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Coping with the cost of cancer treatment—where to find financial help

If you or a loved one has been recently diagnosed with cancer, paying for treatment may be far down your list of immediate priorities. And that's understandable. But making sure that finances don't limit treatment options is, in fact, a very important aspect of your (or your loved one's) care.

Below are some basic questions you'll need answers to. We hope this page gives you a good start.

 

Key questions to ask

Question 1: Do I have health insurance?

Chances are, you already know the answer to this question, as well as its importance. Health insurance helps pay for medical and pharmacy costs. You pay a certain amount of money on a regular basis (the payment is called a premium) and your health insurance (also called a health plan) pays for a portion of your medical bills.

If you don't have health insurance, you might wonder if you can still get it with a serious "pre-existing condition" like cancer. You can, by signing up for coverage under the Affordable Care Act.

Question 2: What kind of insurance do I have?

Your answer to this question can vary. You may have one of the following:

  • Private health insurance—This is also called commercial insurance. It can be employer-based health coverage, or coverage that you purchase from a health plan.
  • Government health insurance—This includes federal programs such as Medicare, Medicaid, Veteran’s Health Administration, the Children’s Health Insurance Program (CHIP), and individual state health plans. This category also includes TRICARE or other military healthcare coverage.
    • Medicare—Medicare covers people aged 65 and older. Some individuals under age 65 may be covered if they have certain disabilities or end-stage renal disease.
    • Medicaid—Medicaid covers people who have limited income and resources and people with disabilities. It is a joint federal and state program.
    • Veterans Health Administration—This program, by the Department of Veteran's Affairs, provides medical assistance to eligible veterans.

Question 3: What portion of my care—including medication—is covered by insurance?

This depends on many things, including:

  • Deductible: the amount you will have to pay for healthcare services your health plan covers before insurance coverage will pay for a portion of the medical expenses
  • Co-pay: the amount you pay for a covered drug or healthcare service such as an office visit
  • Co-insurance: your share of the costs of a covered drug or healthcare service, calculated as a percentage of the allowed amount
  • Out-of-pocket maximum: in some plans, this is the amount you must pay during a policy period (usually 1 year) before your health insurance plan begins to pay 100% of the allowed amount
  • In-network vs out-of-network treatment: in-network treatment is care delivered by healthcare professionals and facilities that have contracted with the health plan to provide care; in-network co-payments or co-insurance usually costs you less than care delivered by healthcare professionals and facilities that are out-of-network. Out-of-network means that the healthcare professionals are not members of your health plan's "contracted" network. These providers are generally referred to as "non-preferred providers."

You or a family member/caregiver can contact your insurance company to find out the specifics of your plan. You may also find answers in what is called an "Evidence of Coverage" document or "Summary Plan Description."

If you qualify for Medicare and/or Medicaid, knowing the limits of your coverage is equally important. For example, a person insured by Medicare can buy Medicare Part B coverage for outpatient services, medical supplies, and medication. Part B has premiums, co-insurance, and deductibles—just like commercial insurance. You can also purchase Medicare Part D coverage, which will also help cover the costs of prescription drugs.

Question 4: What expenses should I be preparing to pay myself?

No matter what type of health insurance you have, you will likely need to pay some of the costs. The costs of cancer care are often very high and include treatment costs such as:

  • medication
  • other forms of treatment, such as radiation
  • surgery
  • rehabilitation
  • hospice

There may be additional costs incurred to support you as you fight cancer. These costs may be less of a concern because you need to focus on your health; however, they have the potential to add up quickly. Consider these expenses, most of which may not be covered by insurance:

  • travel to outpatient visits, including gas and the cost of parking if your cancer treatment is in a big city
  • hotel and meal expenses if the hospital where you are being treated is far from home
  • costs of associated medications and nutritional supplements
  • loss of income due to disability
  • family/caregiver loss of income
  • housekeeping costs, if necessary

Because the cost of cancer treatment can be very high, it is important to have an idea of the impact the management of cancer will have on you and your family and caregivers financially.

 

To offset some of these costs, financial help is available. You just need to know where to find it.

It is important and comforting to know that help is available. Many potential sources of financial assistance for cancer patients exist. In fact, there's a large community out there dedicated to helping cancer patients. Some, like the Road to Recovery program offered by The American Cancer Society, were created for the very purpose of helping to ease the cost of travel to and from outpatient visits. Don't be afraid to reach out to programs like this to ask how they might help you or your loved one.

Remember, there are resources out there that may help lessen the costs and expenses connected with your care that your insurance does not cover.

Consider the help of an oncology social worker or other "navigator"-type professional

You can ask your hospital or healthcare provider if they can connect you with an oncology social worker or other "navigator"-type professional. This person may be a great ally and source of information. This person should help you find sources of financial help, including introducing you to a hospital's financial aid officer or helping you complete a disability benefits application if you are unable to work during your treatment period.

 

Searching for financial assistance for cancer patients on your own

You (or a loved one) can also look for sources of financial assistance on your own. You should conduct your search in 4 basic areas:

  1. Reach out to healthcare insurance companies for financial support that is offered beyond "traditional insurance coverage."
  2. Look for support from pharmaceutical companies.
  3. Determine if you qualify for government assistance options.
  4. Connect with charitable or not-for-profit organizations for help.

