Health Insurance for Cancer Patients
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If you do not have health insurance, here are some options that might be available to you:
State Health Insurance Marketplaces
Marketplaces provide one location for people to learn about private and some public health insurance plans available to them where they live. Individuals who choose plans in the Marketplace may be eligible for financial assistance. Find Marketplace information, review plans and prices, or apply for a plan.
Medicare
Medicare is a federal health insurance program that provides coverage to individuals who:
- Are entitled to Social Security retirement benefits and are 65 years of age or older
- Are under the age of 65, but have been receiving Social Security Disability Insurance for no less than 24 months
- Are entitled to Railroad Retirement benefits or Railroad Retirement disability benefits
- Have end-stage renal disease
- Have amyotrophic lateral sclerosis (ALS)
You may be eligible to receive both Medicare and Medicaid benefits if you are over 65 or are disabled and have very limited income. Medicaid might cover what Medicare does not. Find out more about Medicare.
Medicaid
Medicaid is a federal health insurance program with eligibility criteria and benefits that vary from state to state. Thirty-one states provide coverage for low-income adults, while in other states individuals have to meet other requirements, such as having a disability, having a dependent child, or being over age 65. You may be eligible to receive both Medicare and Medicaid benefits if you are over 65 or are disabled and have very limited income. Medicaid might cover what Medicare does not. Find out more about Medicaid.
COBRA
If you have health insurance coverage through your employer or a spouse’s employer, COBRA may allow you to maintain that coverage if you experience a qualifying event, such as leaving your job. Learn more about COBRA health coverage.
Veterans
You may be eligible to receive health care through the Veterans Administration. Find out more about VA health benefits.
Explore Resources for Health Insurance
Communicating With Your Health Insurance Company
If you have health insurance, it’s important to learn about the specifics of your policy, including:
- What’s covered
- Deductibles (what you must pay out-of-pocket before your insurance company will begin to cover claims)
- Copayments or copays (a dollar amount set by your insurance provider that is required to be paid by a patient each time care or a drug is received)
- Other out-of-pocket costs
- How to best use your insurance benefits
A good place to start is with your health insurance card. Your insurance card will have numbers you can call to learn more about your policy.
Many health insurance companies offer insurance case managers to assist insured individuals diagnosed with cancer. These trained individuals (often registered nurses or licensed social workers) will follow your case closely, helping to coordinate care and insurance benefits. Contact your insurance company to ask if they will assign you a case manager.
Appealing Insurance Denials
It is not unusual for claims to be denied or for insurers to say they will not cover a test, procedure, or service that your doctor ordered. However, you can appeal your health insurance company’s decision and you may be able to get the decision overturned.
Check with your healthcare team to see if there is someone on staff who can help you. If the appeal is for coverage of a specific medication, some manufacturers may be able to help you with your appeal. If you choose to file the appeal yourself, remember that courtesy and a cool head will increase your chances of success. It is normal to be frustrated, irritated, or angry that a claim was denied. However, how you share that frustration and anger may affect the success of your appeal.
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