Managing Health Insurance When Someone Has Cancer
The most important thing for adults and children with cancer is having a health insurance plan that covers needed cancer treatments. It’s key to keep your health insurance coverage with no coverage gaps.
If you or someone in your family has cancer, it’s especially important to know these things about health insurance:
- DO NOT let your health insurance lapse.
- Pay your health insurance premiums and other costs in full and on time. New insurance can be hard to get--you don’t get a special enrollment period to buy marketplace insurance if you lost coverage because you didn’t pay premiums.
- If you are changing insurance plans, don’t let one policy lapse until the new one goes into effect. This includes when you are switching to Medicare.
- Know the details of your individual insurance plan and its coverage. Ask your plan administrator for a Summary of Benefits (SPB). This is an easy-to-understand description of a plan’s benefits and the costs you will have to pay. If you think you might need more coverage than a plan offers, ask your insurance carrier if it’s available.
- When possible, call the insurer to make sure that any planned medical service (such as surgery, procedures, or treatments) does not require prior authorization.
- If a bill looks odd or wrong, make sure to call or email your insurer to avoid being mistakenly charged more than you should.
- Submit claims for all medical expenses, even when you’re not sure if they’re covered.
- Keep accurate and complete records of all claims submitted, pending (waiting), and paid.
- Keep copies of all paperwork related to your claims, such as letters of medical necessity, explanations of benefits (EOBs), bills, receipts, requests for sick leave or family medical leave (FMLA), and correspondence with insurance companies.
- Get a caseworker, a hospital financial counselor, or a social worker to help you if your finances are limited. Often, companies or hospitals can work with you to make special payment arrangements if you let them know about your situation.
- Send in your bills for reimbursement as you get them. If you become overwhelmed with bills or tracking your medical expenses, get help from trusted family members and/or friends. Contact local support organizations, such as your American Cancer Society or your state’s government agencies, for extra help.
Renewing or selecting a new plan
Most work-based insurance plans have an open enrollment period once a year. This is when you can look at all health plans offered at work. You can also change plans or add a new family member to your plan at this time. Sometimes you have the option to keep the same plan you had before, but sometimes that plan is going away or changing. When this happens, you should look carefully at the new options and how they will cover the cancer treatments you need. For a worksheet that helps you compare plans and find a plan that covers your needs, see our Health Plan Worksheet: Know Your Coverage & Costs.
If you get your plan on the state health marketplace, it’s important to select your plan early enough so that it starts before your old plan lapses. See our information Tips for Choosing the Right Health Insurance Plan.
If you have Medicare, you can visit their Open Enrollment Center online at www.cms.gov/Center/Special-Topic/Open-Enrollment-Center.html, or you can call them at 1-800-633-4227. The same general rules apply when comparing plans. When reviewing Medicare Part D, you may want to check out our Tips for Choosing the Right Medicare Prescription Drug Plan.
If you have Medicaid or CHIP, complete your eligibility/renewal forms right away. Most states mail these out each year to be sure you still meet the requirements for coverage. If you move, give your new address to the Health Department right away so you don’t miss your annual renewal. Keep copies of the completed forms for reference, and so that you’ll know when they’re due next. That way you can call if you don’t get your renewal forms on time.
Getting answers to insurance-related questions
Questions about insurance coverage often come up during treatment. Here are some tips for dealing with insurance-related questions:
- Speak with the insurer or managed care provider’s customer service department.
- Ask the cancer care team social worker for help.
- Hospitals, clinics, and doctors’ offices often have someone who can help you fill out claims for insurance coverage or reimbursement. Ask the case manager or a financial assistance counselor to help guide you through what can be a complex process.
- Talk with the consumer advocacy office of the government agency that oversees your insurance plan. (See If Your Insurance Claim Is Denied)
- Learn about the insurance laws that protect the public. Call your American Cancer Society National Cancer Information Center at 1-800-227-2345. You might also visit www.healthcare.gov/using-insurance/understanding/rights/index.html for more information.
Along with the American Cancer Society, other sources of information and support are listed below.
State Health Care Marketplaces – US Department of Health and Human Services
Toll-free number: 1-800-318-2596 (also in Spanish)
Provides information on the new insurance law, takes you through the steps of finding insurance, and much more. If you don’t have Internet access, the phone number will connect you with your state’s marketplace.
Medicaid – US Department of Health and Human Services
Toll-free number: 1-877-696-6775
Your state social service or human service agency can give you the best answers to questions about your benefits, eligibility, and fraud. To get to your state’s Medicaid website, go to www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/By-State.html
Medicare – US Department of Health and Human Services
Toll-free number: 1-800-633-4227
Answers questions, provides literature, and gives referrals to state Medicare offices and local HMO’s with Medicare contracts.
Department of Veterans Affairs
Toll-free number: 1-800-827-1000
For information on veteran’s medical benefits and whether you qualify for them
Toll-free number: 1-877-222-8387
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
Toll-free number: 1-800-733-8387
For information on coverage of eligible families and survivors of veterans and military service members. The program is administered by the Chief Business Office Purchased Care (CBOPC) in Denver, Colorado.
US Department of Labor, Employee Benefits, Security Administration (EBSA)
Toll-free number: 1-866-444-3272
Information on employee benefit laws, including COBRA, FMLA, and HIPAA requirements of employer-based health coverage and self-insured health plans. Also has information on recent changes in health care laws. Information for military reservists who must leave their private employers for active duty can be found at: www.dol.gov/elaws/vets/userra/mainmenu.asp
National Association of Insurance Commissioners
Toll-free Number: 1-866-470-6242
Offers contact information for your state insurance commission (also called state insurance department). You can contact your state insurance commission for insurance information and rules specific to your state and find out what you can do about problems with your insurance plan.
Last Medical Review: November 19, 2015 Last Revised: March 15, 2016