Managing the Costs of Your Cancer Treatment
Cancer is a costly illness. It can take a toll on your health, your emotions, your time, your relationships – and your wallet. There will be unforeseen and unexpected charges, and even the best health insurance won’t cover all your costs.
Costs you have to pay because your health insurance doesn’t are called out-of-pocket costs. They can add up quickly and may make it hard for you to pay for other things you need. In some cases, the cost is so high a person decides to stop cancer treatment, or not get it at all. This may end up costing more later on as the cancer grows. But the bigger problem is that cutting short treatment or not getting it worsens health outcomes.
Sometimes there are things a person can do to try to lower the cost of cancer and its treatment and still get quality cancer care. Don’t wait until you have financial problems to discuss cancer costs with your health care team.
You might feel as if you don’t have the energy to deal with cancer and talk about money, too. You may want to ask a friend or family member to keep track of costs for you. This person can go with you to doctor visits and help with these discussions.
Here we offer some tips on what costs you can expect. We also share some ideas on how to plan for, ask about, and discuss treatment costs with your cancer care team.
Planning for treatment
You want to learn as much as you can about cancer and your cancer treatment before starting treatment. This will help you know what to expect. It also will help you plan for and deal with the costs more realistically. For many people with cancer, there are medical expenses from things such as:
- Doctor visits
- Lab tests (blood tests, urine tests, and more, which are usually billed separately)
- Clinic visits for treatments
- Procedures (for diagnosis or treatment, which can include room charges, equipment, different doctors, and more)
- Imaging tests (like x-rays, CT scans, and MRIs, which may mean separate bills for radiologist fees, equipment, and any medicines used for the test)
- Radiation treatments (implants, external radiation, or both)
- Drug costs (inpatient, outpatient, prescription, non-prescription, and procedure-related)
- Hospital stays (which can include many types of costs such as drugs, tests, and procedures as well as nursing care, doctor visits, and consults with specialists)
- Surgery (surgeon, anesthesiologist, pathologist, operating room fees, equipment, medicines, and more)
- Home care (can include equipment, drugs, visits from specially trained nurses, and more)
What to ask about costs of cancer treatment
Many people feel unsure about bringing up money while planning their cancer treatment. But cost is something you should address up front. You can start by talking with the doctor who’s treating you for cancer. He or she will usually know who can help you find answers.
Here are some questions you can ask about costs. You can choose the ones that relate to you and your treatment.
The overall treatment plan
Here are some ideas for ways to bring up the subject of costs as your treatment plan is developed:
- I’m worried about how much cancer treatment is going to cost me. Can we talk about it?
- Will my health insurance pay for this treatment? How much will I have to pay myself? (Discuss this for each treatment option.)
- I know this will be expensive. Where can I get an idea of the total cost of the treatment we’ve talked about?
Some related or follow-up questions you might want to ask:
- If I can’t afford this treatment, are there other treatments that cost less?
- Is there any way I can get help to pay for this treatment?
- Does my health insurance company need to approve any part of the treatment before I start?
- Where will I get treatment – in the hospital, your office, a clinic, or at home?
Today, more and more chemo drugs are taken by mouth. (This is often called oral chemo, and includes drugs known as targeted therapy.) In most cases, this means you get a prescription and take the drugs on your own, at home.
Chemo taken by mouth is as strong as the other forms and, when taken properly, works just as well. But you need to know that oral chemo drugs cost a lot – sometimes many thousands of dollars per month. And most health insurance plans don’t pay for the oral drugs the same way they pay for the IV drugs (those put into a vein in the hospital, clinic, or office).
Oral chemo drugs are often treated like regular prescription drugs. You have to pay for them and, even if your insurance covers them, you might have a very high co-pay. For example, some insurance companies require a co-pay of 25% of the drug cost. This can be thousands of dollars. And this isn’t a bill that you can pay later – you have to pay when you pick up the drug at the pharmacy.
Make sure you know how much you’ll have to pay for each treatment. Many drug manufacturers have patient assistance plans to help people pay for their drugs. Ask your pharmacist, doctor, or nurse about this.
Please see our web page called Managing Insurance Issues or call us to learn more about this.
Other prescription drugs used with cancer treatment
Many kinds of drugs are used for treating cancer. These may be drugs to prevent nausea, treat pain, help with anxiety, or control diarrhea. Drug prices vary a lot. You (or a family member) may want to call different pharmacies to get an idea of where you can get the best price.
When your doctor prescribes medicines or outpatient care, here are some questions you may want to ask:
- If I get outpatient treatment, how much of it will be covered by my health insurance?
- How much will the chemo drug that I take by mouth cost me? What about the nausea medicines and other drugs that go along with it?
- How much will I have to pay for this drug? Will my insurance cover it? (Ask this about each prescription you are given.)
- Are there assistance programs to help me get the drugs I need?
- Are there less expensive drugs or generic forms that work as well?
- Is there any other way I can get help paying for this drug?
Hospital, surgery, and clinic treatments
If you must have surgery, chemo, radiation, or will be in the hospital for part of your treatment, here are some questions you might want to ask:
- Do we need to get my insurance company’s approval (sometimes called pre-certification) before the test, surgery, treatment, home care, etc.?
- Is there a co-pay for each treatment? (The co-pay is a cost you will be charged each time you get chemo, radiation, intravenous [IV] antibiotics, IV fluids, or other outpatient treatments that you get in an office or clinic. The co-pay amount is set by your health insurance company.)
