Financial Concerns During and After Cancer Treatment

Treatment for cancer can bring about many financial changes and concerns. Treatment and medications are expensive - even with insurance. Trips to the cancer center add up in gas and parking costs. If you aren't able to work your income is also affected. This article provides some guidance for dealing with common financial concerns. Ask to speak with a social worker or financial counselor at your cancer center for help with your specific situation.

Taking Stock of Your Insurance Coverage

Start by REALLY getting to know your insurance plan. Request a copy of your insurance policy from the company. They MUST supply you with this. Important things you want to know about your plan are:

• What is my deductible (the amount I need to pay out of pocket BEFORE the insurance company starts paying for my health care needs)? What out-of-pocket expenses count towards my deductible?
• What are my co-pays for medical appointments (with both your primary care provider and specialists) as well as for procedures such as CT scans, surgery, or radiation?
  • You will also want to know what your co-pay for chemotherapy treatment is.
• What is your out-of-pocket maximum or "stop-gap". This is the maximum amount paid by you ANNUALLY before your insurance plan pays at 100%.
• What does the "year" mean for your plan? Is it the calendar year (Jan-Dec), fiscal year (July-June), or some other pre-determined plan year? This will help you determine where you are in your current benefit cycle.
• What does my prescription plan look like?
  • Is there a separate prescription deductible? What are the co-pays, and out-of-pocket maximums and is there a yearly cap on prescription drugs?
• Does your insurance company offer case management or navigation services to help you through the process of obtaining medical care, authorizations, or appealing denied care?
  • How can I enroll in this service?

After you have all of this information, you can start to assess what your expenses may be, as well as what you can afford, and where you may need to access help.

The Cancer Support Community publishes a very helpful resource, Frankly Speaking About Cancer: Coping with the Cost of Care. This is free and available via download or can be ordered. The Association of Clinical Oncology (ASCO) offers some great educational resources on financial concerns. You can also listen to Oncolink's Health Insurance Webinar Series for more in-depth information. There are many organizations that provide financial assistance for transportation, household items/repairs, lodging, and other financial support. Talk with your local social worker about what organizations might be available in your area.

Managing the Cost of Treatment when "Underinsured"

Many individuals are "underinsured." This means their insurance pays only a portion of their bills, leaving them responsible for 10, 20, and even 30 percent of their treatment costs or hospital bills, which is beyond the financial means of the individual. Talk with someone in the hospital's patient accounting department, as many have charity programs or can offer payment plans. In most cases, you would need to show proof of income and provide some financial documents. A patient may be eligible to receive a partial or sometimes complete write-off of the bill.

Underinsured individuals may also be candidates for co-pay assistance programs offered by non-profit co-pay assistance foundations. There are several organizations that assist with co-pays for medications - both oral medications and those received in an infusion center. These include Cancer Care, PAF's copay assistance program, and Leukemia and Lymphoma Society copay assistance program, just to name a few. Read more from OncoLink about copay assistance.

With the passage and implementation of the Affordable Care Act, many lower-income individuals are now eligible for health insurance coverage through Medicaid. To qualify, you (and your family) must have an income level of 138% or below of the federal poverty level (in 2022, $12,880 for an individual/$26,500 for a family of four). Low-income individuals can apply at their local county assistance office or via their state's website for Medicaid/or Medical Assistance. For more information see http://www.medicaid.gov/. If you do not have health insurance through your employer and are over income limits for Medicaid, you may be eligible to purchase a plan through the healthcare marketplace, healthcare.gov.

For people without prescription coverage, or for those who have exhausted their prescription coverage, many pharmaceutical companies have Patient Assistance Programs (PAPs) that can provide medications at little or no cost. Ask your physician, nurse, or pharmacist who the manufacturer of the medication is and if a PAP is available (you can often find information about PAPs on the company's website). Once you complete a PAP application, your provider will need to sign it and you will also need to provide financial documents showing your income and/or assets. Once approved, the company will arrange to ship the medication to either the patient or the provider's office for pick-up. There are income guidelines for all of these programs. Needy Meds is a helpful online resource for finding PAP programs and other resources for financial support for medical treatments.

Another great resource for low-cost medications is Rx Outreach. This program offers low-cost medications to financially eligible individuals via mail order. They cover some cancer medications as well as medications that are helpful for symptom management including medications for depression, anxiety, seizures, nausea, and reflux. Use a tool like GoodRx to shop around and find the best price.

What about Paying for Wigs, Nutritional Supplements, and Medical Equipment?

