After Diagnosis: A Guide for Patients and Families

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TOPICS

How will I pay for all of this?

How much will it cost?

The cost of treatment depends on the type of treatment, how long it lasts, how often it’s given, and whether you’re treated at home, in a clinic, in the doctor’s office, or in the hospital. Most health plans, including Medicare, cover at least part of the cost of many treatments. In some states, Medicaid might help pay for certain treatments, even if you don’t normally get Medicaid. Before you start treatment, find out whether your insurance will pay for your care. Also, find out what part of the cost, if any, you will have to pay. Talk with your cancer care team social worker about this.

Health insurance

Getting or keeping health insurance

If you’re in a low-income bracket or aren’t working, check to see if you can get state or local health benefits, such as Medicaid. If you’re employed and are thinking about leaving your job, find out about COBRA options through your employer’s insurance plan. (Call us or read What Is COBRA? at www.cancer.org for more on this.) If your employer has been paying part of your health premiums, your cost under COBRA may be much higher than before.

Before you accept COBRA, compare your COBRA costs and coverage with similar health plans in your state health insurance marketplace. Keep in mind that if you lose your health insurance because you quit or lost your job, you don’t have to wait for the open enrollment period in your state marketplace – you’ll have a 60-day special enrollment period. (If you lose your health insurance because your spouse lost their job, through divorce, or a number of other reasons, you may still be allowed the 60-day special enrollment.)

Remember that you can’t be turned down for marketplace insurance plans because you have cancer. Visit healthcare.gov/marketplace to find out about special enrollment periods, compare plans, learn about help with premiums, and even find out if you qualify for Medicaid. Or you can reach your state marketplace on the phone by calling toll-free 1-800-318-2596.

Learning the ins and outs of your plan

Learning about your health insurance plan will help you be ready for the cost of treatment. This can also prepare you to talk with all the people who will work with your health insurance plan to get payment for your care. Ask for a Summary of Plan Benefits from your insurance administrator at work or from your insurance company.

Patients who understand their insurance and know how to talk with their insurance company are more likely to get their medical needs covered. And knowing what your health insurance will cover ahead of time can give you some peace of mind as you make treatment decisions.

Sometimes health plans won’t cover certain things, and will deny payment for them. There are actions you can take to help get health claims paid. Always keep records of your care and all interactions with health insurance staff and your cancer care team. If your plan denies coverage for some treatment or care, ask your doctor how to get help dealing with your health plan.

We have a lot of information on health insurance and financial assistance. You can read it on www.cancer.org, or call us for answers to your questions.

If you don’t have health insurance, it’s very important to get it. Talk to a social worker or call us at 1-800-227-2345 to find out more about your options.


Last Medical Review: 02/20/2015
Last Revised: 02/20/2015