SOMETHING TO CONSIDER:

All programs and resources listed have specific eligibility rules or terms. You need to review the conditions first and then apply for each program. You may or may not receive assistance based on each organization's rules and decisions. The individual organizations are the sole decision makers as to whether or not you are qualified and not Bristol-Myers Squibb.

Reach out to health insurance companies for financial assistance

Private Insurance
Ask your insurance company about financial assistance. Some insurance companies have foundations that can provide financial assistance for cancer patients for portions of care that are not covered or reimbursed.

For example, Humana offers assistance in locating other organizations that can provide drug assistance.

Public Insurance
Medicare and Medicaid offer several government programs that may provide financial assistance for cancer patients. If you are covered by Medicare or Medicaid, learn how you can get help paying costs by doing a quick read on these programs.

Look for support from pharmaceutical companies

Pharmaceutical companies often have "patient assistance programs" or charities designed to help eligible patients.

The best way to explore your options is to search the website of your medication. Most brand name drugs in the United States have websites.

Determine if you qualify for government-assistance options

Are you a veteran or work for the military?

Most veterans are eligible for free healthcare, but some may have to pay co-pays depending on their income and resources. If a veteran cannot pay the co-pays, he or she may be able to take advantage of alternatives such as a waiver, compromise, or repayment plan. Veterans may also qualify for a reduction or elimination of medication co-pays.

Look into state or local programs

In addition to Medicaid, each state may offer financial help for cancer patients. Contact your state government's websites and search for patient assistance programs. Examples of this would be nj.gov for New Jersey and mass.gov for Massachusetts.

Additionally, some counties and cities may also offer resources or services. Visit your local government's website and search for patient assistance programs.

SOMETHING TO CONSIDER:

All programs and resources listed have specific eligibility rules or terms. You need to review the conditions first and then apply for each program. You may or may not receive assistance based on each organization's rules and decisions. The individual organizations are the sole decision makers as to whether or not you are qualified and not Bristol-Myers Squibb.

Connecting with charitable or not-for-profit organizations for help

A number of organizations provide information, referral, or direct financial aid to patients with cancer. Here are some of the most recognizable organizations:

Cancer Financial Assistance Coalition is a coalition of organizations that are knowledgeable about financial help—including co-pay relief programs, patient assistance programs, fundraising, and personal financial planning.

Cancer Patient Support provides emergency financial support AFTER other resources have been exhausted.

CancerCare Co-Payment Assistance Foundation is dedicated to helping patients afford co-payments for cancer treatments.

CancerCare's Financial Assistance Program provides limited financial assistance with travel, child care, and home care expenses while in treatment, as well as other limited special purpose grants.

Health Well Foundation provides financial assistance to specifically cover co-insurance, co-payments, healthcare premiums, and deductibles. The assistance applies to certain medications and therapies.

Joe's House is a search engine that can help you find discounted lodging during your treatment.

Lung Cancer Alliance provides information about services and long-term options specific for veterans.

Partnership for Prescription Assistance (PPA) helps those without prescription drug coverage get drugs for free or at large discounts (for those who qualify). PPA also offers information about Medicare, Medicaid, various patient assistance programs, co-pay assistance programs, a low-cost clinic finder, savings cards, and other services. It is funded by pharmaceutical manufacturers.

Patient Access Network Foundation provides financial assistance to patients with non-small cell lung cancer (NSCLC) who have Medicare, up to $7,500 annually.

Patient Advocate Foundation provides direct financial support to insured patients, including Medicare Part D beneficiaries, who qualify financially and medically.

RxAssist Patient Assistance Program Center is a comprehensive database of patient assistance programs, as well as practical tools, news, and articles for physicians and patients.

SOMETHING TO CONSIDER:

The list of healthcare insurance companies, government programs, and charitable organizations outlined in this section is not exhaustive. As well, the services offered do not promise that all applicants will qualify for financial assistance. However, at a time when you and the ones you love are preparing to fight lung cancer, this important message should be loud and clear: You are not alone in your fight against cancer.

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Find insurance at HealthCare.gov

One of the goals of the Affordable Care Act was to give people who didn't have health insurance the opportunity to buy it at a price they could afford. If you don't have health insurance, you can go to HealthCare.gov and sign up for coverage during the next enrollment period. Based on your income, you may be directed to Medicaid (a government program for individuals with limited income and resources). If you don't qualify for Medicaid, there are other options.

Know the limits of your coverage

If you qualify for Medicare and/or Medicaid, knowing the limits of your coverage is equally important. For example, a person insured by Medicare can buy Medicare Part B coverage for outpatient services, medical supplies, and medication. Part B has premiums, co-insurance, and deductibles—just like commercial insurance. You can also purchase Medicare Part D coverage, which will also help cover the costs of prescription drugs.

 

Could an advocacy group help you or your loved one?

NEXT: Advocacy Groups

 
 

What is your role as a caregiver?

Find out >

Want valuable lung cancer information—delivered right to your inbox?

Sign up now >

A community of help and support awaits you.

Go now >