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5 Gaps in the Health Insurance System for Cancer Patients

By Meredith Ledford on March 5th, 2010
Health Insurance

If you have cancer, you are likely face challenges in accessing the health care system, acquiring quality health insurance coverage, and paying for life-saving health care services. These challenges include running up large debt, possibly filing for personal bankruptcy, and even delaying or forgoing potentially life-saving treatment.

The current health insurance system may have gaps that those with a chronic illness, such as cancer, should be aware of when searching for quality, affordable health coverage.

Here are five gaps to keep in mind:

  1. Employer-Sponsored Health Insurance May Only Apply if You Are Working. Many Americans have employer-sponsored health insurance coverage, and many employers pay a large portion of those health insurance premiums. Under existing law, if you lose your job because you are unable to work, typically you must decide whether to keep your employer-based coverage (for up to 15 months) within 60 days. However, if you decide to keep your insurance coverage, you are also responsible for paying the premium cost. A federal subsidy, that applies to those who experience a qualifying termination event between September 1, 2008 and February 28, 2010, may cover up to 65% of your premium cost
  2. If You Are Unable to Work Because of Your Illness, Restrictions May Apply to Prevent You from Having Affordable Health Insurance. Barriers such as waiting periods, restrictions on eligibility for health insurance coverage, or delays in applying for public programs can leave people who are too sick to work without an affordable insurance option. For example, cancer patients who are unable to work may qualify for Social Security Disability Insurance income and, after two years of receiving this income, may qualify for Medicare coverage. But during the waiting period, patients typically have reduced income and may not be able to afford private insurance coverage
  3. High Cost-Sharing and Caps on Benefits Could Leave You Vulnerable. Various types of cost-sharing (i.e. co-payments and deductibles) and limits on your health insurance coverage may quickly lead to high out-of-pocket costs once cancer treatment begins
  4. You May Have Difficulty Finding Adequate and Affordable Health Insurance Coverage. Even if you are a cancer survivor, have been in remission for years, and have a good long-term prognosis, you may still have trouble finding health insurance coverage due to preexisting disease restrictions. Alternatively, if you find coverage, you may pay higher premiums for coverage
  5. High-Risk Insurance Pools, Designed Specifically for Those with Chronic Illnesses, May Not Be Accessible to You. High-risk pools, which are designed to help cancer patients and others who are uninsurable (i.e. those with preexisting conditions, genetic markers for chronic diseases, poor medical histories, etc.), are not available in all states. If the state in which you live does offer a high-risk pool, rates are likely to be much more expensive than most other health insurance plans offered in your state

Keep these gaps in mind when looking for affordable health insurance--compare health insurance quotes from multiple agents. Be sure to review the extent of services covered in the health insurance plans' benefit package, and review your cost-sharing responsibilities before enrolling.

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