Managing Cancer Costs: Basic Information and Advice

Cancer treatment presents a major financial burden to patients and their families. Whether patients have private health insurance, government insurance, or no insurance, medical and nonmedical costs quickly consume personal and family budgets. Every patient deserves the best treatment plan regardless of cost, and this sheet does not suggest accepting anything less. It provides basic financial information to help patients make informed decisions while preserving their highest possible quality of life. With proactive planning, financial survivorship can accompany cancer survivorship.

Get Organized and Start Budgeting

Getting organized after a cancer diagnosis will help you keep your finances in order. Your treatments will generate paperwork that you should systematically file for easy access. Develop a filing system that works best for you. Be sure to save all your bills and receipts, as many medical expenses qualify as itemized deductions on your federal tax return (see IRS Publication 502 at www.irs.gov).

Financial planning eliminates stressful surprises down the road, so start creating monthly budgets. Whether through a traditional ledger or a software program, identify and monitor your monthly medical and nonmedical costs. Be sure to estimate anticipated costs and project income loss from missing work. Develop contingency plans for unexpected costs. If changes in your condition make handling financial matters too difficult, consider working with a professional financial planner.

Identify Costs Related to Care

Accurate financial planning starts with knowing what costs to expect. To create a useful forecast, it is important to recognize the medical and nonmedical costs associated with treatment and recovery.

Physician Appointments

Your insurance company usually charges a standard copayment for each appointment. Copayments may differ for primary care physicians and specialists, and oncologists are usually considered specialists. Typically laboratory tests, such as blood tests, incur additional costs.

Cancer Treatment and Medication

These are expenses related to your specific treatment plan, such as copayments for radiation therapy sessions. Some insurance plans require copayments at each treatment. Prescription drug costs include payments for treatment medications such as chemotherapy and drugs used to relieve common side effects. Insurance companies may not cover some treatments considered experimental or off-label, so contact your insurance company before starting a specific plan. Also, cancer treatment can last a few days to a few years, so find out how long these costs will accrue to help you plan accordingly.

Clinical Trials

Clinical trials test the safety and effectiveness of promising cancer treatment research. Depending on the trial and your insurance coverage, there may be costs associated with participation. These costs may not exceed your non-trial treatment expenses, so enrollment may be worthwhile.

Transportation

These costs include traveling to and from doctor’s appointments and treatment centers, which sometimes involves air travel. Appointments at long-distance treatment centers may also require hotel stays.

Family and Living Expenses

Beyond your normal living expenses, cancer treatment generates new costs, including special nutritional supplements, childcare, and/or eldercare. You may need someone to pick your child up from school or take your parent to an appointment. Many patients with cancer also find it helpful to meet with a mental health professional, which often requires a copayment. Anticipating these nonmedical expenses is one of the primary keys to maintaining your financial stability.

Employment, Legal, and Financial Matters

Sometimes patients with cancer need professional guidance on a range of issues. These include employment rights, loss of wages, tax-deductible medical expenses, health insurance coverage, appealing Social Security Disability decisions, writing a will, or creating an advanced directive.

At-home and Long-term Care

Some patients require assistance at home from skilled professionals such as nurses, social workers, or physical therapists. Others need extended nursing care at a specialized facility. Insurance coverage of these costs differs among various plans.

Determine Your Insurance Situation

Insurance coverage is the driving force behind the quality and cost of cancer treatment. Although insurance covers a portion of your expenses, you remain responsible for copayments and deductibles. All patients with cancer should fi rst determine how the federal healthcare overhaul (www.whitehouse.gov/healthreform) affects their insurance coverage. To start, uninsured patients may now have coverage and insurance companies can no longer establish insurance caps.

If you have insurance, understanding the details of your coverage will help you determine your out-of-pocket costs. Grasping the terminology is crucial to interpreting your coverage, so start with the key terms on the right. You should also call your insurance company and request assignment to a case manager, which provides a consistent contact point for all your questions. Finally, never hesitate to openly discuss insurance matters with your physicians and healthcare team when selecting a treatment.

If you are uninsured, inquire about a social worker or financial counselor at the facility where you were diagnosed. These individuals might help create a payment plan or set up a discounted payment. If you recently lost a job that provided coverage, contact your former insurance company about your eligibility for COBRA. Veterans should contact the Department of Veterans Affairs for coverage options. Others may qualify for Medicaid, county medical care, hospital charity care, or state-sponsored high-risk insurance pools. Go to a hospital emergency room if you experience a life- threatening symptom. By law, these facilities must treat you.

Additional Financial Resources

If your cancer treatment expenses exceed your resources, you can explore financial assistance options through the social work department of a local hospital, a cancer resource center, a local cancer organization, a local congressional representative’s office, and local community service and religious organizations. Multiple Internet sites provide either direct financial assistance, advice for patients regarding financial matters, or links to additional resources. Start with these:

• American Cancer Society

• CancerCare

• The National Children’s Cancer Society

• The Patient Advocate Foundation

• Support and Assistance Guide for Cancer Patients

Glossary

Case Manager—A healthcare professional, often a nurse with experience in cancer, that helps coordinate the care of a person with cancer before, during, and after treatment. At a medical center, a case manager may provide a wide range of services for patients that may include managing treatment plans, coordinating health insurance approvals, and locating support services. Insurance companies also employ case managers.

COBRA—Consolidated Omnibus Budget Reconciliation Act. A federal law that allows employees in danger of losing health insurance under certain circumstances, such as leaving a job, to pay for and keep their insurance coverage for a limited time.

Copayment—A set fee, in dollars, that an insurance provider requires a patient to pay each time care is received.

Deductible—The amount of approved healthcare costs an insured patient must pay out-of-pocket each year before the healthcare plan begins paying any costs.

Insurance Cap—The amount of money an insurance plan will pay in total benefits. Once a patient’s medical bills reach the total, or cap, the plan will no longer provide coverage.

Medicaid—This is a type of government health insurance for people with low incomes who meet certain conditions.