- If I must go into the hospital, how much will it cost? How much will my insurance cover?
- Is there a way to know beforehand if the doctors who will see me in the hospital are in my health plan network?
- Counting all the charges (hospital, anesthesia, surgeon, pathologist, and more), how much will this surgery cost me? How much will my insurance cover?
- Should I plan for rehab, home care, or long-term care (such as nursing home or hospice care)?
You’ll want to be sure that your health insurance company pays or reimburses the bulk of your medical expenses. This means you’ll need to
- Know the terms of your policy
- Be aware of preferred or network doctors, hospitals, or clinics
- Keep careful records
If any of your treatments might be done by out-of-network doctors or providers, find out about those costs, too. Even when you know the terms of your policy, getting payments can mean re-submitting claims, appealing denials, and much more.
If you have private health insurance, you’ll need to contact your insurance administrator. Find out what is and isn’t covered, what your co-pays are, and what you can expect your out-of -pocket costs to be. If you have insurance through work, start with your benefits department to learn who the administrator is.
If you have Medicare, Medicaid, or other public insurance, talk with your cancer care team about how to get more information on costs and coverage.
Usually, doctors’ offices and clinics have someone who handles health insurance concerns and problems. Ask your doctor if that person can help you with claims and codes on the bills that are sent to the insurance company.
Many complex issues about insurance are not covered here. There are also other expenses that are not strictly medical, for instance transportation, parking, meals, and maybe even extra help you need at home while getting treatment (like childcare, housekeeping, and yard work).
You can find out more about health insurance and other costs in Health Insurance and Financial Assistance for the Cancer Patient. We have more information on a number of financial topics that may be helpful, too. See the “To learn more” section for a list.
Our health insurance experts are also available to answer your questions 24 hours a day, 7 days a week. You can reach one of them by calling our toll-free number, 1-800-227-2345.
To learn more
More information from your American Cancer Society
Here’s more information you might find helpful. You can order free copies of our documents from our toll-free number, 1-800-227-2345, or read them on our website, www.cancer.org.
Insurance and financial information for people with cancer
How Health Insurance Works (also in Spanish)
Health Insurance and Financial Assistance for the Cancer Patient (also in Spanish)
In Treatment: Financial Guidance for Cancer Survivors and Their Families (also in Spanish)
Off Treatment: Financial Guidance for Cancer Survivors and Their Families
Advanced Illness: Financial Guidance for Cancer Survivors and Their Families
How to Find a Financial Professional Sensitive to Cancer Issues: Financial Guidance for Cancer Survivors and Their Families
Help with prescription drugs
Prescription Drug Assistance Programs (also in Spanish)
More about cancer and money
Can I Be Prepared if Cancer Occurs?: Financial Guidance for Those With Concerns About Cancer:
Coping Financially With the Loss of a Loved One: Financial Guidance for Families
National organizations and websites*
American Society of Clinical Oncology (ASCO)
Has a special section for patients on the costs of cancer care at www.cancer.net/managingcostofcare. Also offers cancer and cancer-related information (including many in Spanish), on things like treatment, side effects, coping, and survivorship, as well as a database to help find an oncologist
Patient Access Network Foundation (PANF)
Toll-free number: 1-866-316-7263
Helps underinsured patients with certain cancer diagnoses cover out-of-pocket costs related to cancer care.
Patient Advocate Foundation (PAF)
Toll-free number: 1- 888-879-4210
Serves as an active liaison between the patient and their insurer to resolve insurance problems; also provides direct financial support to insured patients who are financially and medically qualified for drug treatments and/or prescription co-pays, co-insurance, and deductibles related to certain cancer diagnoses.
National Foundation for Credit Counseling (NFCC)
Toll-free number: 1- 800-388-2227
This network of over 900 member agency locations is designed to assist people dealing with stressful financial situations by providing money management education; confidential budget, credit, and debt counseling; and debt repayment plans.
American Society of Clinical Oncology. Managing the Cost of Cancer Care. Accessed at www.cancersupportcommunity.org/MainMenu/About-Cancer/Understanding-Cancer/Coping-with-the-Cost-of-Care/Where-do-I-begin.html on July 15, 2014.
Bullock AJ, Hofstatter EW, Yushak ML, Buss MK. Understanding patients’ attitudes toward communication about the cost of cancer care. J Oncol Pract. 2012;8(4):e50-58.
Cancer Support Community. Frankly Speaking About Cancer: Coping with the Cost of Care, 5th edition. Accessed at www.cancersupportcommunity.org/General-Documents-Category/Education/FSAC-Coping-with-the-Cost-of-Care.pdf on July 15, 2014.
Himmelstein DU, Thorne D, Warren E, Wool handler S. Medical bankruptcy in the United States, 2007: results of a national study. Am J Med. 2009;122:741-746.
Sipkoff M. Managing Cancer Treatment Begins Before Diagnosis, 2007. Managed Care. Accessed at www.managedcaremag.com/archives/0703/0703.cancer.html on July 15, 2014.
Tangka FK, Trogdon JG, Richardson LC, et al. Cancer treatment cost in the United States: has the burden shifted over time? Cancer. 2010;116(14):3477-3484.
Ubel PA, Abernethy AP, Zafar SY. Full Disclosure – Out-of-Pocket Costs as Side Effects. N Engl J Med. 2013;369(16):1484-1486.
Last Revised: 08/04/2014