In the United States, health insurance can help cover the costs of some of your cancer care to reduce your out-of-pocket expenses. Read on to learn about the best health insurance options for people with lung cancer.
Health Insurance Options & Lung Cancer Coverage
There are a wide variety of health insurance plans available, including employer-sponsored plans, private health insurance, and government-sponsored insurance programs.
Each of these plans may require you to pay a monthly fee, known as a premium. Most plans also require you to pay a deductible—a certain dollar amount of your medical costs each year before insurance coverage kicks in. Depending on your plan, you may also be responsible for paying a flat fee for healthcare provider’s visits (co-pay) or a percentage of the cost of services (co-insurance).
The most common types of health insurance plans that provide coverage for lung cancer screening and treatment include employer-sponsored plans, state insurance marketplace plans, Medicare, Medicaid, and individual or private plans.
Employer-Sponsored Plan
Employer-sponsored health insurance plans are offered by companies as a benefit of employment. These plans typically cover the employee and their dependents (and often their spouse). A little over 55% of Americans have employer-sponsored health plans.
You can usually sign up for these plans when you start a new job. You can also add yourself, your child(ren), and/or spouse to your work health insurance plan during the open enrollment period, which happens once a year.
It’s important to understand your health insurance options prior to opting into an employer-sponsored plan. Read through the details of the plan (Summary of Plan Benefits) to make sure it provides the coverage you need for cancer care. Consider the following factors:
Total benefits covered by the plan Your out-of-pocket expenses (e. g. , deductible, copays, coinsurance) Prescription medication coverage If your providers (e. g. , primary care physician, oncologist, cancer treatment center) are in-network with the plan Whether or not there is a cap on what the insurance policy will pay for healthcare
State Insurance Marketplace Plan
The Health Insurance Marketplace is a government-run service that helps people enroll in affordable health insurance plans. All Marketplace plans provide coverage for the treatment of pre-existing conditions, including cancer.
The federal government operates the Marketplace in many states, and other states run their own Marketplaces. Depending on your income, you may qualify for free or low-cost coverage or subsidies to help cover the cost of the plan.
All health insurance plans offered in the Marketplace cover 10 essential health benefits, including:
Outpatient careEmergency servicesHospitalization (e. g. , surgery, overnight stays)Prenatal and postnatal careMental health and substance use disorder treatmentsPrescription medications Laboratory services (e. g. , bloodwork)Chronic disease management and preventative services (e. g. , screening tests) Rehabilitative and habilitative services and devices (e. g. , assistance for people with disabilities and chronic conditions)
Medicare
Medicare is a government-funded health insurance program that covers 80% of the cost of cancer treatments. You will be responsible for paying 20% of the billed amount until you reach your annual deductible.
There are four parts of Medicare, and each part covers different services related to cancer treatment:
Part A (hospital insurance) covers inpatient care in hospitals, including any cancer treatments you receive while in the hospital. It also includes hospice care, home health care, and skilled nursing facility care. Most people don’t pay a monthly premium for Part A, but you must meet your deductible before coverage kicks in for Part A. Part B (medical insurance) helps cover the cost of some cancer-related outpatient treatments and services. This includes healthcare provider visits, many chemotherapy drugs, radiation treatments, diagnostic imaging tests (e. g. , CT scan), medical equipment, nutritional equipment (e. g. , feeding pump), mental health services, and outpatient surgery. Part C (Medicare Advantage) are private health insurance plans that bundle Medicare Parts A and B benefits, and (usually) Part D. These private plans must cover everything that Original Medicare covers for healthcare services and prescription drugs, but they may have more expensive premiums, and it may cost more to see a healthcare provider that is out-of-network with your plan. Part D (drug coverage) is an optional part of Medicare that helps cover the cost of prescription medications, including chemotherapy drugs, anti-nausea drugs, and other medications used to treat cancer and its associated symptoms. Most Medicare Advantage plans provide drug coverage, but if yours doesn’t (or you don’t have Part C), you can choose a Part D prescription drug plan.
Medicaid
Medicaid provides free or low-cost healthcare coverage for those who qualify based on income and family size.
Though Medicaid benefits may differ from state to state, each program must cover certain cancer-related services, including inpatient and outpatient hospital services, physician services, laboratory and X-ray services, and prescription drugs related to cancer treatment. Some states also provide coverage for additional services, including hospice.
Individual Plan
Individual plans offer health insurance coverage for people who do not have access to employer-sponsored or government health plans (e.g., self-employed individuals). With an individual plan, both you and your insurer will pay a certain dollar amount or percentage of the costs of your medical care. Your out-of-pocket costs will depend on the specific plan you have.
Individual plans cover the 10 essential health benefits as mandated by the Affordable Care Act, which include inpatient and outpatient services, approved prescription drugs, screening tests, and other cancer-related treatments.
