By Lisa Seachrist Chiu
Paying for Cancer
There’s no magic solution to the insurance problems that plague cancer survivors, but a patchwork of aid may help
By Lisa Seachrist Chiu
Health Insurance Pitfalls
Nabhan’s financial struggles show how limited benefits can render an insurance policy virtually useless in the face of cancer. And although she has individual coverage, cancer patients with employer-sponsored plans can also find their coverage inadequate or quickly bump up against annual or lifetime benefit limits that result in medical debt.
Debra Gauvin, a breast cancer survivor in Connecticut, ran into such a cap in her employer-sponsored plan in 2008. She chose to delay radiation therapy until the following year, when the insurance would once again help defray the cost of her treatment. Although Gauvin’s plan has proven inadequate, her cancer diagnosis makes it difficult for her to obtain health coverage in the individual market because individual insurance in Connecticut is medically underwritten, which means an applicant can be denied a plan due to a pre-existing condition. Had she lived in one of the five states that preclude the practice, she may have been able to find coverage.
Another reason patients frequently stick with employer-sponsored insurance is to maintain continuous coverage. This is a critical issue for survivors to keep in mind—not only for their health, but also to avoid pre-existing condition exclusions if they change employers.
Cancer patients who find themselves too disabled to work can continue their employer-sponsored health coverage for up to 18 months through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). But this option doesn’t come cheap: The employee usually pays the contributions of the employee and the employer plus a 2 percent administrative fee. (See the sidebar about COBRA assistance.) Medicare—a federal health insurance program for people 65 or older, some people under 65 who are disabled, and people of all ages with end-stage renal disease—is another alternative, but with it, too, there are limitations: a two-year waiting period between obtaining Social Security disability benefits and qualifying for Medicare.
Finding Financial Help
Despite the restrictions, patients should investigate whether they qualify for government assistance (and not just Medicare). In fact, seeking such assistance is one of the primary recommendations offered by Diane Blum, the executive director of CancerCare, a national nonprofit group that offers free cancer support services.
It’s a lesson Joni Lownsdale learned after her breast cancer diagnosis. A self-employed Illinois graphic artist and entrepreneur, Lownsdale had been paying for an individual insurance policy for years. In August 2002, she was diagnosed with stage I breast cancer. Her insurance adequately covered her lumpectomy, chemotherapy and radiation. But a year and a half after diagnosis, her insurance company raised her monthly premium from $300 a month to $1,000 a month. “I remember crying,” she says, “because there was no way I could afford it.”
She contacted the Illinois State Insurance Commissioner, who directed her to the Illinois Comprehensive Health Plan—Illinois’ high-risk insurance pool for residents who cannot afford private health insurance. “It costs $576 per month,” she says. “But it’s the only option that I have. I consider myself lucky compared to some people who’ve survived cancer only to be ruined financially.”