For Any Cancer Diagnosis
Q. My dad has terminal cancer and he is currently at home. He has no insurance, but Medicaid is pending. We're trying to get hospice or some support. What can I do?
It must be a very difficult time for your family and you are to be commended in seeking out resources and support services that are available to assist your family.
Hospice is paid for through the Medicare or Medicaid Hospice Benefit and by most private insurers. If a person does not have coverage through Medicare, Medicaid, or a private insurance company, hospice will work with the family to make sure needed services are provided. In order to receive hospice services, your father’s doctor will need to make a referral to a local hospice provider. You may also contact a local hospice to find out what steps you should take.
The National Hospice and Palliative Care Organization (NHPCO) offers information and resources about end-of-life and hospice through its Caring Connections website. The Caregiver Resource Directory also can provide you with extensive information. We’ve created a fact sheet, Caregiving at the End of Life, that provides guidance as you care for your father.
It’s important that you continue to follow-up with his Medicaid application, as benefits will be retroactive to the date when he applied and can be used to pay any medical bills that may be incurred during the application period. CancerCare’s fact sheets, Getting to Know Your Entitlements and Sources of Financial Assistance, may also be helpful in finding resources.
If you continue to have difficulties finding hospice services for your father, please call us at 1-800-813-4673 (HOPE) to speak with an oncology social worker.
Q. How do I figure out which Medicare plan is right for me? I don't know if I should get a Medicare Advantage plan or a Medigap plan, or if I should just keep my original Medicare and do neither.
When you become eligible for Medicare you receive Part A, which covers certain hospitalization costs. If you want coverage for outpatient services, you should choose Part B as well. Even with Medicare A and B there are still “gaps” in coverage: for example, there is a 20% co-insurance fee for Part B services, and neither A nor B offer drug coverage. Most people choose to supplement their coverage with a retiree plan if their former employer offers it, or a “Medigap” plan, which plugs most of the holes in coverage (except medications). The rest, roughly 18%, choose a Medicare private health plan, called a Medicare Advantage Plan. These plans must offer at least the same benefits as original Medicare but have different rules, costs and coverage restrictions.
Medicare Advantage plans can be useful for those looking for all-in-one medical and drug coverage. However, Medicare Advantage HMOs restrict which doctors and hospitals you can use. An article in Kiplingers magazine sums up the differences well: “Medicare Advantage plans may charge lower premiums than you’d pay for Medicare plus a Medigap policy and Part D prescription-drug coverage. But you could end up paying higher out-of-pocket costs throughout the year. Some Medicare Advantage plans charge higher co-payments for big-ticket items such as hospitalization, or for critical services such as chemotherapy. Or they might not pay for the first 20 days in a skilled-nursing facility (which traditional Medicare covers). In addition, a plan may provide limited coverage if you travel out of state.” Please review this list of questions to ask before you join a Medicare Advantage plan.
Please note: A study of cancer patients by an affiliate of the University of Pittsburgh Cancer Institute suggests that members of Medicare Advantage HMO plans are opting out of clinical trials because these policies generally require that the patient pay 20% of the costs associated with a trial. In contrast, Medigap plans generally cover those costs.
Q. I have insurance, but I still have bills that are stressing me out. I thought I'd be covered, but I don't know how I'm going to pay the part I'm being told I owe.
If you are insured and struggling with outstanding medical bills, consider the following options:
- Read your insurance policy and understand the terms of your contract. If you have questions, ask your insurance company, insurance broker, or the human resources staff at your employer to explain it to you. Your insurer may have denied a claim even though you are entitled to coverage. The Kaiser Family Foundation has an excellent guide on how to dispute claims with your insurer.
- Double check all bills and EOBs (explanation of benefits). You’d be surprised how often billing mistakes are made. Look for incorrect dates of service (you shouldn’t be billed for the room on the day you were discharged) and duplicate fees for tests and procedures.
