Let’s face it — cancer treatment is expensive.
If you have health insurance, it usually pays at least part of your medical costs. It’s a good idea to review your coverage before your first appointment so that you understand the terms of your plan.
If you don't have insurance or need help with costs that aren't covered, financial assistance may be available. Certain government programs and nonprofit organizations can help. You can also discuss concerns about paying your medical bills with your physician, social worker or the business office where you receive your care. Many practices in The US Oncology Network have access to resources to help you manage the costs of your care.
Don’t be embarrassed to share your financial situation with your care team to ensure nothing stands between you and your treatment.
Questions to Ask the Clinic about Insurance/Financial Assistance
Review Your Insurance and Financial Assistance Options
There are many different types of insurance coverage. It’s important to understand the type you have and all it can do for you. If you have questions about your current coverage, talk with your plan administrator.
Below is an overview of various types of insurance.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
In certain circumstances, the federal COBRA law allows an individual’s insurance coverage from his/her last employer to continue for up to 18 months. The individual is responsible for paying some or all of the monthly premiums, depending on the time and circumstances of their termination of employment. For more information, see: www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML.
Health Maintenance Organization (HMO)
HMOs provide services for a group of individuals for a fixed prepayment. HMOs cover costs (sometimes requiring a co-payment) when the policyholder is cared for by his or her primary provider or by another participating provider upon referral.
Indemnity Insurance Policy
Providers receive payment based on each service provided or each office visit. Usually, the policyholder must pay a deductible and/or coinsurance and can see any provider of his/her choice.
Major Medical
Major medical, usually part of an indemnity insurance policy (see above), pays for all or part of hospitalization expenses not covered by the policy.
Medicaid
Medicaid is a program to provide coverage for certain low-income and disabled people. Medicaid is jointly funded by federal and state governments and is run by each state. For more information, please visit your state’s Medicaid site or the federal Medicaid site: www.cms.hhs.gov/home/medicaid.asp.
Medicare
Medicare is the federal insurance program that provides healthcare coverage for people age 65 or older. For more information please visit the Medicare site: www.medicare.gov.
Medicare Advantage
Medicare beneficiaries can opt to receive care through private insurance and managed-care plans (e.g., HMOs, PPOs) instead of the original Medicare “fee-for-service” program. These plans, called Medicare Advantage plans or Medicare Part C, may limit the providers that patients may see or the amount of benefits for certain types of care or drugs. Medigap (see below) policies provide no coverage for persons enrolled in Medicare Advantage plans.
Medicare Part D Plans
Medicare Part D plans are offered through private insurance companies to add prescription drug coverage to original Medicare. Enrollees must pay an additional premium (though Medicare will assist persons with limited income and resources) and fill their prescriptions at participating pharmacies.
Medigap
Medigap policies, also called Medicare supplemental insurance, help pay certain costs that original Medicare doesn’t cover. Persons in original Medicare (but not Medicare Advantage plans) may get a Medigap policy to help cover deductibles, copayments or other cost-sharing amounts.
Preferred Provider Organization (PPO)
In a PPO plan, an individual chooses his or her provider from a list of “preferred providers” and usually does not need a referral for additional treatments or opinions as long they are provided within the network of providers. Usually, the policyholder must pay a deductible and/or coinsurance.
Veteran’s Benefits
In addition to any other coverage they may have, veterans are entitled to benefits through the Department of Veterans Affairs. For more information, see: www.va.gov.
Disability Insurance
You may be eligible for short- or long-term disability insurance through an employer or directly through an insurance carrier.
Social Security Disability Insurance (SSDI)
Your work history determines your eligibility for Social Security Disability Insurance. If you are eligible, coverage usually begins six months after an individual is considered disabled and after 24 months for Medicare patients under 65. For more information, see: www.ssa.gov/dibplan.
Supplemental Security Income (SSI)
SSI payments are available based on financial need. People who get SSI may also receive food stamps and Medicaid. For more information, see: www.ssa.gov/ssi.
