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Health Insurance Rights of Cancer Survivors

When you've fought cancer, you may see health insurance in a new light. Even after cancer, you will likely use your health insurance a lot. You also may have more problems with health insurance. It's important to be aware of your rights and options.

Types of health insurance

It's vital for cancer survivors to have health insurance they can depend on. There are many kinds of policies. But not all of them offer enough protection. It's best to have comprehensive health insurance. It should pay for all your basic healthcare needs. These needs include hospital and doctor care, lab tests, medical equipment, and prescription medicines. When looking at a policy to see if it meets your needs, look at the monthly fee (premium). Then look at:

  • What services are covered and which are excluded

  • How much you have to pay for covered services

  • Who gives you care and if that care is limited to a medical system or network

Be wary of insurance that is not comprehensive. These types of policies are usually not a good deal for cancer survivors. This includes:

  • High-deductible policies

  • Medical savings account (MSA) policies

  • Cancer-only insurance

Getting and keeping private health insurance

You have rights under federal and state laws to help you buy and keep insurance. But these rights vary. They may vary depending on where you live. And they may vary depending on what kind of plan you have or seek.

Who regulates my insurance?

To learn about your rights, it helps to find out who regulates your kind of health insurance. State rules control many plans sponsored by small employers. And state rules control most insurance you buy on your own. But some health insurance is controlled by rules from the federal government. This includes most health plans offered by large employers. Your protections will vary depending on whether state or federal rules apply. Your protections also will vary depending on:

  • Whether state or federal rules apply

  • Whether you are in a group health plan or buying your own insurance

  • Changes to state and federal health laws made by elected officials

Your rights under a group plan offered by an employer

If you are offered a group health plan, you have rights under federal and state law. These include:

Nondiscrimination. Your right to be covered under a group health plan can't depend on how healthy you are now or have been in the past. This means you can't be refused health benefits under an employer's health plan if you are a cancer survivor.

Affordable Care Act (ACA). Under the ACA, insurers must offer open enrollment periods when all applicants must be accepted, no matter what their health is. This part of the ACA also stops insurers from using a person's health status to set monthly premiums. 

COBRA. COBRA is a federal law. It lets you and your family stay covered under your group health plan when you leave your job or in other cases. You, your dependents, or both can remain in the group plan for up to 36 months. When you sign up for COBRA, you have to pay the full premium. This includes the part the employer used to pay for you.

Your rights under an individual plan

The rights you have when buying your own health insurance depend on where you live. State laws vary. Talk with your state insurance commissioner's office for more information. Or you can get a free consumer guide that notes your rights in each state. These are published by Georgetown University. They are available online at chir.georgetown.edu

Public health insurance

In some cases, you can get health insurance from the government. This is instead of insurance from an employer or insurance company. Some public programs are described below.

Medicare

Medicare is health insurance provided by the federal government. You qualify if any of these apply to you:

  • You are 65 or older and get Social Security benefits

  • You are disabled (at any age) and have had Social Security benefits for 2 years

  • You are on kidney dialysis (at any age)

Medicare is divided into these parts:

  • Part A. This covers care you get in a hospital or other care centers. For most people who qualify for Medicare, there is no premium for Part A. You will have to pay a deductible for each hospital stay. For longer stays in a hospital or nursing home, you will have to pay coinsurance.

  • Part B. This covers doctor charges, lab fees, and other outpatient care. You pay a monthly premium for Part B. There is also a deductible for covered services. And there is coinsurance.

  • Part C. This is a combination of Parts A and B provided by private insurers. These private insurers must be approved by Medicare. They must provide all hospital and medical benefits covered by Medicare. These private insurers are called Medicare Advantage. They charge a monthly fee. Some include the Part D medicine plan (see below). Part C is not available everywhere.

  • Part D. This is optional. It helps pay for prescription medicines. If you join, you pay a monthly premium. The amount varies by plan. You also pay a yearly deductible. You will also pay a part of the cost of your prescriptions. This include a copayment or coinsurance. Costs vary based on which medicine plan you choose.

Many people buy extra insurance to pay for costs Medicare does not cover. This is sometimes called Medigap.

Medicare can be very confusing. This is often the case for Parts C and D. It's best to talk with an independent expert before buying a Medicare Advantage Plan or Medigap insurance. Visit the Medicare  website. It has information to help you select a plan that fits your needs. 

Medicaid

Medicaid is a shared federal and state program. It provides health insurance for low-income people and families. There are federal rules that states must meet to get federal funds. Each state has the right to develop its own Medicaid program.

In most states, to qualify for Medicaid you must:

  • Have very low income

  • Be a child, a parent, an elderly adult, or disabled

Some states do cover low-income adults who aren't elderly, disabled, or parents.

You can find Medicaid information for your state at Medicaid.gov.   

Other public health insurance

Some states have more help for people who can't afford health insurance. This is in addition to Medicaid. A few states have other plans that you can buy at lower premiums if you have low income. Some states have high-risk pools. In these, you might be able to buy coverage if a private insurer turns you down. 

Using your health insurance  

When you need to use your health insurance, keep these things in mind:

  • Know what rules you must follow.  You may need to get a referral to see a specialist. You might be restricted to a network of doctors or hospitals. Going out of network might mean you pay more. Or your claim may be denied. You might need to submit a claim within a certain number of days in order for it to be paid.

  • Keep good records. This includes copies of all bills and correspondence. Ask for names, addresses, and phone numbers of people you talk to. Write down the dates of your conversations.

  • If a claim is denied, appeal it. Appeal it again and again if you have to. Ask your doctor to help you make your case. Keep records of all your correspondence. Keep track of all time deadlines. You may only be able to appeal a denial within a certain number of days after the decision. If you are in a state-regulated plan, you may be able to appeal to an outside panel of experts. These panels overturn about half of claim denials.

Other rights you have

You also have rights about:

  • Privacy of your health information. The government protects your right to private health information. For information on your rights, see the U.S. Department of Health and Human Services.

  • ACA enrollment. The ACA has an open enrollment period each year. If you miss that, you may qualify for a special enrollment period. Find out more about ACA insurance here.

Online Medical Reviewer: Lu Cunningham
Online Medical Reviewer: Marianne Fraser MSN RN
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 5/1/2019
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