Financial Resources | Cancer.Net

Once diagnosed with cancer, one of the last things you want to worry about is how you are going to pay for treatment and other expenses. Unfortunately, one of the realities of dealing with cancer is the financial upheaval brought on by heavy expenses, which go well beyond medical costs.

There are many resources available to help manage the cost of living with cancer. Below is a summary of the issues you should consider as you face paying for treatment and other costs.

Getting familiar with insurance

For most people, successfully managing and treating illness is highly dependent upon access to quality health care. In the United States, such access generally requires health insurance to cover or offset the costs of care. Most people obtain their insurance through their employer or through government programs such as Medicare. The following information is meant to help you understand the types of health insurance coverage.

Private insurance

Fee-for-service

Before health maintenance organizations (HMOs) and preferred provider organizations (PPOs) were developed as a means to contain rapidly increasing health-care costs, most people had one option for private health insurance: fee-for-service coverage. This type of plan generally does not place any restrictions on which doctors or hospitals you choose. You simply visit the doctor, hospital, or health-care center of your choice, anytime or anywhere, submit a claim form, and the health insurance company pays the bill. Typically, you share some of the cost, as described below, and some types of services may not be covered.

Costs

Common expenses under this type of plan include:

Premium: Monthly fee

Deductible: The amount you are responsible for during a calendar year before insurance begins paying for services (this can be a few hundred or a few thousand dollars, depending on the plan).

Co-insurance: The proportion of a health-care bill you are responsible for (after meeting your deductible); for example, you may be responsible for 20% of all bills.

Insurance cap: The maximum amount you will pay "out-of-pocket" during any year (such as the total of your deductible and co-insurance costs throughout the year, but not including the cost of your monthly premium).

Restrictions

Although fee-for-service plans allow for the greatest freedom in choosing doctors and hospitals, there may be restrictions to some services, including:

Types of services: As with almost any type of health insurance, the kinds of services covered will be carefully spelled out in the plan's policy. Some plans may not include psychological therapy, physical therapy, home health, and "experimental" or "alternative" care.

Pre-existing conditions: Long-term illnesses or injuries incurred before entering the plan may not be covered.

Reasonable and customary fees: Costs deemed by the insurance company to be above the customary fee charged by other doctors or hospitals in your area may not be covered, leaving you to pay the difference.

Health maintenance organizations (HMOs)

HMOs can be thought of as health-care insurance "clubs," with patients and doctors as members. HMOs are set up to keep health-care costs down by working with patients to comprehensively manage their health care. Patients either choose or are assigned to one primary care doctor, who, as a member of that HMO, handles the patient's routine care and refers him or her to specialists within the plan for specific health-care needs.

As a member of an HMO, you pay a monthly premium, with only a small additional "co-payment" for each office visit. HMOs generally do not require you to submit any claim forms, unless you visit doctors who are not members of the plan.

HMOs may be actual health-care centers, in which all of the doctors in the office are part of the organization. In other cases, individual doctors contract with the HMO to care for patients covered under the plan—agreements known as individual practice associations (IPAs).

Because you pay a flat rate to your HMO, the plan will often encourage and cover preventive care intended to avoid the need for more expensive care later. However, as with most insurance plans, covered services vary, and some, such as outpatient mental health care, "alternative" treatments, and physical therapy, may not be covered, or covered only on a limited basis.

Costs

Common expenses under this type of plan include:

Premium: Monthly fee

Co-payment: Small fee for every doctor's office visit (such as $5 or $10)

Out-of-network care: Additional costs for visiting doctors who are not members of the HMO (if such coverage is provided at all).

Restrictions

Compared to fee-for-service plans, total medical costs in an HMO are usually lower and more predictable. However, these reduced costs are typically accompanied by additional restrictions, including:

Choice of doctors and hospitals: Only physicians and hospitals that are members of the HMO are covered under the plan, although many companies make exceptions as medically necessary and for emergencies. Many HMOs allow you to visit doctors outside the plan for a higher fee.

Specialist care: Visiting a specialist usually requires a referral from your primary care doctor.

Precertification: You are required to notify the HMO before nonemergency, hospital visits and some types of specialist care, and call within 24 hours of any emergency care.

Types of services: As with almost any type of health insurance, the kinds of services covered will be carefully spelled out in the plan's policy; psychological therapy, physical therapy, home health, and "experimental" or "alternative" care are among services that may be exempt from the plan.

Pre-existing conditions: Long-term illnesses or injuries incurred before entering the plan may not be covered.

Preferred provider organizations (PPOs)

PPOs combine certain aspects of both fee-for-service plans and HMOs.

PPOs offer a limited network of "preferred" doctors, and most of your medical costs are covered when visiting these "in-network" doctors. However, PPOs typically do not require you to see a designated primary care doctor who manages your care and controls your access to specialists. PPOs may also be more flexible than an HMO in allowing visits to "out-of-network" doctors, although these visits usually require you to pay a larger portion of the bill.

Like fee-for-service plans, PPOs may require you to pay a deductible or co-insurance for some services.

