Paying for Cancer Treatment: Insurance and Costs

Cancer treatment can be very expensive, even when you have insurance. Specialists, tests, drugs, travel, and time away from work all add up. Costs pile up in ways nobody warns you about. The problem is common enough that it has a medical name: financial toxicity. That means money problems caused by the cost of treatment.

Here is the encouraging part. Some concrete steps reliably make it easier to handle. And your hospital has people whose whole job is helping with this.

Money problems from cancer are a known, treatable side effect. The earlier you raise them, the more can be done.

Costs vary a lot. They depend on where you live, what insurance you have, and what each hospital charges. Learn what to expect before treatment starts, as much as you can:

• ask what your recommended treatment plan is likely to cost with your insurance
• remember the indirect costs of having cancer, such as drugs, travel, parking, lodging, and childcare
• if you are thinking about a clinical trial, ask which costs are research costs and which are patient care costs. The study usually covers research costs. Insurance is usually billed for patient care costs.

Call your insurance company. Ask to talk with a benefits coordinator. Have your policy in hand, and go through this list:

• which tests, treatments, and drugs are covered, and whether your referrals and specialists are in-network
• your copays, the fixed amount you pay per service or prescription
• your deductible, what you pay before the plan starts paying
• your coinsurance, your percentage after the deductible. For example, you pay 20% and the plan pays 80%.
• your out-of-pocket maximum, the yearly cap. After that the plan pays 100% of covered costs.
• which services need prior authorization, your insurer's approval before you can get the care
• how the appeals process works if something is denied

Keep a log of every insurance call. Write down the date, the name of the person, and what was said. Get approvals in writing when you can. Your insurer may not be able to answer every coverage question. Your state's insurance department and the hospital's financial counselors can help.

If you get insurance through work, ask your human resources department. They may have someone who can answer plan questions in detail.

People skip this step, and it matters most. NCI's guidance is direct. Tell your health care team if you think the costs of care could be a burden for you. Here is why:

• your doctors need and want to know how costs are affecting you
• decisions about treatments and medicines can be made with your concerns in mind. Sometimes a generic drug or a different schedule works just as well for less.
• they can point you to resources you would not find alone

Many patients say sharing cost concerns with their doctor made them feel better. Ask the hospital social worker about programs beyond insurance. Ask whether there is a financial counselor or patient navigator.

Your care team can only work around costs they know about. Telling them is a medical conversation, not an embarrassing one.

• Talk to the billing office about payment plans, reduced rates, and patient assistance. Do it before bills become overdue.
• Question confusing charges. Billing errors happen. Ask the billing office or a social worker to explain anything unclear. Medical billing advocates can help for a fee, and may save you more than they cost.
• Keep one folder for bills, claims, and insurance letters. Match them against your appointment record.
• Household bills count too. Rent, mortgage, or utilities may become hard to pay during treatment. Contact those companies early. Payment schedules are usually possible, and reaching out beats falling behind.
• Save money on medicines. Ask whether generics are available. Ask about discount drug programs.

• Medicare — federal health insurance for people 65 and older and some people with disabilities.
• Medicaid — health coverage for people with limited income. Rules vary by state.
• Social Security disability — pays benefits when a medical condition is expected to keep you from working for at least a year.
• Healthcare.gov — insurance options under the Affordable Care Act. Marketplace plans cannot deny you coverage or charge you more for a pre-existing condition such as cancer.
• Department of Veterans Affairs — benefits for eligible veterans and their dependents and survivors.

Call NCI's Cancer Information Service for help finding any of these, at 1-800-4-CANCER (1-800-422-6237). They can point you to referrals and resources for practical and financial support.

You cannot control what cancer care costs. You can control how early you see the bill coming. Learn your coverage. Tell your care team money is a concern. Use the hospital's financial counselors and social workers. Treat every bill as negotiable until someone explains it. And when costs outrun what insurance covers, real help exists — see Financial Assistance Resources.