Questions to Ask Your Healthcare Provider
Navigating the healthcare and health insurance ecosystem can be confusing, even if you have a good understanding of your insurance coverage. Talking to your healthcare provider about the financial aspects of cancer care can help provide clarity and support when you need it.
These questions may be a good way to open the conversation with your healthcare provider:
Insurance Coverage
Can someone in this healthcare provider’s office/hospital help me work with my health insurance provider? Is there someone who can help me review my medical bills to make sure they’re correct? If an insurance claim is denied, can someone help me file an appeal? Is there someone who can help me keep track of my expenses and incoming bills related to cancer care?
Appointments
How much is my co-pay for each healthcare provider visit? Do you offer payment plans to help me pay back the costs over time? How will I be billed for laboratory tests (e. g. , blood work), and is it covered by my insurance? Does my insurance cover other healthcare provider visits (e. g. , seeing a different healthcare provider for a second opinion?).
Cancer Treatment Costs
Can someone help me estimate the total costs of the recommended treatment plan? Are there other treatment options that are effective but not as expensive? Do I need pre-approval from my insurance company before beginning treatment? Is the cancer treatment center/hospital in-network with my insurance plan? What expenses does my health insurance cover for hospitalization? Outpatient treatment? Are there co-pays for each individual treatment? Is there a place where I can get low-cost or free counseling to help me process and cope with my diagnosis?
Prescription Drug Costs
What is my co-pay for prescription drugs? Can I switch to a generic or less expensive drug that works just as well? Can we review my list of medications to see if there are ways to reduce my drug costs? Are there over-the-counter medications that can help manage side effects from treatment? Are there programs that can help cover the cost of my drug(s) for cancer treatment?
The Cost of Lung Cancer
In 2019, lung cancer patients in the United States paid $1.35 billion out of pocket for treatments, including chemotherapy drugs, radiation treatments and surgical procedures.
Because lung cancer treatments and health insurance options vary so widely, the out-of-pocket costs can be vastly different from patient to patient. There are several factors that contribute to your overall cost of care, including:
Insurance status/type of health insurance coverage (e. g. , deductible, monthly premium, copays, co-insurance)Type and duration of treatment (e. g. , chemotherapy, radiation, surgery)Geographic location (costs tend to be higher in areas where the cost of living is highest)Treatment setting (e. g. , hospital, cancer clinic, healthcare provider’s office) Travel and transportation (e. g. , hotels, gas, public transport) Time (time spent waiting for/receiving care, missed work)
Many people with cancer find it difficult to pay their medical bills in addition to their typical expenses (e.g., mortgage, car payment). Talk to your healthcare provider about your financial concerns—they may be able to find less expensive treatment options or connect you with someone who can help you manage the financial aspects of cancer care.
Choosing the Right Plan
Trying to choose the right health insurance plan can be a complicated task. Putting in some time and effort to compare the different options available will help you choose the plan that fits within your budget and ensures you get the health care you need.
Here are some tips for choosing the right insurance plan for cancer care:
Check to see if your healthcare providers are in-network: When shopping for a plan, check to see if your primary care provider, oncologist and/or hospital and treatment center are in-network for the plan(s) you are considering. Getting care from healthcare providers and facilities that are in-network with your insurance plan may help keep your costs lower. Consider all aspects of the plan: Monthly premiums are the amount you pay each month for insurance coverage. But this isn’t the only out-of-pocket expense to consider. Look through the details of each plan to check the deductible, coinsurance, copays, and out-of-pocket maximums. If you know you have a lot of healthcare provider appointments and cancer treatments ahead of you, it’s best to choose a plan that provides the most coverage and lowest out-of-pocket costs. Talk with an insurance professional: It can be helpful to talk with an expert who can guide you through the process of choosing a health insurance plan. Insurance brokers and insurance provider customer service representatives have the knowledge needed to help you understand plan details and determine which plans will best meet your needs. The Marketplace has a call center that is open 24/7 to help you compare plans, start your application, and answer your questions. Know when you can enroll: The federal health insurance exchange opens on Healthcare. gov each fall and runs until mid-December. This is your window to shop for insurance and enroll in a plan. Some states run their own exchanges, so it’s important to check and see when open enrollment begins where you live. You may qualify for a special enrollment period due to a life event (e. g. , losing other coverage, getting married, having a baby). If you have an employer-sponsored plan, talk to your organization’s HR department to find out when you can enroll.
Summary
A lung cancer diagnosis can take a toll on your physical, emotional, and financial well-being. Health insurance can help cover the costs of cancer care and treatment to help relieve some of the financial burdens many people living with cancer face. Understanding your options for health insurance can help you choose the plan that best meets your needs.
A Word From Verywell
Getting a lung cancer diagnosis can be a scary, overwhelming experience. Worrying about finances on top of concerns for your physical and mental well-being adds to the stress. The right health insurance plan can help cover the costs and relieve some of the financial burdens related to cancer care and treatments.
