Almost one-third of cancer survivors experience financial hardships related to their diagnosis and/or treatment.
The Financial Impact of Cancer Treatment
Cancer is an expensive medical condition to treat in the United States. Unfortunately, people diagnosed with cancer often face financial hardship. The financial impact of cancer can continue for months and sometimes years after intensive treatment ends.
Costs of cancer may include:
- Direct medical costs, such as medicine, hospital stays, appointments, procedures, and equipment.
- Non-medical costs, such as transportation, childcare, over-the-counter medications, and home care.
- Lost income from being unable to work.
Managing the cost of cancer treatment will depend on your health insurance access.
- If you have health insurance, it will cover at least some direct medical costs, but probably not all.
- If you do not have health insurance, you will be financially responsible for all the costs of treatment. It is very important that you review your health insurance options and seek financial assistance as soon as possible.
Take Control of Your Finances
There are steps you can take now to help manage the costs of cancer treatment and care. We go into more detail about some of these tips later.
- Make sure that you have health insurance and understand what your plan covers.
- Talk to your health care team. They can connect you with a social worker, case manager, or financial counselor.
- Contact the hospital or clinic billing department to discuss payment plans that allow you to pay smaller amounts over a longer period of time.
- Ask if your medical providers can provide alternate treatment plans that will be just as effective, but might cost less.
- Review your regular expenses and assets.
- Know your rights under the law, especially your employment rights.
- Find more information or speak to someone about financial concerns by calling the American Cancer Society’s helpline at 1-800-ACS-2345.
Do not skip medical care or avoid filling prescriptions because of your finances. Talk to your health care team if you cannot afford your prescriptions. Your health is the number one priority, and missing treatments can increase your risk of cancer coming back.
Health insurance is the best way to cover the direct costs of cancer treatments, but it can be difficult to understand what your plan includes. Learn about the different insurance plans you may be able to enroll in or find information that will help you understand a plan you may already have.
Be aware: Health insurance scams are out there! Know how to avoid health insurance scams.
Common Health Insurance Terms
Knowing health insurance terms will help you navigate health insurance decisions. Briefly, a benefit is the amount the insurance company will pay for medical costs. A claim is a request for the insurance company to pay for medical service, which may be sent by either you (the plan member) or your health care provider.
A provider is any person (e.g., a doctor) or organization (e.g., a hospital) that provides medical care. Some insurance plans have a list of in-network providers, where you will receive the most financial benefits.
There are different types of fees that may be associated with your plan.
- Premium: A monthly fee you must pay for your health insurance. Almost all health insurance plans require you to pay a premium. Depending on state regulations, some Medicaid users may not be required to pay a premium.
- Deductible: A flat amount of money that many plans require you to pay each year for your medical costs, before the insurance plan will pay anything.
- Co-payments (or co-pays): The flat fees you must pay when you receive a service, treatment, or drug.
- Co-insurance: A percentage of each medical bill that your plan might require you to pay, even after you have paid your deductible.
- Out-of-pocket maximum: The most you will pay for covered services in a year. This amount includes money spent on deductibles, copayments, and coinsurance. Once you have paid this amount, your health plan pays 100 percent of the covered costs.
Choose the Right Plan
There are many types of health insurance plans. Plans are usually offered for individual or group policies and by both the private sector and the government. Some common types of plans include:
- Health maintenance organizations (HMOs)
- Preferred provider organizations (PPOs)
- Fee-for-service plans
- Catastrophic plans
You may also hear about health savings accounts (HSAs), which are sometimes an added benefit of an insurance plan. These accounts allow you to pay for your out-of-pocket medical expenses with pre-tax dollars. HSAs are usually offered with plans that have high deductibles.
Deciding on the Right Plan for You
Here are some things you should look for when comparing your insurance plan options:
- Estimate total out-of-pocket costs of the plan. Get an estimate of what you will owe each year by reviewing the costs of premiums, deductibles, and co-pays and co-insurance for medical services you might expect to have in the next year. Don’t forget to consider a plan’s out-of-pocket maximum—this is the most you would potentially have to pay in one year.
- Make sure your providers are in the plan’s network. Some plans will only provide full benefits if you receive medical services at one of the providers (i.e., doctors, health care facilities) in their network.
- See if your plan covers your prescription drugs. If a plan requires co-pays with your prescription drugs, compare how much these co-pays cost.
When weighing your options, it is important to consider your personal health care needs. In general, a plan with lower monthly premiums will have higher out-of-pocket costs (e.g., a higher deductible or higher co-pays). A plan with higher out-of-pocket costs may not be a good option for you if you have a chronic condition or expect to need significant medical care in the next year.
