Cost of Cancer Care
THE COST OF CANCER CARE
Overview of Costs
Cancer is an expensive illness. The different kinds of costs faced by people with cancer include:
Direct medical costs. These include doctors' fees, hospital charges, and medication costs. If you have health insurance, your insurance will cover at least some, but probably not all, of these costs. For example, many people find that their insurance provides only limited coverage for prescription drugs. For people without insurance, the direct medical costs of cancer can be a serious obstacle to obtaining care. Sometimes even when you have insurance, the “out of pocket” costs are just unbearable. Some insurances require you to pay before you can receive a service, product or drug. These costs could be a deductible, copay, coinsurance or some other fee that your specific insurance company requires.
- Non-medical costs. These may include the cost of transportation to and from treatment, over-the-counter medications, child care, home care, and medical devices or supplies that you need to be compliant with your cancer treatment plan. These costs are usually not covered by any health insurance and must be paid out of pocket.
- Daily living expenses. These costs — for food, housing, utilities, and so on — these costs may suddenly be more burdensome if the patient with cancer or the caregiver needs to stop working.
Tips for Taking Control of Your Finances
When you or a loved one has received a cancer diagnosis, money may be the last thing you want to think about. But taking control of your finances from the start may be the best way to prevent a crisis later on.
- Talk with your health care team about your financial situation as soon as possible. Most providers of cancer care understand that patients have concerns about the costs of care. A social worker or financial counselor may be able to help you understand your insurance coverage and help you find further assistance, including financial aid if you are eligible. Many providers will work with patients to set up a monthly payment plan.
- Let your creditors know about your financial situation. If you're having trouble paying your bills, it's best to face up to the problem now rather than let the bills pile up. You can nearly always negotiate with creditors. A nonprofit credit counseling service may be able to help you work with your creditors. You have a right not to be harassed by creditors. It's up to you to decide which bills to pay and in what order. You may also wish to talk to a financial advisor about the pros and cons of putting your assets into a trust to shield them from creditors.
- Get a handle on your income and expenses. Figure out how much money is coming in to your household, how much you spend, and what you spend it on. Contact your utility company and mortgage company and ask about setting up a payment plan. You may be able to obtain a disability waiver for your mortgage, car loan, or other debts. Think about how your household could either earn more income or cut back on spending. Do you have money saved for an emergency? Do you have assets (a home, other property, a retirement plan, life insurance) that you can use to obtain cash?
- Understand your benefits and rights under the law. You may have a legal right to certain benefits. A social worker can help you understand and apply for benefits you qualify for. For example, under the Family and Medical Leave Act (a federal law), you may be entitled to unpaid leave from your job to care for a loved one with cancer. If you leave your job or are laid off, a federal law called COBRA may allow you to keep your health insurance coverage for up to three years. If you change jobs, another federal law called HIPAA may protect you from being denied health insurance coverage.
- Make use of resources in your family, among your friends, and in your community. Family members and friends may be able to lend you money or help you find sources of financial help in your community. Many community-based organizations offer assistance with housing and transportation and help applying for benefits to people with disabilities. If you can't pay your utility bills, your community may have a Low Income Home Energy Assistance Program that can help.
Sources of Financial Assistance
Help with the costs of cancer care can come from many sources. It will take effort to piece together what is available. A social worker or financial counselor may be able to help you find out what assistance you may qualify for and apply for it.
- Health Insurance. If you have health insurance, it should cover many of the costs of cancer care. To obtain all the benefits you're entitled to, it's important to understand how your health insurance policy works. Review your policy to find out what it covers and what you need to do to ensure coverage for your cancer treatment. Ask your insurance company if they can assign you a case manager to help you and answer your questions.
You have the right to appeal if your health insurance company denies coverage for any aspect of your cancer care. Find out from your insurance company what you need to do to appeal a denial of coverage. If your appeal is denied, you may be able to get help from your state's insurance department.
- Government Programs. You may qualify to receive financial help from a government program. The federal government offers several programs that provide assistance with medical and living expenses. Many of these programs (including Medicare, Medicaid, and Social Security) are targeted to people who are disabled or elderly or who have low incomes. Many state governments also have programs to assist qualified state residents with medical and living expenses. Most government programs take time to process your application, so the sooner you send in your paperwork the sooner you will receive assistance.
