Finding a health insurance plan that works best for you can be an overwhelming task. With the number of cancer diagnoses predicted to rise about 70% worldwide over the next couple decades, in addition to rising cancer treatment costs, quality health insurance is more important than ever. In case of an unexpected health concern like cancer, it’s crucial to understand as much as you can to help you get the most out of your plan and relieve some of the financial burden of treatment.
Healthcare for cancer patients
The majority of people in the United States receive health insurance through their job or through a government entity such as Medicare. So what do you do if you’re purchasing health insurance on your own? First, you should know and understand your rights as an insurance buyer in order to make the best and most informed decision.
Thank to the Affordable Care Act, health insurance carriers can no longer deny you coverage based on a pre-existing condition. It’s also important to understand that your policy cannot be canceled if there was an error in your initial application and carriers cannot place a limit on how much they pay for your healthcare. This is a huge breakthrough for anyone with cancer because prior to the ACA, insurance companies were able to limit a patient’s coverage throughout their lifetime. This historical shift in healthcare has provided hope and justice for those who are in a constant uphill battle with the cost of their medical treatment.
Understanding your coverage
Health insurance plans usually help cover prescriptions, screenings, hospitalization, and other routine procedures. However, cancer often demands far more involvement from doctors, specialists, and others closely linked to that type of treatment. For example, anyone dealing with a rare condition may benefit from emerging treatments, such as immunotherapy or gene therapy, which may not be covered under your plan.
Certain health plans may only cover “in-network” partners, limiting patients to specific doctors, clinics, or hospitals. This means if you are considering options outside of your policy, you may be liable for additional costs. This can become a pressing concern. Especially if you are dealing with a rare condition in which there are limited specialists and options for treatment. This limitation can force patients to pay more out-of-pocket or accept care from a less qualified healthcare provider.
Aside from out-of-network partners, you should also understand the costs you’re responsible for when it comes to your health insurance. This may include monthly premiums, annual deductibles, copays, and coinsurance. By educating yourself about your plan’s financial requirements, you are already one step ahead of unexpected medical bills.
It’s not uncommon to come across coverage limitations, which is why it’s so important to learn how to handle and overcome unexpected financial obstacles. One option is to appeal a decision. This requires the patient to keep track of all secondary costs so they can appeal any claims that are denied. Another suggestion is to consider supplemental insurance which helps support additional costs not covered in your primary plan, such as disability or long-term care insurance.
Criteria for clinical trials
With more than 30 million people nationwide diagnosed with a rare disease, clinical trials are sometimes the best option for overcoming a poor prognosis. For example, mesothelioma is a rare and often fatal cancer that usually leaves patients with less than twelve months to live after diagnosis and little time to financially prepare for treatment.
Despite the benefits of clinical trials, certain policies may not cover research expenses. The good news is that oftentimes they have sponsors to help cover these costs. Fortunately, federal law requires a majority of plans to cover routine costs when you’ve been diagnosed with certain illnesses. If your condition would benefit from a clinical trial, the next step is to make sure you meet the requirements to participate. In addition, depending on your plan you may be limited to in-network partners and the clinical trial must be approved by the FDA. Once you are sure these guidelines have been met, you are officially eligible to participate in what could be a life-saving treatment.
When diagnosed with cancer, understanding the important factors when choosing a health insurance plan can make all the difference for your future. With the cost of cancer treatment on the rise, planning ahead could greatly reduce the financial stress behind a serious diagnosis. Feel free to check out HealthSherpa’s health insurance tool to explore the best options available for you.
This article was written by the Mesothelioma + Asbestos Awareness Center team, working to help mesothelioma patients, caregivers, advocates and others looking to learn more about this disease.