Employer-Based Group Policies
Group health insurance policies are generally offered as a benefit by an employer to employees and their dependents (i.e., spouse or children). The employer may offer one or more types of insurance plans to choose from, and usually agrees to pay for some of the costs. Other groups, such as professional organizations or societies, may offer group plans too.
Group plans almost always cost less than individual plans. In most cases, it makes sense to enroll in a group plan through your workplace if you have the option.
Know Your Rights
Your employer is allowed to restrict or refuse coverage for reasons such as for part-time employment, but not for reasons related to health statuses. The Affordable Care Act ensures that you cannot be denied health coverage through the workplace because of your health status or that of your dependents—meaning you cannot be denied coverage because of a cancer diagnosis.
Plans that are exempt from this rule are called grandfathered health plans. All health insurance policies must disclose if they are grandfathered plans.
If you cannot get health insurance at work or through another group plan, you may need to get an individual insurance policy. Under current health care laws in the U.S., it is especially important that you have some type of qualifying health coverage. If you do not, you may have to pay a penalty fee at tax time.
Current laws in the U.S. ensure that you cannot be denied coverage because of your health status. This means that you can get coverage if you have a cancer diagnosis and do not already have coverage. If this is the case for you, look into getting coverage immediately.
The Affordable Care Act and the Health Insurance Marketplace
Take these steps to apply for marketplace coverage:
- Gather your household information. You might want to view a checklist to see what information will be required.
- Visit healthcare.gov to apply. When you apply, you will also find out whether you qualify for Medicaid, if your child qualifies for CHIP, or if you qualify for financial assistance to help you pay your monthly premiums.
Be aware that some people can only enroll in a plan during Open Enrollment. Open Enrollment usually occurs from November to December, but the dates may change from year to year. Certain life events like losing other health coverage, marriage, or having a baby may make you eligible for a Special Enrollment Period.
You can also get health coverage at any time of the year if you are eligible for Medicaid or CHIP.
Medicare and Medicaid
Medicare and Medicaid are both U.S. government-funded insurance programs.
- Medicare is an insurance program for people age 65 and older, or people with certain disabilities. You can learn more about Medicare and it’s coverage for cancer-care related costs, or go to Medicare.gov to apply.
- Medicaid is a U.S. government insurance program that you may qualify for if you are unemployed or have a limited income. If you meet certain eligibility criteria, your children may also quality for an insurance program called CHIP. You can learn more about Medicaid and CHIP and apply for coverage at Medicaid.gov.
Other Individual Insurance Policies
You can also shop for individual insurance policies outside of the health insurance marketplace. If you shop for an individual plan:
- Make sure the plan meets the requirements for qualifying health coverage in order to avoid penalty fees.
- Be aware of scammers! They try to take advantage of people seeking individual health plans.
Know What Is Covered by Your Health Insurance
As you and your health care team are developing a treatment plan, it is important to know how to manage your health insurance. Be sure to review your policy to understand what will be covered and what you may have to pay. When you’re reviewing your policy:
- Make sure that your providers (e.g., your doctors or health care facility) are covered in your health plan’s network.
- See if you need your insurance company’s pre-approval before receiving a planned treatment or procedure.
- Review your plan to see how much you will owe in co-payments for each treatment, procedure, or prescription drug. Your health providers may also be able to tell you what out-of-pocket expenses to expect.
- Keep accurate records of every claim you have submitted, and everything you have paid.
If you are worried that you will not be able to afford the out-of-pocket expenses for your treatment, discuss these concerns with your health care team. They may be able to find an alternate treatment plan or drug that will work just as well but cost less. They might also be able to provide an alternate payment plan.
Being Denied Coverage
Insurers must tell you why they have denied a claim or why they have ended your coverage. You also have the right to ask the company to reconsider its decision through an appeal.
If you are not feeling well enough to go through an appeal process on your own, ask a trusted friend, family member, or other caregiver for help. Your health care provider may also be able to connect you with a social worker or case manager who can provide support.
Disability insurance is separate from health insurance. It may provide benefits if you become unable to work due to a cancer diagnosis. Disability insurance might be offered by your workplace, or you can buy it on your own.
There are also two government disability insurance programs that you may qualify for:
- Social Security Disability Income (SSDI) is a federal disability insurance benefit for people who have worked and have paid into Social Security recently enough to qualify.
- Supplemental Security Income (SSI) is a federal benefit for disabled adults and children who have a limited income, or for adults over 65 years old.
The approval process for SSDI and SSI can take a long time, so it is important to begin your application as soon as possible. To qualify for either benefit program, you must meet the Social Security Administration’s very strict definition of disability. If you do get turned down because you do not meet the disability standard, you may want to reapply and appeal. Many cases end up being approved after an appeal.
After a cancer diagnosis, you may have to make a decision about whether you will be able to continue working while you receive treatment. It is important to understand the protections you have as an employee.