- Public and Nonprofit Hospitals. Hospitals operated by state or local government and some nonprofit hospitals provide a safety net for anyone who needs care, regardless of ability to pay. A social worker or your local health department may be able to help you find out what kind of "charity care" or "indigent care" programs are available in your community.
- Co-pay Relief Programs. Many nonprofit organizations, like the Cancer Resource Foundation offer financial assistance to people with cancer who cannot afford to pay insurance premiums, co-payments, deductibles, and other out-of-pocket costs. Each organization offers different kinds of assistance and has its own eligibility rules. Some programs may be available only to people with specific types of cancer. Funds are limited and the amount of funding available can change. It is best to contact each organization to find out what is available.
- Patient Assistance Programs. Many pharmaceutical companies have patient assistance programs that may provide help with insurance reimbursement, referrals to co-pay relief programs, and help with applications for assistance. Many companies also offer medications at little or no cost to patients who don't qualify for other help. Your doctor's office may be able to help you locate patient assistance programs for your medications.
- Assistance from Voluntary Organizations. Voluntary organizations may offer assistance with practical needs such as child care, household help, and transportation. Each organization offers different kinds of assistance and may have its own eligibility rules. It is best to contact each organization to find out what is available.
- Fundraising. Fundraising may be an option to pay for your cancer care. Be sure you have explored all other sources of financial help first. Also make sure that raising funds will not disqualify you for other benefits such as Medicaid or Social Security. Consider working with an organization that has experience raising funds for medical treatment. If you want the funds you raise to be tax-deductible for the donors, you will need to work with a tax-exempt organization. Be sure to follow Internal Revenue Service guidelines for using tax-exempt donations.
- Personal Financial Planning. Consider seeking advice on your financial situation from a professional such as an accountant or a financial planner. An accountant may be able to help you save money on your income taxes. For example, you may qualify for tax credits that will reduce your taxes. If you have a lot of out-of-pocket medical expenses, you may be able to reduce your taxes by deducting some those expenses from your income. A financial planner may be able to help you take control of your finances and plan for your financial future. Look for free or low-cost financial planning talks sponsored by organizations such as AARP or by investment management companies.
Finding Help in Your Community
Organizations in your community may offer help with transportation, lodging, child care, and home care — costs of cancer care that are rarely covered by health insurance.
- Local chapters of the American Cancer Society may be able to provide volunteer drivers to take people to and from appointments for cancer care.
- Several nonprofit organizations can arrange free or reduced-cost air transportation for cancer patients who are traveling to receive treatment away from home.
- Other voluntary organizations offer free or reduced-cost lodging for patients receiving treatment away from home.
- Some organizations can provide limited financial assistance for child care and home care.
The United Way and other local charities may offer assistance with living expenses such as rent and food.
Don't forget about the power of using your local elected officials. They often have resources and connections that can be useful.
How Advocacy Organizations Can Help
Cancer advocacy organizations offer many kinds of help and support for people with cancer and their families and friends. Many of these groups focus on helping people with specific types of cancer (e.g., breast cancer, colon cancer, lung cancer, prostate cancer). Some advocacy organizations operate throughout the country, with chapters in most states and many communities. Other groups focus on helping people with cancer in specific communities.
Advocacy organizations may offer a variety of programs and services to assist with the costs of cancer care. Counselors and social workers may be able to help with managing finances, understanding health insurance coverage, and offering advice about benefits and rights under the law. Some advocacy organizations may offer direct financial assistance with medical expenses or provide help with practical needs such as child care, household help, and transportation. Each organization offers different kinds of assistance and has its own eligibility rules. Funds are always limited and the amount of funding available can change. It is best to contact each organization to find out what is available.
A Note About Financial Assistance
The fact that an organization offers direct financial assistance does not guarantee that funds are always available. Patients may have to meet certain conditions to qualify for help. Organizations may also limit the assistance they provide depending on demand, the amount of funds available, or for other reasons. In the case of organizations that provide funds for specific diagnoses, covered medical conditions may change. Always check with an organization for the most up-to-date information about its programs.
Financial considerations – Managing the cost of cancer care