Colon cancer is the third most common cancer in the United States, and the third most lethal in our country, as well. In 2011, it is estimated that 141,210 new cases were diagnosed and 49,380 deaths occurred as a result of colorectal cancer. The majority of cases (72 percent last year) occur in the colon, and the remaining had formed in the rectum. This condition is important for men and women over the age of 50 to get screened for regularly. One of the better aspects, if there were to be one, of this disease, is that the cancer takes 10 to 15 years to develop once a polyp has been discovered. As long as routine exams and necessary polyp removals take place, it is possible to fight off and never develop full-on colorectal cancer.
Though the potential for acquiring a colorectal cancer occurs in both genders, it is more common among men. If you have a family history of polyps or colorectal cancer, it is more likely that you could acquire the illness. Screenings, blood work, and tests are very costly if not covered by health insurance. It is very important for those with a genetic predisposition or other health risks that may lead to colorectal cancer to obtain coverage before the condition presents itself. Many times, this means getting insured earlier in life, or making sure your coverage is continuous.
Colorectal cancer can be treated and prevented by lifestyle choices and medical care. This is one of the greatest attributes of our medical system, as cancer is a thoroughly researched disease. If you have been previously diagnosed with colon cancer or had polyps, it may make your eligibility for health insurance suffer a bit. However, there is no question you need coverage to treat it, unless you happen to be in the upper-upper echelon of earners and feel like being reckless with your health care dollars instead of buying an imported supercar.
How Colorectal Cancer Impacts Insurance
The individual market for health insurance is filled with people who seemingly cannot wait to say “no,” depriving sick persons of their right to be well. The pitiful reality is that cancer is one of the most evident signs leading to an insurer’s decline. Your eligibility will vary based on your medical records from an oncologist, the time frame and intensity of treatment, and your current diagnosis. Based on these factors, any insurer will decide according to their underwriting guidelines whether or not to approve an applicant.
This leaves a wide open area of question for individuals with colorectal cancer in their past or present. The best way to avoid rejection is to get coverage before you are diagnosed. Easier said than done, as with most health conditions. Fortunately there are states where insurers do not have the right to turn anyone away for coverage. In Massachusetts, New York, New Jersey, Vermont, and Maine, all insurance companies are required to accept any applicant. Though this has been getting more people insured, the individual market in these states is priced incredibly high.
Other states that comply with some variation of guaranteed issue policy include Rhode Island, Oregon, Utah, where certain plans are available to every resident. In Idaho, all plans are available to some residents. Michigan, Ohio and West Virginia offer specified plans to individuals who apply during an open enrollment period. Despite the somewhat confounding regulations, it is worth taking the time to find out if you are eligible for coverage if you live in one of those states. Find out more particulars from the Kaiser Family Foundation.
Health Plan Alternatives for Colorectal Cancer
Most, if not all, Americans who have reached a certain ripened age realize they can give themselves a 65th birthday present of Medicare. Whether using an Advantage plan or receiving public assistance, this is the main source of coverage for the aged. Colorectal cancer can start as early as a person’s late 40s, which means other types of coverage are still needed. Those who do not earn enough to support a monthly premium may apply for Medicaid, and hopefully their state is accepting enough to provide a plan. Group coverage and PCIP are also options for people with colorectal cancer.
Getting coverage through the workplace is a great way to battle colorectal cancer, whether you are an employee or married to one. Typically offered to full-time workers, it is a necessary benefit to look into, as insurers can never decline an employee for group coverage based on health. You may want to purchase a short-term plan while they process your application, which generally takes one to three months. These plans are covered by a major health plan like Aetna or Cigna, and your employer and you share the premium costs.
Colonoscopies and other necessary tests will be covered by your group plan, and the only issue is your employer’s overall bill increasing if you are diagnosed with colorectal cancer. Rates are not likely to increase if you only receive the screenings and are making sure to take necessary health measures. These plans will not refuse to cover most types of care, though it is important to check the schedule of benefits before receiving a specific type of care or visiting a certain provider. As with all types of preventive care, colonoscopies are covered for free.
The lovely health reform solution for all adults with conditions, the Pre-Existing Condition Plan is the current depository for uninsured, individual health plan rejects. If you have been denied coverage, or have been uninsured for 6 months with proof of your condition from a doctor, PCIP may be your plan. Set up to make sure sick people get the treatment they need, PCIP will not deprive you of any necessary treatments. Though it is a temporary source of coverage, there is still a year until the health care law becomes effective, and provides you the full gamut of provider network and benefit options.
PCIP also may take a few months to approve your application, in which case a short-term policy will also be a good solution. Such plans cover a minimal amount of services, but they are inexpensive and do not discriminate against health conditions. Once enrolled in PCIP, you will have access to coverage for a similar pricing method to individual coverage, and the network is somewhat limited. However, if you are in a dire health situation, something is much better than nothing.
Though according to a recent study of Medicaid members who have survived colorectal cancer indicated many individuals are not receiving proper follow-up treatment, it is certainly covered by the program. While colonoscopies may be the more dreaded of procedures, it is essential to receive them as needed, especially after one has experienced polyps or cancerous growth in the past. Medicaid covers these services for individuals with the disease and who wish to prevent it. In order to qualify, you must have a low income, according to your state’s standards.
Some Medicare beneficiaries may qualify for Medicaid assistance if their income is less than or equal to the current Federal Poverty Level ($11,170 per year for one person). Also, having children who live with you is a plus if you want to qualify for Medicaid. Adults in most states who do not have children or a disability and are younger than 65 may not be able to receive Medicaid. Hopefully, that will be changing soon via health care reform and the states who elect to expand their Medicaid programs.
Health Reform & Colorectal Cancer
Anyone who has had a colorectal cancer diagnosis will no longer be able to be denied coverage for their condition as of January 1, 2014. Thanks to the Affordable Care Act, all individuals with a pre-existing condition will have their pick of any insurance company after this magical date. It is also going to be required by law that everyone obtain a health plan, but for those who need an annual colonoscopy, it seems like a reasonable request. The ACA also approved screenings for colorectal cancer as a free and mandatory preventive benefit through all health plans.
The law will also give more low-income Americans coverage through Medicaid, in the states that decide to expand their programs. This will include the previously excluded group of non-disabled adults without children whose income is at or below 138 percent of FPL, which is an annual salary of $15,415 or $1284 per month. Just imagine, retail workers! Regardless of political views, it is hard to deny the ACA has already made positive changes for individuals who have cancer, and will do even more in due time.
Find out if you qualify for Individual Health Insurance
1. American Cancer Society. “Colorectal Cancer Facts & Figures 2011-2013″. http://www.cancer.org/Research/CancerFactsFigures/ColorectalCancerFactsFigures/index.
2. National Cancer Institute. “Colon Cancer Treatment”. http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient/page1.
3. Kaiser Family Foundation. “Individual Market Guaranteed Issue”. http://statehealthfacts.org/comparetable.jsp?ind=353&cat=7.
4. Foley KL, Song EY, Klepin H, Geiger A, Tooze J. “Screening colonoscopy among colorectal cancer survivors insured by Medicaid”. http://www.ncbi.nlm.nih.gov/pubmed/21358299.