- The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives people an option to keep employee workplace insurance for a time period (usually up to 18 months) after leaving or losing their job, or reducing their work hours.
- The Americans with Disabilities Act (ADA) protects employees from employer discrimination due to a disability, such as a cancer diagnosis, and may protect an individual’s right to certain workplace accommodations that allow them to perform the job.
- The Family and Medical Leave Act (FMLA) gives employees the right to take up to 12 weeks of unpaid job-protected leave per year for certain family and medical reasons. It also ensures that employees’ health benefits are protected during their leave.
In addition to the federal laws listed here, some states have employment laws for people with illnesses such as cancer. You can find out more by looking up your state on the US Department of Labor website.
Being aware of your finances might help you manage the expenses related to your cancer treatment and care. Do a check-up on your finances by reviewing what you owe (liabilities) and what you own (assets).
- Liabilities are things that you owe money for, such as mortgages, loans, unpaid taxes, credit card bills, or previous unpaid medical/dental bills.
- If you have concerns about making payments, look into your options. You may be able to take a break from your payments during your illness through a deferment.
- Assets are things that you own, such as money from a savings or checking account, investments, or retirement funds. Assets may serve as alternate sources of income if you are facing financial hardship.
- Life insurance plans may allow you to receive benefits if you have received a terminal diagnosis, or if your illness prevents you from caring for yourself or working. In a financial emergency, you might look into borrowing money from the cash value of your plan.
- Retirement plans may permit you to make a hardship withdrawal if you have a critical illness. To find out if your plan allows for this type of withdrawal, talk to a plan administrator or someone in the benefits department at your workplace.
- Selling other properties, stocks, or investments may be sources of extra income.
Before taking any steps to use your assets as alternate sources of income, it is a good idea to speak to a financial planner or a social worker who can help you review your finances and come up with the best plan.
Get Additional Financial Assistance
Sometimes insurance will not cover all treatment costs, and the related costs of treatment—such as transportation and childcare—can strain your finances.
Speak to your health care team about your financial concerns. Many hospital systems will connect you with a social worker or other professional who can help you find good financial resources and support.
There are programs that can provide assistance for both direct and indirect expenses. For a list of support organizations, visit the National Cancer Institute, call the National Cancer Information Center at 1-800-227-2345, or see some suggestions below.
If you are facing financial hardship due to medical treatment costs, there are a number of programs that may help you pay for out-of-pocket expenses, such as copayments or premiums, not covered by your insurance. A few examples of co-payment assistance programs are:
- CancerCare Co-Payment Assistance Foundation
- Hill-Burton Program
- HealthWell Foundation
- Patient Services, Inc.
Applying for financial assistance usually involves completing an application form that asks you information about your health status, insurance, and finances. It is likely that your health care team will also have to complete some of the paperwork.
Prescription Medication Assistance Programs
If the cost of prescription medicine is an issue, it is important to speak to your health care provider. He or she may be able to prescribe less expensive medications that are just as effective. Do not skip doses or save them for later. This can harm your health and increase the chances of your cancer coming back.
Try these other ways to save money on prescription drugs:
- Ask your doctor about generic drug alternatives. These may be just as effective but cost less.
- If you are over age 65, review Medicare Part D coverage, which may help lower your prescription drug costs.
- Call the pharmacies in your area and compare prices.
Assistance for Cancer-Related Expenses
Cancer treatment costs often go beyond the direct costs of medical care. Transportation to and from a treatment location, lodging, and childcare expenses can add up. Your regular food and living expenses may also become difficult to manage. However, there are many national programs that can help with some of the related costs of cancer treatment.
In addition, you may find services that offer financial help in your local community. To get started, you can call the National Cancer Information Center at 1-800-227-2345 to get connected with local programs and resources.
Transportation and Lodging Assistance
You may have to travel far from home for your cancer treatment. As always, speak to your health care team. Many treatment centers will have short-term housing options or discount programs with local hotels and motels.
In addition, there are programs that provide financial assistance for lodging near a treatment center. A few examples include:
There are also programs that provide transportation or financial assistance for transportation costs to and from a treatment location. A few examples include:
Some programs offer help specifically for children with cancer and their families. A few examples include:
- Ronald McDonald Houses (temporary lodging near treatment)
- Miracle Flights for Kids (transportation to treatment)
Fundraising for your medical expenses may be an option—but make sure you have looked into all other options first. There are a number of online fundraising platforms that allow you to create a fundraising page and easily spread the word (YouCaring, GiveForward, Go Fund Me, or Indiegogo Life).
Cope with Stress or Anxiety
Call the doctor right away if you have:
- Thoughts about hurting or killing yourself
- Feelings of helplessness or hopelessness, as if life has no meaning