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Can You Afford Cancer?

What To Do If You’re Un- or Underinsured

by Mark Fesen, MD, FACP

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The last thing you need to be concerned about when you’re dealing with cancer is how to pay for treatment. Yet many survivors with little or no insurance have to do just that. This is no time to tell you that you should have made health insurance a higher priority. Instead, let’s explore how you can get the care you need.

In our clinic, we have a social worker and a full-time employee who are both focused on obtaining assistance for our uninsured patients. Here are some strategies that have worked for them and may work for you as well.

If you are self-employed …
You could stay on as an employee and buy insurance to cover everyone, including yourself, even if the business is just you and one other person. A patient of mine who worked with his son hired an additional employee and purchased a policy for the business that also covered him.

Investigate Medicare and Medicaid.
Those who are over 65 or disabled for two years (and have paid into the Social Security system) are eligible for Medicare. However, Medicare pays only 80 percent of hospital and outpatient bills. Treatment for cancer is so expensive that few can afford the 20 percent co-pay.

Medicaid is a federally mandated healthcare program for the poor. If you have cancer and are uninsured, apply for it at once.

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Dr. Mark Fesen

Once your assets are gone, the only option is to try to apply for other government programs, such as Medicaid. This is a federally mandated, state-administered healthcare program for the poor. Medicaid is retroactive from the date of application. If you have cancer and are uninsured, apply for it at once. Look for larger clinics if this is your only coverage.

Purchase high-risk insurance.
State-sponsored high-risk insurance pools are targeted to people denied coverage because their illnesses make them high risks. Medicare/Medicaid-eligible people don’t qualify. Premiums are higher than for standard insurance, but they are also capped.

Ask your oncologist about specialty pharmacies.
These pharmacies provide medications costing approximately $3,000 per month. Pharmaceutical companies provide reimbursement assistance to outside companies that work with these pharmacies. In order to get you the drugs you need, they look at all possibilities, including disease-specific foundations and veteran, state, and drug company programs.

Look into local nonprofit foundations.
These organizations may also help you defer expenses. They might also pay costs for related drugs, such as nausea medication. Contact your local cancer society and ask what is available in your area.

Divide assets.
Nursing home stays can rapidly devour your income, especially if you lack insurance coverage. So does care at home. One option is to divide yours and your spouse’s assets. The ill partner’s assets are spent on the healthcare expenses. Once these assets run out, Medicaid pays, and the well partner’s half remains.

When you need immediate help …
If you have a rapidly worsening condition and no insurance, consider going to the emergency room at your local hospital. They will be able to rapidly evaluate and triage you. If necessary, the physician there will consult by phone with specialist physicians. Then, they will decide whether or not you need to be admitted.

Can you afford cancer?
Few of us can. But help is there if you seek it out. For additional assistance, talk to your oncologist. He or she is responsible for orchestrating your care. A bonded relationship with your oncologist can make a difference in every aspect of your care.

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Dr. Mark Fesen is an oncologist and patient advocate based at the Hutchinson Clinic in Hutchinson, KS. He has trained at the National Cancer Institute and is a clinical assistant professor at the University of Kansas. His book Surviving the Cancer System: An Empowering Guide to Taking Control of Your Care is published by Amacom, amacombooks.org.

This article was published in Coping® with Cancer magazine, March/April 2010.