For Any Cancer Diagnosis
Q. I think I may have cancer but I don't have any insurance and I'm not sure I can afford it. What can I do?
I understand your concern about the cost, but if you think you have cancer, you can’t afford not to visit the doctor. Cancer responds to treatment better when it’s caught early, and if it turns out that you don’t have it, you will have peace of mind.
There are 5 main ways to get health insurance:
Your, or your spouse’s, employer or union. If you or your spouse has a job that offers health insurance, ask if you’re eligible to receive it or buy into it. If you had insurance but lost your job within the last 60 days, ask if you’re eligible for COBRA. COBRA is a law that lets you keep your insurance for 18 months, sometimes longer. You pay the full cost.
Your school. If you are currently a full-time or part-time student, check with your college or university to see if you can get coverage through them.
Purchase it on your own. You can buy insurance either directly through an insurance company, or through your state’s Marketplace/Exchange. If you buy it directly through an insurance company, you will not be eligible for discounts based on your income. If you buy it through your state’s Marketplace/Exchange, your income will be taken into account, and you may receive an immediate subsidy, which will lower the cost of your premiums, and possibly your deductibles and co-pays as well. To find your state’s Marketplace, go to www.healthcare.gov. Please note: whether you buy it directly from an insurance company or through the Marketplace, you can only buy insurance during Open Enrollment. Open Enrollment occurs once a year, generally between November and January. There are a few exceptions to this rule – if you lose your job-based coverage mid year, get married, have a baby, move to another county or state, or become eligible for Medicaid, you are eligible for a “special enrollment period”. For more information on special enrollment periods, visit www.healthcare.gov.
Medicaid. Medicaid is a state-administered health insurance program that provides free or low-cost coverage to millions of Americans. In the 30 states that have chosen to “expand” Medicaid, it covers all children and adults below 138% of the Federal Poverty Level, which for 1 person in 2016 is approx.. $16,240. In the remaining 20 states, it only covers low-income families with children, pregnant women, the blind, and the disabled. To see if your state has expanded Medicaid, and to apply, visit www.healthcare.gov.
Medicare. If you are 65 or over, or have been deemed disabled by the Social Security Administration for 2 years, you may be eligible for Medicare. Contact www.medicare.gov for more information.
If you are unable to afford insurance and are ineligible for Medicaid or Medicare, ask about charity care and sliding scale programs (fees based on your income) at hospitals and clinics. Some hospitals are required to see patients who are uninsured. Contact your local department of public health, social services, or business office of your hospital of choice for more information.
Finally, if you are concerned about either breast or cervical cancer, the National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured women access to screening and diagnostic services to detect breast and cervical cancers. Women who are subsequently diagnosed with cancer may be immediately eligible for limited Medicaid.
Q. Now that March 31 cut-off date for the Affordable Care Act has passed, how do people apply for health insurance? My dad had to go to the emergency room a couple of days ago and they suspect cancer. He has no insurance. How do we apply for help?
Yes, Open enrollment for 2014 coverage is over, but you may still have options to get health coverage. Some of the options are:
You can still enroll in a private health plan through the Marketplace if you qualify for a special enrollment period. You can qualify for a special enrollment period if you have a qualifying life event. A qualifying life event could include getting married, divorced, moving to a new area or losing other health coverage, for example. To learn more about the special enrollment period and what constitutes special circumstances, please visit www.healthcare.gov/sep-list. If you think that you qualify for a special enrollment period you can call the Marketplace Call Center at 800-318-2596 and speak with a representative to determine if your circumstances qualify.
There are no enrollment time restrictions for Medicaid and the Children’s Health Insurance Program (CHIP). In all states, Medicaid and CHIP provide health coverage for some individuals, families, and women, the elderly with certain incomes and people with disabilities. You need to check the Medicaid eligibility regulations of your state. A cancer diagnosis would constitute a disability. For more information about eligibility in your state please visit: www.healthcare.gov/do-i-qualify-for-medicaid/.
Private plans outside the Marketplace. In some limited cases, some insurance companies may sell private health plans outside the Marketplace and outside open enrollment that count as minimum essential coverage. These plans meet all the requirements of the health care law, including covering pre-existing conditions, free preventive care and not capping annual benefits. Insurance companies, agents, brokers and online health insurance sellers may offer these plans outside of the Marketplace. The Marketplace does not list or offer these plans nor can you get premium tax or lower out of pocket costs for plans you buy outside the Marketplace. To learn more, you can call insurance companies directly or work with an insurance agent or broker. Your state insurance department will know what companies are operating in your state.
Q. I know the Affordable Care Act deadline has passed for signing up this year, but could you explain Medicaid expansion? Is it easier to get Medicaid now?
Even though the deadline for the ACA has passed, qualified patients can sign up for Medicaid any time of the year. Free or low cost health care coverage through Medicaid is based on income and family size.
In all states, Medicaid provides heath coverage for some low-income people, families and children, pregnant women, low-income elderly and people with disabilities (and that includes people diagnosed with cancer). Medicaid programs must follow federal guidelines but they vary from state to state.
In 2014, Medicaid was expanded to include individuals between the ages of 19-65 (parents and adults without dependent children) with incomes up to 138% of the Federal Poverty Limit ($16,105 for an individual and $31,809 for a family of four).
Not all states expanded their Medicaid program (view map for more information), but if you have a disability you may still qualify under your states existing rules.
To find out if you qualify for Medicaid in your state, please visit your state’s Medicaid website or visit this section of healthcare.gov.