Costs

Expenses under this type of plan may include:

Premium: Monthly fee

Co-payment: Small fee for each visit to an in-network doctor (such as $5 or $10)

Out-of-network care: Additional costs for visiting doctors who are not members of the PPO

Deductible: The amount you may be responsible for paying in a calendar year before insurance begins paying for services.

Co-insurance: For some services, the proportion of a health-care bill you are responsible for (after meeting your deductible); for example, you may be responsible for 20% of all bills.

Restrictions

Under a PPO plan, you may encounter some or all of the restrictions common to fee-for-service and HMO plans. These restrictions may include:

Choice of doctors and hospitals: More complete reimbursement of health-care costs is provided for visits to doctors and hospitals that are members of the PPO.

Specialist care: Visiting a specialist may require a referral from your primary care doctor.

Precertification: You may be required to notify the PPO before nonemergency, hospital visits and some types of specialist care, and call within 24 hours of any emergency care.

Types of services: As with almost any type of health insurance, the kinds of services covered will be carefully spelled out in the plan's policy; psychological therapy, physical therapy, home health, and "experimental" or "alternative" care are some services that may not be included in the plan.

Pre-existing conditions: Long-term illnesses or injuries incurred before entering the plan may not be covered.

Reasonable and customary fees: Costs deemed by the insurance company to be above the customary fee charged by other doctors or hospitals in your area may not be covered, leaving you to pay the difference.

Government-sponsored insurance

Medicare

Medicare is health insurance provided by the federal government for those 65 and older, as well as for some disabled Americans. People over 65 who are eligible for Social Security or Railroad Retirement benefits automatically qualify for Medicare, along with their spouse.

Medicare is divided into two parts: Part A and Part B.

Part A is free and covers hospital care only. For an additional cost (premium, deductible, and co-insurance), Part B provides supplementary insurance to cover doctor care and medical supplies.

Medicare has traditionally operated like a fee-for-service plan. However, HMO and PPO plans are becoming increasingly available to Medicare participants, as a way to manage costs not covered by Medicare and to keep overall costs down.

Some Medicare recipients also buy private insurance called Medigap to cover Part B deductibles and co-insurance, and other bills not reimbursed under Medicare.

Costs

Part A: Free hospital care

Part B: Premium, deductible, and co-insurance to cover supplementary care (doctor care and medical supplies)

Restrictions

Even with Part B coverage, Medicare does not cover all health-care expenses. Costs not covered include:

Nursing home care
Long-term home care services
Prescription drugs

In addition, in December 2003, Congress signed into law the Medicare Modernization Act of 2003 or "the MMA." This law is primarily intended to provide seniors and people living with disabilities with a prescription drug benefit. The law includes provisions addressing payments for drugs and drug administration services that institute significant cuts to cancer care over the next 10 years. The impact of the legislation on cancer care appears to be more severe in 2005 and subsequent years than in 2004.

The MMA changed the Medicare payment system for cancer drugs (chemotherapy) and patient support services, including chemotherapy administration, social work services, psychosocial support, nutritional counseling, and other related services.

Further information on Medicare and Medigap can be obtained at www.medicare.gov.

Medicaid

For some low-income people who cannot afford health insurance, the federal government provides Medicaid to cover their health-care bills. Medicaid covers people who are eligible because they are elderly, blind, or disabled, as well as certain people in families with dependent children.

Although the federal government funds Medicaid, each state operates the program individually and determines who is eligible and what services are covered.

Other coverage

Supplemental insurance

Supplemental insurance policies help cover expenses not covered by your primary insurance or costs you pay as part of your existing plan. These policies generally cover deductibles, co-insurance, co-payments, and other out-of-pocket expenses. They may also offer additional benefits such as compensation for lost earnings due to missed work.

Disability insurance

Disability insurance replaces income lost if you are unable to work due to a long-term illness or injury. Such coverage is often provided through your employer or government-sponsored programs, although individual policies are also available.

Further information is available from America's Health Insurance Plans (AHIP).

Hospital indemnity insurance

Hospital indemnity insurance provides limited coverage for hospital stays, usually a fixed amount each day, up to a maximum length of stay.

People may decide to purchase supplemental insurance if their basic insurance plan limits coverage of hospital care.

Long-term care insurance

Because most basic private insurance plans and Medicare generally provide very limited coverage for long-term care such as nursing home care, some people elect to obtain additional coverage to offset the costs of such care.

Finding financial support resources

The financial burden of cancer can be a source of significant stress for many people with cancer and their families. As mentioned, the costs associated with cancer go beyond paying for treatment to include travel expenses, child care, medical supplies, counseling, items such as wigs, and even lost or reduced wages. Fortunately, there are many resources available to help those living with cancer manage their finances.

Because bills and debt can add up quickly, people may want to seek financial help soon after being diagnosed with cancer. Oncology social workers are trained to help people living with cancer deal with financial concerns and can provide access to community resources. Most hospitals and clinics have social workers (or case managers) on site. The doctor or oncology nurse may also be able to provide a referral.

