Health Insurance Options for Individuals with Breast Cancer

Breast Cancer and Health Insurance

Breast cancer is one of the most commonly acquired cancers of the female body, the runner-up to lung cancer in claiming the most lives. An estimated 230,480 new cases of invasive breast cancer were diagnosed among women in 2011, and an approximate 39,520 women were expected to have died from the disease last year. Additionally, 2,140 men were expected to have been diagnosed with breast cancer in 2011, with an estimated 450 deaths among them. Mainly affecting women, clearly, the risk for breast cancer usually increases with age, as the majority of cases occur between women ages 75-79. Risks also include having a family history of the disease, hormone imbalance, as well as drinking heavily and being white.

Treatment of breast cancer begins with the (now) preventive service of a mammogram, which is free with any health insurance plan. If you suspect a lump, it will not be a free service, as it is considered diagnostic. Clinical breast exams and regular physical evaluations can initially help determine changes in the breast, which can lead to more thorough screening through ultrasounds, MRIs, and blood chemistry studies. In the case that suspicious cells or tissues are discovered through a screening, a biopsy will be necessary, and will decide upon the next steps. It is no secret that the process is a long, detailed, and stressful one for preventing and treating this condition.

While it has been a struggle for women with a history of breast cancer or abnormalities to obtain health insurance, there are currently more options than they have been able to access in the past. Individual health insurance plans may still be more difficult to get approved for, but it is necessary as a woman to have health insurance, regardless whether you have had the disease or are adamant about making sure you never have to. All women have received a bit of a bias in the underwriting realm, which is now changing due to the health care law. Though having had breast cancer may have previously left coverage off-limits, it is now within reach.

How Breast Cancer Affects Insurability

Unfortunately, individual health insurance carriers have the option of declining women who have cancer currently or have had it in the past. Whether or not you will be declined completely varies based on your present diagnosis and health status, and also the degree to which the cancer developed. Metastatic cancer of any sort is an automatic decline with nearly every insurance company across the country. Also, if you are currently undergoing treatment or recently received diagnosis, it is more than likely you will face rejection from any of these companies.

However, if you happen to have a guaranteed renewable or non-cancelable health plan before you get breast cancer, the insurer is unable to cancel your benefits. These plans are offered by most insurers in both individual and group markets. If you have such a plan, the insurer will be required to cover medically necessary treatments, though with guaranteed renewable plans the premiums may increase when you acquire breast cancer or signs thereof. Also, individuals living in guaranteed issue states will be able to obtain coverage, even when diagnosed with breast cancer.

States that currently offer all insurance products guaranteed to all individuals include New York, Massachusetts, Maine, Vermont, New Jersey, and some individuals in Washington. Other states have laws that all insurers must guarantee issue certain plans for some applicants at certain times, such as Michigan, Ohio, and West Virginia. In Utah, Rhode Island, Oregon, and Idaho, some health plans are guaranteed issue for some or all individuals with varying specifications on which type of plan covers which. Visit Kaiser Family Foundation for more detailed information about these states.

Health Plan Alternatives for Breast Cancer

If you are not living in a guaranteed issue health insurance state or did not have the protection of a non-cancelable plan, there remain several options for coverage. Those who have access to group coverage through their jobs cannot be turned away because of their breast cancer, no matter what stage it may be in. Also, there is a breast cancer-specific Medicaid program for women who have a low-income and need treatment. Each state offers one of these programs, as required by federal law. Here are some of the ways to get coverage when you need it most.

PCIP

The Pre-Existing Condition Insurance Plan (PCIP) was set up by the Affordable Care Act to empathize with adults who have been declined for a pre-existing condition. If you have no other source of health insurance and have been without it for at least 6 months, PCIP is a great (and perhaps your only) option. Costs vary based on your income, as there are several different plans levels, all of which have similar coverage. PCIP will not place any exclusions on your plan based on your condition, and should cover all necessary treatment for getting through cancer.

Employer-Sponsored Coverage

Many large companies offer their workers health benefits, and if you have not yet taken advantage of your ability to obtain coverage, you should. Once diagnosed with breast cancer, the amount of treatments, procedures, and doctor’s office visits you will require are sure to get really expensive really fast. Group coverage allows you the opportunity to have those tests and appointments for a fraction of the cost, and feel a little peace of mind through a tumultuous time. These plans usually take several months for an insurer to approve, not because of assessing your health status, but to make sure you are a trusted employee. In the meantime while waiting for approval, a short-term health plan is also a judgment-free way to get coverage for a few months at a time.

Medicaid

The public health insurance program, Medicaid has set up several programs to help women with breast cancer. Beginning with the National Breast and Cervical Cancer Early Detection Program, low-income, uninsured women of a high-risk age in every state should have access to preventive services. Though the program varies slightly by state, it was set up by the federal government in order to help women get the testing they need to keep breast cancer at bay. If someone has been diagnosed with breast cancer, they will then receive services through Medicaid’s breast and cervical cancer program. This also varies by state, though all necessary treatments and services are covered for eligible women.

Medicaid also offers comprehensive coverage to individuals who qualify, for the not-so-serious medical care. A down side to the program is that in most states, there is only room for adults with children, disabilities, or who are over age 65 and receive SSI. The health care law is working to add the non-disabled childless adult group, giving the opportunity for health care to millions more Americans.

Health Reform & Breast Cancer

As you may have heard, the Affordable Care Act was definitely a favorite for women’s health care rights. For breast cancer victims and survivors, this landmark law relieves a huge amount of stress and pressure. Individuals with pre-existing conditions, such as breast cancer, will be able to apply with any insurer they like and not get declined, issued an exclusion period, or have an elimination rider. In addition to those who can afford coverage on the private market, there are health insurance subsidies that will be issued to the individuals who cannot afford to buy a plan, yet earn too much for Medicaid.

Medicaid expansion will also help a vast number of Americans, in those gracious states that decide to not completely disregard their poor population. As it is now optional, it leaves the question as to where more coverage will be offered to more low-income residents, but we will see in 2014. Medicaid will include not only a higher income percentage, but also low-income adults between 18 – 64 without children. While certain elements of the ACA, such as free mammograms, have already been put in place, the most drastic and helpful of changes will occur on the 1st of January, 2014.