Cancer can be a costly illness. It can take a toll on your health, your emotions, your time, your relationships—and your wallet. Those with no health insurance may have extra worries when facing such a serious and expensive disease. But it turns out that having health insurance is no guarantee that you will be protected from major, life-changing expenses if you have cancer. In fact, most bankruptcies that happen as a result of medical problems are filed by people who have health insurance. Keep in mind that even the best health insurance won’t cover all your health costs and even with the best planning, there will be unforeseen and unexpected charges. Those you must pay because your health insurance doesn’t are called out-of-pocket costs.
Although the picture may change as health insurance reform goes into effect, it’s likely that out-of-pocket costs will remain a burden for many people with cancer. These expenses can add up quickly and affect your ability to pay for other things you need. In some cases, the cost is so high that a person decides to stop cancer treatment early, or not get it at all. Sometimes this backfires, and it ends up costing more later on. But the bigger problem is that skipping treatment can worsen health outcomes.
Whether or not you have health insurance, there are things you can do to try to lower the cost of cancer and its treatment. It’s often possible to keep costs down and still get excellent cancer care.
Dealing with the fact that you have cancer can take a lot of energy. On top of that, you are trying to learn about your kind of cancer, understand the cancer treatments your doctor is talking about, and figure out your next step. This is a lot to sort out. You may feel as if you don’t have what it takes to deal with everything and talk about money, too. Some people might need to get help from a friend or family member to keep tabs on costs. This person can go with you to the doctor to help with this discussion.
Here are some tips on what costs you can expect and how to plan for and talk about them. Friends or family members can use these same tips.
Planning for treatment
You want to know as much as you can before you start cancer treatment, so that you’ll know what to expect. This can 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, doctors, pathologists, and more)
- Imaging tests (such as x-rays, CT scans, MRIs, which may mean that you are billed separately for radiologist fees, equipment, and any medicines used in 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 care
Many people feel unsure about bringing up money while planning their cancer treatment. But cost is a valid concern that you should address up front. You can start by talking with the doctor who is 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. Some questions may not apply to you, but 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?
- I know this will be expensive. Where can I get some help to 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:
- Will my health insurance pay for this treatment? How much will I have to pay myself?
- If I can’t afford to follow this treatment, are there other treatments that cost less?
- Is there any other 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?
The average cost of a 30 day cancer drug prescription was more than $1,600 in 2006 and it’s even higher today. Many cancer drugs cost much more than drugs for other illnesses. Some of the newer cancer treatments can cost as much as $10,000 for a month’s supply. Also, co-pays are often higher for these prescriptions than those for other types of treatment. When your doctor prescribes medicines or outpatient care, here are some questions you can ask:
- If I get outpatient treatment, how much will be covered by my health insurance?
- How much will the chemotherapy 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 pay for this drug? Will my insurance cover it?
- 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 be in the hospital for part of your treatment, here are some questions you may want to ask:
- Do we need to get my insurance company’s approval (sometimes called pre-certification) before we do the test, surgery, treatment, home care, etc.?
- Is there a co-pay for each treatment session? (The co-pay is a cost you may 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 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)?
If you have health insurance, you’ll want to be sure that the company pays or reimburses the bulk of your medical expenses. This means you will need to
- Know the terms of your policy
- Be aware of preferred or network doctors or clinics
- Keep careful records
If any of your treatment might be done by out-of-network doctors or providers, find out about those costs as well. Even when you know the terms of your policy, getting payments can involve re-submitting claims, appealing denials, and much more.
If you have private health insurance, you will want to contact your insurance administrator to learn more about these details. 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 a person 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 due to cancer and its treatment 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
The following related information may also be helpful to you. You can read many of these on our Web site, www.cancer.org, or order free copies by calling our toll-free number, 1-800-227-2345.
Insurance and financial information for people with cancer
Health Insurance and Financial Assistance for the Cancer Patient (also in Spanish)
Financial Guidance for Cancer Survivors and Their Families: In Treatment (also in Spanish)
Help with prescription drugs
Prescription Drug Assistance (also in Spanish)
More about cancer and money
National organizations and Web sites*
American Society of Clinical Oncology (ASCO)
Web site: www.cancer.net
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
Cancer Support Community
Toll-free number: 1-888-793-9355
Web site: www.cancersupportcommunity.org
Has information on cancer treatment costs and provides free support, education and hope to people with cancer and their loved ones. Their 2012 booklet on costs can be read online at www.cancersupportcommunity.org/General-Documents-Category/Education/FSAC-Coping-with-the-Cost-of-Care.pdf
American Society of Clinical Oncology. Managing the Cost of Cancer Care. Accessed at www.cancer.net/patient/Diagnosis%20and%20Treatment/Managing%20the%20Cost%20of%20Cancer%20Care/Cost_of_Care_Booklet.pdf on July 5, 2012.
Cancer Support Community. Frankly Speaking About Cancer: Coping with the Cost of Cancer, 3rd edition. Accessed at www.cancersupportcommunity.org/General-Documents-Category/Education/FSAC-Coping-with-the-Cost-of-Care.pdf on July 5, 2012.
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 5, 2012.
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.
Last Revised: 08/10/2012