Nonmedical expenses related to cancer

The nonmedical costs associated with cancer can be divided into six basic categories:

Clinic visits, which include costs for meals, child or elder care, and transportation to and from treatments and appointments
Symptoms and side effects, including medication, equipment, supplies, clothing, and other items (wigs, comfortable clothing, and special foods). Not all drugs are covered by insurance, and many patients try a variety of over-the-counter medications in an effort to relieve treatment side effects.
Support or assistance, including child care, housekeeping, and meals ordered out due to fatigue
Administrative costs such as increases in telephone bills and insurance premiums
Counseling, supportive therapies, special gifts, vacations, and other quality of life items. When some people are very ill, they do things they normally wouldn't do, including buying things to make themselves feel better. These expenses should be considered costs related to being seriously ill.
Lost income, whether through taking time off work for treatment, or losing one's job because of illness

Taxes and debt

Fortunately, some medical expenses not covered by insurance, including mileage for trips to and from appointments, prescription drugs, and meals during lengthy medical visits, can be deducted from federal income taxes.

While coping with daily financial responsibilities can sometimes seem overwhelming, it is important not to let bills pile up and go unpaid. Often, if you show concern and interest in being responsible for debt, you may be able to arrange lower monthly payments.

Private and government-sponsored health insurance

Medical Insurance and Financial Assistance for the Cancer Patient from the American Cancer Society, discuss different types of private and government-sponsored health insurance and disability programs and provide links to additional sources of information.

Cancer Facts: Financial Assistance for Cancer Care, available from the National Cancer Institute, provides links and contact information for government-supported health insurance and disability programs, as well as general financial assistance information.

AHIP publishes consumer guides for various kinds of insurance, including health insurance, managed care, and long-term insurance, as well as a glossary of insurance terms.

Local service organizations

Local service or voluntary organizations such as Catholic Charities, Lutheran Social Services, Jewish Social Services, the Salvation Army, the Lions Club, and others may offer financial assistance. Some of these organizations offer grants to help cover the cost of treatment and other expenses, while others provide assistance with specific services or products such as travel or medications. A social worker or the local telephone directory should have a list of organizations. Many hospitals and clinics also maintain a list of service organizations in the community.

The American Cancer Society (800-ACS-2345) and the local United Way office can also direct people to services in their community.

General assistance programs providing food, housing, and other services may also be available from the county or city Department of Social Services (check the local telephone directory for contact information).

For direct financial assistance, people can contact their city's Department of Social Services.

Community-based groups, such as local churches, synagogues, mosques, and lodges may also provide assistance for people with cancer, sometimes even if the person is not a member of that particular organization or religion. Some hospitals also have private funds available for patients in need.

See also Patient Information Resources to connect to cancer organizations nationwide.

National service organizations

The Leukemia & Lymphoma Society's patient financial aid program (800-955-4572) provides limited financial assistance to patients with significant need to help defray treatment-related expenses.

CancerCare's financial assistance programs (800-813-4673) provide limited grants for certain kinds of cancers and for people in various locations.

The National Foundation for Transplants (800-489-3863) provides fundraising assistance for patients needing transplants, including bone marrow and stem cell transplants.

Travel assistance

Air Charity Network (877-858-7788) coordinates free air transportation for people in need.

The Corporate Angel Network (866-328-1313) arranges free air transportation for people with cancer traveling to treatment using empty seats on corporate jets.

The National Patient Travel Helpline (800-296-1217) provides information about charitable, long-distance medical air transportation and provides referrals to appropriate sources.

The Candlelighters Childhood Cancer Foundation maintains a list of additional organizations offering assistance for treatment-related travel.

The National Association of Hospital Hospitality Houses (800-542-9730) is an association of more than 150 nonprofit organizations that provide lodging and support services to families and their loved ones who are receiving medical treatment away from home.

Ronald McDonald House Charities (630-623-7048) offer free or reduced-cost lodging for families of seriously ill children who are receiving treatment at nearby hospitals.

Medication assistance

NeedyMeds.com is an information source on companies that offer patient assistance programs. These programs help those who cannot afford medications to obtain them at no or low cost through the manufacturer.

RxHope.com (908-850-8004), supported by the Pharmaceutical and Research Manufacturers of America, provides information on patient assistance programs offered by federal, state, and private organizations. This site also provides an online patient assistance application.

Advocacy and additional information

The Patient Advocate Foundation (866-512-3861) provides education, legal counseling, and referrals for people with cancer who need assistance managing insurance, financial, debt crisis, and job discrimination issues.

CancerCare's Tips for Finding Financial Assistance section and Financial Help for People with Cancer fact sheet provide information on financial resources.

Financial Health Matters, a booklet available from the Leukemia & Lymphoma Society, offers information and tips on money management, health insurance, and financial resources.

The Lance Armstrong Foundation's website LIVESTRONG offers a section for survivors entitled Planning Your Financial Future.

The Support and Resources page on the National Cancer Institute website provides links to information about cancer support organizations, finances, insurance, and hospice and home care.

Online resource guides to organizations offering financial assistance are available on the National Coalition for Cancer Survivorship website.