurance marketplace.
- Requires that most Americans buy health insurance or pay a penalty along with their income taxes.
- It gives states the option to broaden access to Medicaid coverage to include everyone below a certain income level (133% of the federal poverty level, which is about $15,000 for one person and roughly $30,000 for a family of 4).
Health insurance marketplaces
By 2014, each state will have a health insurance marketplace (sometimes called a health insurance “exchange”) that offers consumers a one-stop shop online or through a toll-free phone number. There, they can compare health insurance plans by benefits, quality, and price. Information about prices and what a plan covers will be written in simple terms that are easy to understand. A person will be able to enroll in their chosen marketplace plan online, by phone, by mail, or in person.
People will not have to buy health insurance from the marketplace, but it will be the place to go if you’re looking for cost reductions and tax credits to help pay for insurance. Most employed people who get insurance through their employers are likely to keep it that way, so their situation may not change much.
If you are under 65 and can’t get health coverage through your employer or Medicare, you may be able to buy a health plan through your state’s health insurance marketplace. Low- and middle-income people and families can get financial help (through the health insurance marketplace) to help them afford a plan sold on their state marketplace. People with health coverage through work whose health care premiums are too high compared to their income may also be able to buy coverage through the marketplace.
Starting in 2014, the health care law requires all health plans sold in a state marketplace to cover essential benefits, such as coverage for cancer screenings, treatment, and follow-up care. Each state’s marketplace will put the health plans into groups (platinum, gold, silver, or bronze) based on the level of coverage they offer and the cost of the plan.
After you give your information, the marketplace will tell you if you qualify for financial help to buy a plan. It will also tell you if you qualify for Medicaid, a government program that offers health coverage to low-income people. People who make up to $45,960 per year and families of 4 with a combined income of up to $94,200 a year should qualify for some help to purchase a health plan through the marketplace.
In the states where Medicaid coverage was not expanded, many low-income people will not qualify for it. Some very low-income people also won’t qualify for help paying for insurance in the marketplace. For details on whether you qualify and for how much, visit www.healthcare.gov, or find your state marketplace by calling 1-800-318-2596.
Choosing a plan
When choosing the plan that’s right for you, it’s important to look at the benefits that the plan offers and the total amount you will have to pay, including:
- Monthly premium – The monthly amount you pay the insurer for health coverage.
- Annual deductible – The amount you pay for health care in a calendar year before the plan begins to cover those costs.
- Co-pays – A flat dollar amount you pay for a covered health service, each time that you use that service.
- Co-insurance – The percentage of the total cost of the health service you must pay.
Enrollment in state health insurance marketplaces starts October 1, 2013, and coverage begins January 1, 2014. Enrollment closes for the year March 31, 2014. You can enroll through www.Healthcare.gov/Marketplace. Each state will have trained “navigators” to answer questions and guide consumers.
Visit www.healthcare.gov to get more information about your state’s marketplace and how to enroll. If you don’t have internet access, you can call 1-800-318-2596 or see the “To learn more” section. Or you can watch for information about your state’s marketplace starting in October 2013.
For general information, please read our brochure called The Affordable Care Act: How It Helps People With Cancer and Their Families. You can also get up-to-date information online from the US Department of Health & Human Services at www.healthcare.gov.
Medicaid Under the ACA
Beginning in 2014, the health care law 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) will extend Medicaid coverage to everyone earning up to a certain amount, regardless of whether they’ve ever qualified for coverage before. These “newly eligible” Medicaid beneficiaries will be covered for essential health benefits to prevent and treat serious diseases such as cancer.
The law also ensures that anyone can learn whether they are eligible for Medicaid through their state’s health insurance marketplace. The marketplace is a website where people can look for health coverage on their own. (See the section above, “Health insurance marketplaces” and the “Medicaid” section under “Government-funded health plans” below.)
Low-income people in states that chose not to expand their Medicaid coverage may find that they still don’t qualify for Medicaid. Many of these people also are not eligible for help paying for health insurance in the health insurance marketplace.
Avoiding ACA identity theft and scams
Scammers are already using the ACA to try to get your personal information for identity theft, or to sell you fake insurance. Some even call and pose as government workers looking to “update” your information, asking for your date of birth, Social Security number, or bank account numbers. If you get such a call, notify the FTC online at www.ftccomplaintassistant.gov/ or call 1-877-FTC-HELP (1-877-382-4357). Also see “Fake health insurance” in the “Other things to know about health insurance” section.
Last Medical Review: 06/24/2013
Last Revised: 08/05/2013