- Ask the hospital or doctor to consider the insurance payment as “payment in full.” Many people don’t think to do this, and it is often more successful than expected. Some hospitals have funds to offset medical services that aren’t fully covered by insurance.
- Negotiate the outstanding balance by asking for a discount. According to a Wall Street Journal survey, 70% of adults who talked with a hospital say they were successful in negotiating a lower price for their medical bills; 61% were successful with their doctor. You will likely get a greater discount (sometimes as high as 50%) if you pay the outstanding balance in a lump sum. You can also set up a payment plan.
- The Volunteer Lawyers Project of the Boston Bar Association offers good advice on medical debt. Although some of the information is specific to Massachusetts, sections like “deciphering a medical bill” and “negotiating tips” are useful wherever you live. Healthinsuranceinfo.net also has a concise guide on managing medical debt.
- Explore the resources for co-payment and other medical cost assistance.
Remember to reach out for help—medical debt understandably causes emotional stress and it’s important to get as much support as you can. Speaking with a counselor can help you manage some of your stress and come up with a plan so that you feel more in control.
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 3 main ways to get health insurance:
- Through an employer, union, professional association or other job-related source. If you have a job and your employer 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. If you are self-employed, see if there is a professional association in your state that offers group coverage at discounted rates. If you are a small business owner, check with your local Chamber of Commerce.
- Buy it on your own.Compare plans and prices by speaking with an insurance broker or visiting an online broker like www.ehealthinsurance.com. Please note that your rights as a consumer are different in every state: in most states, insurance companies can refuse to sell you insurance based on your age, gender, or medical history (but not in New York, New Jersey, Massachusetts, Maine, Vermont, and, with limitations, Washington); in all states they can exclude pre-existing conditions from coverage for a period of time (however, there might still be circumstances in which you would be eligible for coverage). You may also be protected by a law such as HIPAA. Before you buy anything, please visit The Kaiser Family Foundation for information on your rights.
- State and federal health care programs. You may be eligible for health care based on your age, income, or pre-existing disability. To see what programs are available in your state, visit The Foundation for Health Coverage Education.
If you are unable to buy insurance and are ineligible for public programs, you have 2 main options:
- Pre-Existing Condition Insurance Plan. Those who have been uninsured for 6 months or more and have been denied coverage can receive insurance through the Pre-Existing Condition Insurance Program. Pre-existing conditions are covered upon enrollment, and premiums are capped at the average cost of private policies in your area. The federal government will operate the Pre-Existing Condition Insurance Program in those states who choose not to create their own program. In 2014, insurers will no longer be able to deny anyone coverage and this program will end.
- Hospitals and clinics. 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. I am currently on my former employer's group insurance policy, and was able to maintain the benefits through COBRA. The policy is about to end and I have been trying to "find" another insurance carrier. I have been denied by a few agencies. Is there any advice you can provide?
Because you were covered by a group insurance policy and have exhausted your COBRA coverage, you are protected by the Health Insurance Portability and Accountability Act, known as HIPAA. This law mandates that people in your situation cannot be denied insurance coverage due to pre-existing conditions. However, there are some stipulations: 1) you must present a certificate of creditable coverage to the insurer, which shows that you are HIPAA eligible; 2) you cannot be eligible for government-subsidized insurance such as Medicare or Medicaid; 3) you must apply for a HIPAA plan within 63 days of losing your coverage.
The Cancer Legal Resource Center of the Disability Rights Legal Center has compiled a list of private insurance companies that offer HIPAA policies:
In many states, HIPAA-eligible individuals can buy insurance through high-risk pools, which are state-run programs that offer individual health insurance policies to residents who do not have access to group coverage and who have been denied individual coverage. The National Association of State Comprehensive Health Insurance Plans provides links to state high-risk pools.
HIPAA policies can be quite expensive. You may want to check to see if you’re eligible for Medicaid or another government-subsidized plan first. The Pre-Existing Condition Insurance Plan, a program instituted through the Affordable Care Act, also offers guaranteed access to coverage for people with pre-existing conditions, and rates are generally lower than those offered through high risk pools or HIPAA policies. However, you have to have been uninsured for at least 6 months in order to apply. To review what public and private insurance options are available in your state, visit the Foundation for Health Coverage Education’s website.
