For Any Cancer Diagnosis
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?A.
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; in most states, you must enroll between November 1 and December 15. 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 33 states (including Washington DC) that have chosen to “expand” Medicaid, it covers all children and adults below 138% of the Federal Poverty Level, which for 1 person in 2020 is $17,237. In the remaining 18 states, it only covers low-income families with children, pregnant women, the blind, and the disabled.
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.
What’s the current status of the Affordable Care Act?A.
Despite the unsuccessful attempts to repeal the Affordable Care Act (ACA), the Open Enrollment period begins November 1. Premium assistance and cost sharing reductions are still in place, although there is no longer a federal penalty for being uninsured. However, in some states you must be insured or pay a fine on your tax return. They include New Jersey, California, Washington DC, Rhode Island, Vermont, and Massachusetts.
What to look for:
Pay attention to the open enrollment period in your state. Open enrollment begins November 1 across the country and has been shortened to end on December 15 in most states. New York and California have extended the deadline until January 31, 2020; other states vary.
If you have insurance through the ACA, check your health insurance provider to make sure they will continue to offer plans in 2020. Also, check with your medical providers and billing department to determine which Marketplace health insurance plans they will be accepting in 2020.
Plans purchased through your state Marketplace have to abide by ACA regulations, including the right to coverage of pre-existing conditions and coverage of 10 Essential Benefits, such as hospitalization, medications, and mental health services. Short-term plans, association plans, and religious cost-sharing plans do not have to abide by these regulations. Please read your summary of benefits carefully before you choose to purchase one of these plans.
How to protect yourself:
- Shop around! If renewing, you should be aware of alternatives in case you need to switch to a different plan. Make sure to calculate the monthly premium costs and compare them with the out-of-pocket expenses you estimate for 2020 based on the different metal tier levels.
- Advocate for yourself. Contact your elected officials and tell them why protecting the ACA and stabilizing the insurance market are important to you.