It can be hard to know how to find a health insurance plan that offers the best coverage with so many to choose from – including Original Medicare, supplement plans (MediGap), Medicare Advantage plans and employer-sponsored private insurance plans – and sign-up periods can be time-sensitive. By asking the following questions, you can narrow your choices and determine the best insurance coverage for your situation.
Does this insurance plan cover cancer treatments?
Among the first questions to ask of any health insurance plan is whether it covers cancer treatments such as chemotherapy, radiation and surgery, and the details of coverage for each. If you’re receiving government-provided Original Medicare, this guide called Medicare Coverage of Cancer Treatment Services can help you understand conditions and treatments that are covered.
Medicare Supplement plans are additional health insurance plans that cover costs that Medicare does not pay for. These, along with Medicare Advantage plans, as well as employer-sponsored health insurance plans, are provided by private health insurance companies. You need to contact their representatives or research details of their plans online.
People looking for a health insurance plan under the Affordable Care Act can visit HealthCare.gov to see health insurance plans in their area and begin researching their cancer-related coverage.
It’s also important to check the out-of-pocket costs you will have to pay such as premiums, co-pays, deductibles and maximum costs for each plan. Different plans can vary significantly.
Are my doctors in a plan’s network?
If you have favorite doctors, check to see if they are part of a health insurance plan’s network of physicians before signing up. Websites for health insurance company plans provide ways to plug in a doctor’s name to find out if they’re part of a given network. Doctors or institutions outside of a plan’s network might be partially covered or not at all, so ask what the cost would be if you decide to seek care outside of a plan’s network.
Are cancer-related testing and equipment covered?
Ask about a plan’s coverage for imaging and blood tests as well as commonly ordered medical equipment like a cane or hospital bed.
Check whether cancer care items – such as wigs or mastectomy prosthetics for breast cancer patients – are covered. And may want to review the plan’s formulary or speak with insurance to see if your current prescriptions are covered. You may also want to confirm if pre-approval or prior authorization is required for drugs, tests or procedures.
A comprehensive overview of what health insurance plans cover for cancer patients, as well as other costs associated with cancer care, is included on the American Cancer Society’s Health Insurance Options page.
While coverage for cancer diagnosis, care and treatment varies among different plans, the Affordable Care Act mandates that no one can be dropped or denied health insurance because of a pre-existing condition including cancer. Contact representatives from insurance companies you’re interested in to ask about their coverage for treatments you may need.
Is integrative medicine covered?
Integrative medicine treatments for cancer patients, such as acupuncture, stress management and massage therapy, can provide substantial benefits for cancer patients, so research if these are covered in a health insurance plan. Also ask about coverage for home health visits and supportive care such as palliative care, physical therapy, rehabilitation services and mental health counseling.
Does this insurance plan cover cancer screenings?
Routine screenings and preventive tests, including genetic testing for cancer as well as other illnesses can make a vital difference. Some plans make a distinction between routine and diagnostic testing in terms of what they will pay. This information should be included in the plan’s “summary of plan benefits” document.
Many insurance companies cover routine screenings such as colonoscopies and mammograms, based on government recommendations and guidelines.
Glossary: Health insurance terms to know
Here is a list of some of the most common terms you will come across in your search for health insurance plans that cover cancer, and what they mean.
Deductible: The amount you must pay out of pocket before your health insurance plan begins to pay for your care and services. For instance, if you have a $1,000 deductible on your health insurance plan, you will need to pay that amount for any health care services you receive before your health insurance begins to pay.
Premium: The monthly amount you pay for your health insurance coverage.
High-deductible health plan (HDHP): With this type of health insurance plan, the amount you must pay before your health insurance plan begins – your deductible – is high but the monthly premium is typically low. Anyone who has an HDHP may be eligible for a health savings account (HSA), which can help offset some expenses and may offer some tax advantages.
Out-of-pocket maximum: This is the most you’ll be asked to pay annually out of your own funds toward deductibles, co-pays or co-insurance before your health insurance plan will pay 100 percent for eligible services, medications and other benefits.
Co-pay: This is the amount you may have to pay at the time you visit a doctor or receive a service. This payment will vary depending on the type of doctor or service you need and will count toward your out-of-pocket maximum. Be sure to review what a health plan’s co-pays are when selecting health insurance since these out-of-pocket charges can add up.
Co-insurance: After you’ve paid your deductible, it’s likely you will share a percentage of the cost of the health care services you receive with your health insurance plan in an arrangement called co-insurance. For instance, if your deductible is $1,000, once you have spent that amount, your health insurance plan may pay 80 percent of future charges while you will be responsible for the remaining 20 percent. The money you spend on co-insurance will accrue toward your out-of-pocket maximum and once that maximum amount is reached, the health plan will cover 100 percent of charges going forward.
Cancer insurance: This is a supplemental insurance plan designed to cover out-of-pocket costs not covered by your primary health insurance plan as well as non-medical expenses including childcare costs and lost wages due to your illness. People who’ve already been diagnosed with cancer are usually ineligible for this type of coverage. Shop around and review these policies carefully to be sure they enhance your overall plan rather than create more limitations.
Catastrophic illness insurance: This may be added to your regular health insurance or life insurance plan to cover the added expense of treating and living with an illness like cancer.
Also read:
Insurance and financial help offered at City of Hope
Helpful questions to ask your oncologist
What you need for a chemotherapy care kit