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, the risk for breast cancer usually increases with age, as the majority of cases occur among 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 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.

As a woman, it is necessary to have health insurance, regardless of whether you have had breast cancer or are adamant about making sure you never do. While obtaining health insurance has been a struggle for women with a history of breast cancer or abnormalities, there are currently more options than have been accessible in the past. Individual health insurance plans must approve your application under the Patient Protection and Affordable Care Act, whether you’ve just been diagnosed or are a long-time survivor. All women have received a bit of a bias in underwriting, which is now changed 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: Past and Present


Health Reform & Breast Cancer

The Affordable Care Act was definitely a favorite among advocates for women’s health care equality. For breast cancer victims and survivors, this landmark law has brought significant relief: all individuals with pre-existing conditions, such as breast cancer, will be able to apply with any insurer they like and not get declined, rated up or issued an exclusion period or an elimination rider. In addition to the availability of coverage on the private market, there are health insurance exchanges that will include financial assistance via tax credits. If you earn between 130 percent — 138 percent in some states, depending on Medicaid income guidelines — and 400 percent of federal poverty, you qualify for a price break on premiums, and possibly medical costs. This allows low- to middle-income Americans the opportunity to purchase coverage at a manageable cost.

Medicaid expansion will also help a vast number of Americans, in the states that decide to not completely disregard their poor population. About half of the states offer medical assistance to an additional needy population under the health care law. Medicaid programs that have expanded accept low-income adults between 18-64 without children, a large and underserved group, which includes women susceptible to breast cancer.



Individual health insurance carriers had the option of declining women who had cancer at the time of their application or who had it in the past. Whether or not you would be declined varied based on your diagnosis and health status at the time, and also the degree to which the cancer had developed. Metastatic cancer of any sort would result in an automatic decline with nearly every insurance company across the country. Also, if you were undergoing treatment or recently received diagnosis, it was more than likely you would face rejection from any of these companies.

However, if you happened to have a guaranteed renewable or non-cancelable health plan before you were diagnosed with breast cancer, an insurer would be unable to cancel your benefits. These plans have been offered by most insurers in both individual and group markets since before the major changes of the ACA took root. If you had such a plan, the insurer may have been required to cover medically necessary treatments, though with guaranteed renewable plans, your premiums could increase when you acquire breast cancer or signs thereof. Prior to health reform, people living in guaranteed issue states would have been able to obtain coverage, even when diagnosed with breast cancer. All states have since become guaranteed issue, making the process of obtaining coverage much smoother for people with health problems.


Health Plan Alternatives for Breast Cancer

Most Americans have the option of buying their own health plan without being turned away or having their rates increased based on gender or health status. You can shop the private individual health plans in your area, or buy a plan on the exchange with the potential for reduced premiums and medical costs. However, if you have a strong set of health care benefits at your job, you may not qualify for the exchange. No health plan can discriminate against you for having or having had breast cancer, but your options may be limited by your employment, age or income. You may also be eligible for a public program such as Medicaid, or medical assistance, or Medicare, the insurance program for the elderly. Regardless of your situation, you can find a health insurance policy to help keep you healthy and cancer-free.

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 at work, you should! Once diagnosed with breast cancer, the amount of treatments, procedures and doctor’s office visits you will require are sure to get very expensive very quickly. Group coverage allows you to receive those tests and appointments with some amount of cost sharing and feel a little peace of mind through a tumultuous time. Find out how much your plan covers and what benefits they include before enrolling, as an individual health plan may cover more than your employer. These plans usually take several months for an insurer to approve, not because of assessing your health status, but to make sure you aren’t going to use the job for the health care and quit. In the meantime while waiting for approval, an individual health plan can cover you for a few months and include the benefits you need.



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 some states, enrollment is limited to adults with children, pregnant women, people with disabilities or Medicare beneficiaries with low income. The health care law has also added the non-disabled childless adult group in other states, improving access to health care for millions more Americans.



Many older women have a higher risk of breast cancer, and the Medicare program help keep you covered no matter what your health problems may be. As the aged population is more susceptible to illness, Medicare makes it possible to receive care while staying continually insured. You can choose a health plan from a private insurer, also known as Medicare Advantage plans, or use the government-run Medicare Plans A, B and D if you need prescription coverage.



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1. American Cancer Society, “Breast Cancer Facts & Figures 2011-2012″. PDF.

2. Kaiser Family Foundation, “Individual Market Guaranteed Issue”