Finding Stability

Cancer and Health Insurance: What’s Not Covered?

Out-of-pocket costs associated with cancer can cause financial distress. Find out how you can prepare.

One of the biggest shocks after getting a cancer diagnosis is the staggering cost of treatment. After finding out what your health insurance plan will cover, you need to prepare yourself for what it won’t. Even patients with robust health insurance will face out-of-pocket costs. The latest figures from the American Cancer Society (ACS) show cancer patients spent almost $4 billion in out-of-pocket costs on cancer treatment in 2014.

Knowing what to expect and what resources are available can help reduce the financial toxicity related to your treatment, and lessen the stress of dealing with cancer and health insurance.

Cancer and Health Insurance Costs

Expect to receive large medical bills early on. Newly diagnosed cancer patients experience their highest out-of-pocket costs in the first two to three months following their diagnosis, until they meet their annual deductible and out-of-pocket limit, according to ACS.

Stay in-network when possible. Some health insurance plans either charge a higher deductible or don’t pay for any out-of-network providers, facilities or pharmacies. Once your deductible has been met, you still must pay a percentage of covered services, usually 10 to 40 percent, until you meet your out-of-pocket maximum — the amount you need to pay each year before your insurance plan will pay 100 percent of covered services and drugs.

Indirect Costs of Cancer Treatment

Cancer patients deal with numerous indirect costs associated with their cancer care, including mental health services to cope with the emotional elements of the disease, transportation to medical appointments, lodging, childcare and petcare, complementary treatments like massage or acupuncture, special food and nutritional supplements, and supportive care drugs like anti-nausea medication and moisturizing creams.

Young women undergoing cancer treatment may also face the prospect of infertility. Egg and embryo freezing can cost thousands, and only 15 states have infertility insurance laws, according to The National Infertility Association.

Where to Get Help

Both the ACS and the American Society of Clinical Oncology list a variety of financial resources, free services and support programs to assist cancer patients, from wigs, cosmetics and mastectomy products, to lodging and transportation, to online support communities.

Rely on family, friends and neighbors who offer their help. Free online calendar programs and smartphone apps, such as Lotsa Helping Hands, Caring Bridge and Meal Train make it easier to coordinate volunteers to provide childcare, assist with household chores, run errands or drop off a healthy meal for you and your family.

Before you begin treatment, UVA Cancer Center financial counselors can help you determine what financial costs to expect. They can also assist you with finding additional financial support.

If your cancer treatment spans several years, a little pre-planning will help absorb the immediate financial hit the next year. To avoid early out-of-pocket costs, consider a high-premium, low-deductible plan. If you choose a lower premium, high-deductible health plan (HDHP), you can lessen the financial blow by opening a health savings account (HSA) to pay for qualified medical expenses, excluding premiums. Contributions to and earnings in HSAs are tax-exempt. The Internal Revenuce Service sets the requirements for which HDHPs qualify for an HSA. And unlike Flexible Spending Accounts, HSA assets carry over to the next year.

You can’t eliminate out-of-pocket costs entirely, but by using various resources available to cancer patients, you can lessen their impact on your bottom line.

Making cancer treatment affordable is an important step on the road to recovery. Financial assistance may be available to you.

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Rita Colorito