Can I Get Health Insurance If I Have Cancer?

How does the ACA help lower costs?

The ACA offers important protections. For example, a health insurance company:

• Cannot deny you coverage, charge you more, or refuse to cover essential health benefits because of pre-existing conditions, such as cancer, that you had before the new health coverage starts. However, this may not apply to certain plans, including grandfathered plans and short-term limited duration plans.
• Must limit the amount an individual or family has to pay out-of-pocket each year.
• Cannot charge women more than men.
• Cannot require pre-authorization for emergency care. They also cannot charge you higher out-of-pocket fees if you receive emergency care from an out-of-network health care provider or emergency department.

If you have a grandfathered health insurance plan, these protections may not apply to you. Your insurance provider is required to tell you if your plan is grandfathered, but ask them if you’re not sure.

The ACA also provides for more low-cost options in certain situations:

• If your work only offers a health insurance plan that’s not affordable, you may be able to get financial help to buy a more affordable plan through your state’s Health Insurance Marketplace.
• If your income is low enough, you may be able to sign up for Medicaid. This depends on the rules of your state.

You may also be able to get financial help to lower monthly costs through premium tax credits.

What are essential health benefits?

Essential health benefits are types of care that the ACA requires most health plans to cover. They include:

• Outpatient care (care you get without being admitted to the hospital)
• Emergency care
• Inpatient care (care you get when you are admitted to the hospital)
• Pregnancy, maternal, and newborn care
• Mental health and substance abuse disorder care
• Prescription drugs
• Rehab care and devices (recovery of daily living skills)
• Lab tests
• Preventive care, such as screening mammograms and colonoscopies
• Children’s health

The ACA reduces the cost of some of these services. Some are even required to be provided at no cost.

Where can I find health insurance if I have cancer?

The Health Insurance Marketplace offers health insurance plans that people can buy directly. Other options will depend on where you work and any government programs you qualify for.

The Health Insurance Marketplace

Plans available through the Marketplace meet ACA rules about providing people easy-to-understand details about coverage.

The ACA also helps set up the process for buying health insurance through the Marketplace. People can choose a plan during the yearly open enrollment period. They may also sign up during a special enrollment period if they have a qualifying life event, such as having a baby, or if household income drops.

Marketplace health plans vary in price based on your income, family size, and which state you live in. There are many plans to choose from. Learn more at HealthCare.gov.

Employer insurance

Employer-sponsored health insurance is offered through your job. Employers usually pay part of the cost, which reduces the overall costs for the employees. Under the ACA, you can’t be denied coverage based on health history or charged more because of a pre-existing condition, such as cancer. These plans usually cover a range of services, including preventive, emergency, hospital, and office visit care. The ACA also reduces out-of-pocket costs.

If you are not able to work and lose your work-sponsored health coverage, you have the right to continue your health coverage under COBRA (the Consolidated Omnibus Budget Reconciliation Act). This coverage can start on the day your employer-sponsored insurance ends. However, the cost is higher because you would be paying the full costs without your employer contributing to the cost.

Medicare

Medicare covers people with pre-existing health conditions, including cancer. If you qualify, you can’t be denied based on your health. There are some important details that need to be reviewed to find out if you are eligible, such as age and disability. Learn more in Does Medicare Cover Cancer Treatment?

Medicaid

Medicaid covers people with low income and pre-existing health conditions, including cancer. If you qualify, you can’t be denied based on your health. Usually, Medicaid covers a wide range of services such as doctors’ visits and treatments, but this may vary by state. Learn more in Medicaid for People With Cancer.

Veterans Affairs health care and TRICARE

If you’re a veteran, active-duty service member, or part of a military family, you may qualify for coverage through VA health care or TRICARE. These programs offer a range of coverage, including for pre-existing health conditions. Coverage and benefits may depend on your service history and status. Learn more about what is covered at VA financial resources.

Insurance shopping tips for people with cancer

As you’re reviewing options, keep in mind that some health plans may not start right away. This could delay treatment or leave you with high costs if you need care before coverage starts.

Also, be aware that out-of-pocket costs such as co-pays may be high for certain plans.

When reviewing possible health insurance plans:

• Check to make sure your doctors and treatment are in-network.
• Check to make sure your prescription drugs are covered.
• Find out your costs for co-pays, deductibles, and out-of-pocket limits.
• Be sure you know when coverage will start.

If you’re having trouble understanding your options, you can:

• Get help from Marketplace assisters or navigators to learn about plans.
• Talk with your social worker or patient navigator about financial help and resources such as nonprofit organizations, state, and local programs.