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.
For Breast Cancer
Q. I'm looking for help. I do not have insurance and do not think I qualify for any charitable help. I need surgery for breast cancer and chemotherapy. Is there anywhere I can get help?
I understand your concern about not having insurance and being diagnosed with breast cancer and needing surgery and chemotherapy. This can be overwhelming and I hope to guide you in the right direction so that you can find assistance.
Listed below are resources for people who have been diagnosed with breast cancer and do not have medical insurance to cover the cost of their treatment:
Susan G. Komen (www.komen.org or 877-465-6636, Monday–Friday, 9:00 a.m.–10:00 p.m., EST). They can assist you in locating your local affiliate that provides grants to local community-based organizations providing education, screening and treatment programs. Some of these programs may include financial assistance programs to those that are uninsured.
The Centers for Medicare and Medicaid has information on your state’s Medicaid program eligibility requirements. Medicaid is a free, state insurance plan that covers the cost of medical care to those who qualify. Please visit: www.cms.hhs.gov/home/medicaid.asp.
Many state and corporate prescription assistance programs help patients obtain free or low-cost medications. To learn more about the patient assistance programs (PAPs) that are offered by pharmaceutical companies and states, visit the Partnership for Prescription Assistance at www.pparx.org or call 888-4PPA-NOW (888-477-2669).
The Foundation for Health Coverage Education’s mission is to simplify public and private health insurance eligibility information in order to help more people to access coverage. You can visit their website at www.coverageforall.org.
A social worker at the hospital where you will be receiving treatment often can provide referrals to local sources of financial aid. In addition, it might be helpful to explain your financial situation to the hospital’s business office and your physicians. Professionals involved in caring for you are well aware of the economic burden that cancer imposes on patients and families. They might be able to develop a plan to reduce costs or extend payments over a longer period of time.
Other organizations that may be of assistance to you during this time include:
CancerCare offers limited assistance for transportation, home care and child care for women who qualify. Limited funds are also available to assist with certain oral, pain, and anti-nausea medications, lymphedema supplies and durable medical equipment.
Patient Advocate Foundation offers a one time grant of $300 for qualified patients to cover expenses for lymphedema care and supplies, durable medical equipment, transportation costs associated with getting to and from treatment, prostheses and wigs or child care and/or elder care necessitated by treatment. Eligible patients include those who have been diagnosed and are in active treatment for breast cancer who fall within 250% or less of the federal poverty limits. For more information, call 855-824-7941.
For additional support, I encourage you to call CancerCare’s Hopeline at 800-813-4673 to speak to an oncology social worker.
For Cervical Cancer
Q. What resources are available for women with cervical cancer who have no medical insurance? I was going to a specialist and my cancer was advancing. I have had no treatment since due to lack of insurance.
The many challenges of being diagnosed and not having insurance are stressful and emotionally difficult. Feelings such as anger and anxiety are very common, but these should not keep you from getting treatment. Give yourself credit for seeking help, and for learning about and using available resources.
Being organized can help ease some of your anxiety. Keep a notebook with a list of organizations you contact and write down the name of the person with whom you speak, and what information they provide to you.
- Medicaid is a jointly funded, federal-state health insurance program for people who need financial assistance for medical expenses. A current law exists that allows state Medicaid programs to provide treatment to women diagnosed with cervical cancer.
- Contact local hospitals to see what types of free care or charity care programs they offer. Speak with a financial counselor or social worker to explain your situation. Federal law requires that non-profit hospitals provide some amount of charity care in exchange for tax-exempt status.
- The Patient Advocate Foundation (PAF) provides education, legal counseling, and referrals to cancer patients and survivors concerning managed care, insurance, financial issues, job discrimination, and debt management.
- Contact local community or religious organizations that may be able to provide guidance and resources.