Cancer is one of the five most costly diseases in the U.S., according to the 2009 report "Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System." The report, released by the American Cancer Society and the Kaiser Family Foundation, highlights the issues that cancer patients and survivors face as they try to find and maintain affordable medical coverage.
According to the report, about 684,850 new cancer cases in the U.S. were diagnosed in 2008 for people under the age of 65. Of those patients, the majority had some type of private health insurance.
Yet insurance does not protect all cancer patients from high health care costs. "Because cancer treatment can be very expensive and because patients and survivors often need long-term treatment and monitoring, they are among those who are likely to have difficulties navigating the U.S. health insurance system."
Insured Patients Unprotected
For many cancer patients, medical insurance provides only limited protection. Cost-sharing in the form of high-deductibles and out-of-pocket expenses (not covered by their policies) can add up quickly. For example, patients must often pay separate deductibles for different types of services. When patients are faced with such expenses they may postpone or forego necessary treatments.
Many insurance policies also put annual or lifetime caps on the total amounts they'll pay for a patient. What might have seemed to have been plenty of coverage when the patient was healthy could easily be exceeded by a regiment of treatments, medication, and years of follow-up monitoring. In some cases, cancer patients have accrued over $100,000 in medical debt.
Employer-Provided Insurance No Guarantee
Many cancer patients depend on their employers for medical insurance. Even with this protection, there can still be significant out-of-pocket expenses. In addition, if patients become too sick to work, they often must come up with the cost of the premium itself as well as money for additional expenses.
According to the report, many patients must tap their retirement funds and use up their life's savings to keep up with the expenses. Others are forced to take out loans to maintain coverage. "While this may be the only way to maintain coverage, these moves threaten patients' financial security and cause stress at a time when they are already coping with a disabling condition."
Medical Insurance Unavailable
Cancer patients and survivors often cannot find affordable or adequate coverage in the private market. Even if they have been in remission for years and have a good long-term prognosis "many may not be able to find individual coverage or may have to pay higher premiums even if they have a low risk of occurrence."
Patients and survivors who are protected under group policies can be left uninsured if they lose their jobs or decide to leave those jobs. Although some cancer patients and survivors have limited protection under the Health Insurance Portability and Accountability Act (HIPAA), they are not protected from paying higher premiums, and those "not eligible for HIPAA may find that no insurers in the individual market will sell them coverage."
High-Risk Pools Unavailable
High-risk pools offer coverage to individuals who are considered uninsurable and cannot buy medical insurance in the individual market. Currently, about 200,000 people in 35 states are covered through high-risk pools. However, for many cancer patients and those in remission, these pools are neither affordable nor provide comprehensive coverage.
For example, premiums can run 125-200% higher than standard market rates, and many pools limit the coverage of pre-existing conditions for 6-12 months, despite the fact that the reason many patients need high-risk pools is because of pre-existing conditions. In addition, lifetime caps can be as low as $500,000, with $1 million being the most common maximum.
Public Coverage Inadequate
When cancer patients have nowhere else to turn, they must look to public programs such as Medicare and Medicaid. However, applications for such programs are often delayed, waiting periods are long, and there are strict restrictions on eligibility.
Patients too sick to work might qualify for Social Security Disability Insurance and then might qualify for Medicare two years after this. During that two-year period, they live on reduced incomes and often cannot afford private medical insurance. On top of this, they still might not qualify for Medicare. In fact, many of the patients described in the report do not qualify for public coverage, despite their limited incomes and high health care costs.
In the end, cancer patients, as well as others with serious illnesses, are being left with few options. "Addressing the holes in the current system will be key to providing the privately insured with economic security and access to health care in the face of illness."
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