Access to a wig, and the ability to pay for it, can be a big issue for cancer patients. Some health insurance policies cover the cost of wigs; you just have to know their language. Usually, they are referred to as "cranial hair replacement" or "cranial prosthesis." You should contact your insurance company first to see if you have coverage for a wig.

Talk with your social worker to determine if any local organizations offer support for wigs. The "TLC" catalog, published by the American Cancer Society, offers a wide selection of lovely wigs, turbans, and head coverings at reasonable prices.

Many cancer patients struggle with maintaining their weight while going through treatment. The physician or dietitian may suggest using nutritional supplements. However, unless these are given via a feeding tube and are the only source of nutrition the individual is able to tolerate, these supplements are typically not covered by insurance plans, including Medicare and Medicare Advantage plans. Many oncology offices have coupons and samples of supplements available. The Oley Foundation also hosts an online database of donated supplements and tube feedings which are often free or available only for the cost of shipping. Ask your dietitian or social worker for assistance with accessing nutritional supplements.

Most insurance companies cover medically necessary medical equipment, called durable medical equipment (DME), such as walkers, wheelchairs, hospital beds, and bedside commodes. It is important to understand your coverage for DME as well as your potential out of pocket costs for DME, including deductible, copays, and rental fees. Oftentimes, lower-cost items such as a raised toilet seat or a cane are cheaper when purchased at your local drug store or online. Some types of equipment are not covered by insurance including adult diapers, over-bed tables, and stair chairs, as they are not medically necessary.

What if I Can't Work While Going Through Treatment?

Applying for disability is a big decision when diagnosed with cancer and also a very personal one. Many people feel up to working throughout their treatment plan; others cannot work from the day of diagnosis.

First, you should start by investigating your disability benefits, both short and long-term, through your employer. Contact your Human Resources office to initiate this process. This should be considered a confidential discussion. You can ask them not to share your concerns or health issues with your direct manager.

Secondly, think about applying for social security disability (SSDI); the caveat with SSDI is that you will not see any payments until six months AFTER social security decides you are disabled and unable to work. For example, if you are diagnosed in July, but continue working until May, Social Security will count MAY as the date you were disabled and you will not receive disability payments until December. Obviously, SSDI is not a short-term solution; but if you have paid into the system and meet qualifications, it can offer substantial financial resources down the line.

If you haven't worked enough to be eligible for SSDI, you may be eligible for SSI (Supplemental Security Income). This is also administered through the Social Security Administration. With SSI your date of application is your date of the disability.

To apply for either SSI or SSDI, the fastest method is through their website, www.ssa.gov. You can also call 800.772.1213 to initiate your application.

If you need further legal information, contact the Cancer Legal Resource Center. The CLRC can provide legal assistance and direct you to local legal resources that may be available. Another valuable resource for navigating legal, work, and insurance concerns is Triage Cancer.

Cancer and Careers is a great resource for all things employment-related, including issues encountered when working during treatment or getting back to work after an absence for treatment. They also have resources for coworkers and managers to help them support the patient and understand the laws related to cancer patient rights, discrimination, privacy, and benefits.

Getting Life Insurance After a Cancer Diagnosis

Accessing life insurance is not out of the question after a cancer diagnosis, but it will require some extra legwork and effort on your part. Due to a pre-existing cancer diagnosis, you will likely be subject to higher premiums for life insurance. However, the longer you are cancer-free, the more likely it is that your premiums won't be as high.

If you are still working, you can look into options through your employer for group life insurance; especially if it is near the open enrollment period. Finally, you can always contact a broker (ask people who you know!) and see what they will do to work with you. The cost may be high, but if you have a family to plan for, this may outweigh the cost of the plan.

Estate Planning

Every individual should have a will. Without one, any assets or property you own could become the property of the state in the event of your death. It is important to talk to an attorney who specializes in estate planning who can help you understand the various ways to spell out what you want in a will. If you need help accessing legal assistance, contact the Cancer Legal Resource Center or call your local law school as many have legal aid clinics. Your social worker can also help you find legal resources.

Bankruptcy

Medical debt is the number one cause of personal bankruptcy in the United States. Filing for bankruptcy is not to be taken lightly. It can have long-term consequences that influence your ability to get credit or to finance things like a home or car. If you are considering bankruptcy as an option for resolving your debt, it is imperative to talk with a qualified personal bankruptcy attorney who can guide you as to what type of filing you may be eligible for, as well as the impacts of the filing on your long-term financial well-being.