Everyone needs reliable health insurance coverage, but it becomes especially important for cancer survivors, who can have trouble getting new coverage if an existing policy is terminated. Paying high premiums, exclusion of pre-existing medical conditions and waiting a year or more for certain medical services to be covered are all practical reasons to keep any coverage you might already have. But having health insurance is not always enough. Health care consumers need to understand their insurance policies, as well as know their rights.
Considerations
Problems getting health insurance can affect a cancer survivor's future health. It may seem like a no-win situation to someone who needs follow-up care. If you are currently uninsured, a past medical history of cancer can keep you from being accepted by a health plan. If you have health insurance at the time of a cancer diagnosis, you could face paying higher premiums, along with losing some of your coverage following treatment. In most cases, cancer patients are not only fighting their disease, they often find themselves fighting insurance companies. Many times, cancer survivors lack access to adequate health insurance, with some of the other options available to them frequently unaffordable to most.
Types
Most insured Americans are covered by either a managed care or fee-for-service health care plan. Health maintenance organizations (HMOs), preferred provider organizations (PPOs) and point-of-service (POS) plans all fall under the category of managed care, which focuses on preventative care coordinated by a primary care physician.
HMOs provide care within a network of contracted health professionals and hospitals. Although PPOs operate in much the same way, the premiums are usually higher because patients are allowed to use out-of-network services.
Traditional fee-for-service plans are the least restrictive; however, you pay more out-of-pocket costs for your health care. Premiums are higher, and you typically have to pay an annual deductible before the health plan pays its portion of medical expenses. A private insurance company pays anywhere between 50 and 80 percent of medical costs depending on the plan you choose. Because of the many differences in health care plans, it is especially important for cancer survivors to know what services are covered under a plan.
Features
If at all possible, cancer patients should try not to change insurance companies, especially while still receiving treatments, as there can be problems with coverage for continuation of care. Check with a new insurance company about its policies for pre-existing conditions.
If you have cancer, you may have trouble getting new coverage if your existing policy lapses, particularly if you change employers, or your employer changes insurance plans. While there are federal laws providing for the continuation of employer-sponsored health insurance coverage, if you must purchase a health insurance plan that is not group coverage, many states set pre-existing condition exclusion periods that can last for many years.
Similarly, if you purchase an individual plan that is not through an employer, the insurance company may require an elimination rider that would not allow treatments for cancer to be covered by the policy ever. Even though many insurance companies will not accept a person who has or has had cancer, some will accept a cancer survivor after five years. Keep in mind, though, that acceptance by a health insurance plan does not guarantee that full coverage will be provided immediately. Unless they were insured before the diagnosis of cancer, many cancer survivors are unable to get coverage.
If you are uninsured or aren't eligible for group plan rates, contact your state Department of Insurance to inquire about other alternatives to help you manage the enormous medical costs of ongoing treatments, prescription drugs and doctor's care critical to your health.
Warning
Cancer survivors who are accepted on a new health insurance plan usually face a pre-existing condition exclusion period. Often individuals must wait as long as one year before even an employer-sponsored health plan will pay for any costs related to pre-existing cancer. However, in certain situations federal law prohibits an employer from imposing an exclusion period for a pre-existing medical condition.
For example, employees with cancer may be exempt if they were covered under a previous employer and have not gone without health insurance for more than 63 days. But even so, health plans set limits on the maximum benefits they will pay, in addition to placing other restrictions on coverage. This is all the more reason for you to read your health plan so that you know what services are covered.
You should never assume that a health insurance plan covers everything, as not all plans provide the coverage you need. Make sure you understand specifically what services are covered under the plan, how much the health plan pays, how much you will be expected to pay for certain services, what doctors you can see, as well as what hospitals are available for providing you with treatment and care.
If you are covered under an employer-sponsored group plan, talk to your human resources department or contact the insurance company directly if you have questions about anything in the policy that you do not understand.
Expert Insight
Patient advocates who work for organizations that help cancer survivors resolve issues related to health insurance coverage point out that eventually most cancer patients are faced with the problem of lifetime benefit limits. To make matters worse, in recent years many insurance companies have lowered their caps to just $50,000 to $100,000.
After the cap has been reached, patients are then responsible for paying their own medical bills exceeding that amount. This can be financially devastating to those who have plans that only cover up to a certain dollar amount for outpatient services and/or limit coverage to 'x' number of radiation treatments.
Consumer experts recommend a minimum lifetime limit of $1 million for adequate coverage. Some health plans also require patients to pay a percentage of the total cost of prescription drugs rather than just the usual co-payment. Many survivors who need cancer drugs that can cost thousands of dollars every month go without, simply because they have no way to pay for the remaining cost of the drugs.
Benefits
For those individuals who are fortunate enough to have a comprehensive health insurance plan, access to the continued care they need to recover improves their chances for surviving cancer. Having health insurance that provides for routine cancer screenings also increases the chances for early detection. Since people with health insurance usually have regular physical exams, their cancer can be diagnosed earlier. In view of these potentially life-saving advantages, it is important to pay your insurance premiums in full and on time so that your health insurance coverage doesn't lapse. You don't want to find yourself not receiving the medical care you may need because you don't have medical insurance.
Tags: health insurance, health insurance plan, health plan, insurance plan, covered under