Sadly, American health insurance isn’t the number one option for those who truly need to use it during scary diagnoses. And when it comes to breast cancer, the average treatment will cost between $20,000 and $100,000 for the over 250,000 women that are diagnosed each year. Breast cancer vs. health insurance is a hot topic right now, but for the women actually dealing with it, what do you do? Let’s talk about it.

Breast Cancer vs. Health Insurance: Shop Smart

Even if you haven’t been diagnosed with breast cancer, it’s important to know what you’re purchasing when signing up for your annual health insurance plan.

When shopping, look for a higher tier (like gold or platinum) that has a fairly low deductible (that you know you’d be able to afford each year). Some of these plans may seem expensive month to month, but their coverage can save you thousands once you’re diagnosed. That’s because they offer more coverage and you’ll pay less yearly.

Also, before you purchase your insurance plan, see if you’re eligible for a subsidy. Depending on your income, dependents, and other life situations, you could qualify for assistance.

Here’s what to look for when choosing a plan: 

  • Find what the plan covers, and what the deductible and final out-of-pocket costs will be.
  • See which medications are covered.
  • Find out if your current doctor or potential future doctor’s would be in-network (and if you would need referrals).

Once you’ve chosen a plan, you’ll be ready to take the next step.

Know What You Have In Coverage

Now you have health insurance, what’s next? First, all Affordable Care Act-approved plans come with preventative services and more that can help you prevent and manage breast cancer. These services are covered 100%, no matter what plan you choose.

They include: 

  • Breast cancer genetic test counseling if you have a history in your family of breast cancer.
  • Mammography screenings (for women over 40).
  • Annual physical screenings and well-woman visits — including a PAP smear.

Next, you need to look at the specific coverage of your health plan, and what they cover after you’re diagnosed with breast cancer. Let’s take a deeper look at that.

After your diagnosis, you’re going to be using your insurance often. Here’s what to keep on hand.

Your Summary Of Benefits and Coverage

You need to have your own copy of your SBC. This provides your plan’s coverage and the benefits you have as a paying member. This can include your copay’s, deductibles, and what’s covered (plus what’s not).  While these are usually easy to download or print on your insurance’s website, you can also give them a call to get your own copy.

Know Your Insurance Company’s Website

Luckily, technological advances have made it easy for consumers to access their health insurance information easily. If your insurance company has a website (which they should!), you’ll want to get acquainted with it. Look at your deductible, locate doctors in-network and pharmacies, view estimated costs, and track your spending easily with the website.

Get A Good Case Manager

It can be frustrating constantly talking to someone new when you’re going through breast cancer treatment. So ask your health insurance if they can give you one case manager to work with. That way, you can ask all of your questions with one person vs. always talking to new people.

Here are some great questions to ask:

  • What happens if I need out-of-network care?
  • Do I need a referral for specialists?
  • Is this covered by my health insurance plan?
  • What treatments need pre-approval?

Keep ALL Of Your Records

Yes, you need to keep all of your paperwork. This includes:

  • Medical claims
  • Receipts of any payments you made during treatment
  • Conversations you had with your insurance company: including the representative’s name, date, and time.
  • Conversations you had with your providers.
  • Copies of anything you send your insurance (or vice-versa)

Be Willing To File An Appeal

If your insurance denies any part of your treatment, and you believe it should be covered, you can file an appeal up to 80 days after the denial. There are many ways to file a proper appeal, so don’t be afraid to get some help.

Look At Out Of Pocket Costs

The average cost for a breast cancer patient’s first year of treatment is about $60,000. This is why it’s so important to have the right health insurance. But even that should be looked at too.

First, treatment will be lower when you stay in-network with your doctors and specialists. This includes the use of lab work and imaging facilities, hospitals, and providers. And of course, always confirm that they are in-network before receiving any treatment.

Also, the most common out-of-pocket expenses for breast cancer patients are medical devices (including wigs), alternative medicine, and certain drug prescriptions. If your health insurance denies these claims, you can still appeal and get them covered.

Different Types Of Health Insurance

Next up, let’s talk about the different types of health insurance, and how they can benefit you after being diagnosed.

There are three major health insurances that you’ll most likely work with when you’re diagnosed with breast cancer. These include:

  • Health insurance – Your main insurance that pays for some or most of your medical care costs. This could be an ACA plan, Medicaid or Medicare, or a private plan with your employer.
  • Disability insurance – This is not mandatory, but can cover part of your income if you can’t keep working during or after breast cancer treatment. You can get coverage for short-term or long-term disability.
  • Long-term care insurance – Also not mandatory, but it covers any help needed if you become unable to care for yourself. This includes in-home care and nursing home/hospice care.

COBRA Coverage

Also, it’s important to note COBRA coverage as well. This is the benefit you get if you’re changing jobs and get breast cancer treatment after you’ve lost insurance coverage. COBRA (the Consolidated Omnibus Budget and Reconciliation Act of 1986) allows you to temporarily stay on your insurance plan sponsored by your former employer until you’re able to get a new one.

You’re also covered if you’re on a spouse’s plan and they lose insurance coverage (or you get divorced). Remember that this law only applies to group health plans maintained by private-sector companies (ie your employer).

However, you can get up to 18 months of COBRA coverage if you stop working or reduce your hours worked (same with your spouse). And you can get up to 3 years of coverage if you lose coverage because of a divorce or spousal death. However, COBRA coverage isn’t automatic. You MUST ask for it within 60 days of getting your COBRA notice.

If you choose to forgo COBRA, you can qualify for special enrollment in a Marketplace plan as long as you select a plan within 60 days of losing coverage.

No matter what insurance coverages you have, you’ll want to keep copies of your potential benefits and what is and isn’t covered.

Resources For Those Who Don’t Have Great Healthcare Insurance

As you can see, there are many ways to get decent healthcare coverage. But what if your coverage doesn’t include breast cancer treatment, or if you can’t afford out-of-pocket costs? Don’t worry, there are many national resources that can help.

Susan G. Komen

This resource helps you locate your local affiliate to receive grants, get education, and get access to affordable screening and treatment programs. This also includes potential financial assistance if you qualify.

Centers for Medicare and Medicaid

They have information on your state’s Medicaid and Medicare eligibility requirements. If you qualify, you can get low-cost or free health insurance that covers most of your needs.

Living Beyond Breast Cancer

They offer assistance with living expenses: rent, mortgage, car payment, car insurance, phone, internet, cable, electric, gas, & heating oil. Their grants range between $500-$1000; the amounts awarded are dependent on funding and the number of applications they receive.

TriageCancer

Need legal assistance? They can get you recommendations and low-cost services to help.

And, there are many other resources out there, including The Tutu Project. Don’t be afraid to ask and receive the help you need while on your journey. There are many resources out there that you can use while you’re getting treatment. You don’t have to do any of this alone.

Breast Cancer vs. Health Insurance: You Got This!

It can seem daunting when you’re looking at breast cancer vs. health insurance. But I promise, it’s not as bad as it seems, especially when you’re armed with the knowledge of what you have and what you need. Don’t be afraid to ask questions and advocate for yourself, your life and financial well-being are important!

*The information provided on this website is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Reliance on any information provided by this website is solely at your own risk. The owners, contributors, authors, and publishers of this website are not liable for any losses, injuries, or damages arising from the use of the information on this website.*

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