Cancer care costs can impoverish even those with insurance – report says

Having health insurance may not protect you from the high cost of cancer care, according to a report by Kaiser Family Foundation and the American Cancer Society.

The report profiles 20 patients and tells how they’ve had to struggle to pay for the costs of cancer care even though they had private insurance when they were diagnosed with cancer. 

The report identifies “five key gaps” in the U.S. health care system that leave many people with cancer and other serious diseases in financial jeopardy.

The report is accompanied with a documentary that profiles 3 of the 20 patients. The documentary can be viewed online.

One the patients, a 52-year-old woman named Susan Young, had health insurance through her employer when she was diagnosed with breast cancer.

Her treatment required a mastectomy and chemotherapy and seven weeks of radiation treatments.

But her health plan had a $2,500 deductible and requires her to pay a $25 co-pay for doctor visits, outpatient visits, and prescriptions.

So, as a result, despite having insurance, Young has had to charge more than $5,000 on her credit card to cover her medical bills

Susan and her husband earn only about $40,000 a year. 

“If I didn’t put these co-pays on my credit care, I wouldn’t have enough money to pay my bills,” she says in the report.

The Five Key Gaps:

• High cost-sharing and caps on benefits: Cost-sharing provisions and benefit caps in health plans can quickly lead to high out-of-pocket expenses for patients with cancer.

• Insurance tied to employment: If patients become too sick to work, they can lose their employer-based health coverage.
   
• Challenges of individual market: Individuals with a history of cancer often cannot buy insurance because insurers often often refuse to cover them or charge unaffordable premiums even though the individual has a good prognosis.
   
• High-risk insurance pools not available to all: High-risk insurance pools, which are design to cover “uninsurable” patients, such as cancer patients, are not available in all states and even when they are the premiums can be prohibitively expensive.
   
• Waiting Periods: Patients disabled by their disease may, for example, face a two-year waiting period before they can receive Medicare coverage during which time they may not be able to get other coverage.

The report concludes:

It is impossible to determine exactly how many privately insured individuals in the United States are at risk of high out-of-pocket health costs. However, research indicates that a growing percent of the population is already facing high out-of-pocket costs. Gaps in the current private health insurance system leave cancer patients and others with serious illnesses vulnerable even when they have coverage. Eligibility restrictions prevent public programs from reaching some of the individuals who are struggling to maintain coverage or afford care in the private health insurance system . Addressing the holes in the current health insurance system will be key to providing the privately insured with economic security and access to health care in the face of illness.

To learn more:

• The report and the video are available online the Kaiser Family Foundation Web site.
• The American Cancer Society has some information about financial resources on its Web site.

Tags: Cancer, Health Insurance

Category: Cancer, Health-care Policy, Insurance