Joanna L. Morales, Esq. has served the cancer community as a cancer rights attorney, advocate, speaker, and author for over 18 years. She is CEO of Navigating Cancer Survivorship, a nonprofit organization providing education on the continuum of cancer survivorship issues.
When individuals are diagnosed with cancer, few realize just how expensive cancer care can be. Whether it is chemotherapy, biologic therapy, surgery, stem cell transplantation, or other health care, treatment costs can easily add up and become a burden for patients and their families. But there are some resources out there to help you manage cancer care costs.
Patient Protection & Affordable Care Act (ACA)
There are a few ways that ACA (also known as health care reform) helps to cover the costs of health care for individuals with cancer. Although much of the law does not go into effect until 2014, there are a few ways that the law has already started to help:
1. Access to clinical trials: Participating in a clinical trial might be an excellent option for someone diagnosed with cancer. However, insurance companies will often not pay for any care if an individual decides to participate in a clinical trial. The company sponsoring the clinical trial will usually cover the prescription drug, treatment, or procedure being tested, but that leaves the “routine costs” of care for the patient to pay, including doctor visits, blood tests, scans, etc. There are 36 states and the District of Columbia which have laws that require insurance companies to cover those routine costs for individuals who decide to participate in an eligible clinical trial. The ACA makes this requirement federal law, but does not go into effect until January 1, 2014. Click here for information about your state’s laws on clinical trials coverage.
2. Lifetime Limits: Insurance companies can no longer place lifetime limits on policies, which is especially important for individuals with serious or chronic medical conditions.
3. Annual Limits: Insurance companies are now restricted in the way that they place annual limits on health insurance policies.
4. Medical Loss Ratio: In general, insurance companies are now required to spend 80-85% of your premiums on providing you with quality health care, rather than on administrative, overhead, and marketing costs. Insurers that do not comply must provide premium rebates to consumers and employers. This year, health care consumers and employers across the country received premium rebates. Click here to view a rebate calculator to see if you were entitled to a rebate.
For more information about how health care reforms might apply to you, visit www.HealthCare.gov.
Oral Chemo Parity Laws
Although there has been some progress, there are still many opportunities to address the costs of health care. For example, oral chemotherapy generally brings much higher out-of-pocket costs for patients. Oral cancer medications are typically covered under a health plan’s pharmacy benefit, and often requires patients to pay high out-of-pocket co-pays to fill these prescriptions. There are often no intravenous substitutes for oral chemotherapy drugs. Unfortunately, in this case, insurance coverage has not kept up with medical advances. These are state protections, but a federal law would provide comprehensive protection. As of January 2012, only 15 states have enacted oral chemotherapy access laws: Oregon, Indiana, Iowa, Hawaii, District of Columbia, Vermont, Connecticut, Kansas, Colorado, Minnesota, Illinois, New Mexico, Texas, New York, Washington, and New Jersey.
Click here to learn more about how you can get involved in The Leukemia and Lymphoma Society’s legislative advocacy efforts, which include advocating for insurance coverage of clinical trials and oral chemotherapy.
Financial Assistance Programs
There are many programs available that provide financial assistance with co-pays, health care premiums, co-insurance, deductibles, and other expenses. These are just a few places to look for financial assistance programs:
• The Leukemia & Lymphoma Society
• Cancer Financial Assistance Council
• National Cancer Institute
Think creatively. Maybe you can get assistance with your utility bills, so that you can use that money that you have set aside for your utilities to pay some of your health care costs. Some health care providers may be willing to discount your medical bill, so it can be worthwhile to ask. Consider setting up an online fundraiser through a website such as GiveForward, to raise money to help pay for medical bills or living expenses. There are also resources out there to help with transportation, lodging, house cleaning, clothing, utilities, food, and other necessities. Even if you think that you may not qualify, it doesn’t hurt to apply. Searching on Google can be a very useful tool to find financial assistance programs.
Remember that you are not alone. Getting assistance from your support network, professionals, and other resources can help you build a foundation for a healthy financial future.
Please note that this information is designed to provide general information on the topics presented. It is provided with the understanding that the experts are not engaged in rendering any legal or professional services by its publication. The information provided should not be used as a substitute for professional services.
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