Lung cancer is by far the most common and most fatal type of cancer. Each year, more men and women die of lung cancer than cancers of the breast, colon, and prostate combined. As we all know, the easiest way to acquire lung cancer is through smoking, though it can stem from other factors, as well. Like all cancers, having a genetic predisposition to lung cancer poses a higher risk. Exposure to cancer-causing chemicals, high levels of air pollution, asbestos, and high levels of arsenic in tap water are also contributors to cancer of the lungs. The most typical form of the disease is non-small cell lung cancer (NSCLC), which usually begins with smoking, and leads to many tests, treatments, and surgeries.
This disease can be treated with chemotherapy, radiation, surgery, laser therapy, and other procedures. When lung cancer spreads, it usually heads for the bone, liver, small intestine, and the brain. The ability to heal from the disease varies greatly, depending on the individual and the type of cancer. Many survive and their tumors can be cured, while others experience recurring episodes or are never cured. Quitting smoking and avoiding other risk factors is the best way to prevent lung cancer. Once a person stops smoking, their risk level decreases by leaps and bounds within a year.
It may be difficult for individuals with lung cancer to get health insurance, as it is such a serious illness requiring much treatment and medical care. Cancer is generally not among the favorites of conditions for accept for any insurer, though some have a more generous outlook than others. For the most part, however, unless the cancer is long gone and you have been cured, you can expect an obstacle course when getting coverage on the individual market. Although your health plan of choice may not be available, there are other solutions for finding health insurance with lung cancer if you are declined.
How Lung Cancer Affects Insurability
Lung cancer will typically create a barrier when applying for an individual health plan, as with most cancers. As everyone’s history and disease are different, and all underwriting guidelines are as well, the outlook is highly variable. A number of health plans will request your information from an oncologist and review your records, prognosis, and address your current state before making a final decision. At the very least, this is a slight consideration for those who have overcome the disease and want to apply for individual coverage.
The underwriting process is the same in every state, though the specific look back periods vary depending where you live. In Florida, the maximum look back period is two years. Therefore, if you have had two years of being cancer-free your chances of approval are higher, if not guaranteed. If you are accepted for coverage and you have had cancer in the time frame the insurers are looking, you will likely be declined. Coverage is declined immediately for those who have had cancer recur or spread to other ares of the body. Even the most laid back underwriting guidelines are strict in that way.
Based on your risk level with lung cancer in your past, you may receive an elimination rider or an exclusion period on your plan, indicating the insurer does not plan on paying to treat your illness should it return. Preventive care will be available, and you should have no problem receiving coverage for screenings to ensure your cancer does not return. Those who currently are diagnosed with any form of lung cancer will be declined by any insurer, as they do not accept people with the greatest risk, highest expenses, and a dependency on frequent medical care.
Health Plan Alternatives for Lung Cancer
Lung cancer can lead to much disappointment with health insurance companies, but there are other options if you experience rejection due to your condition. The best way to find coverage the works for your is to consider your most tangible, probably options. Some individuals have access to insurance through their jobs, while others may not earn enough to support a monthly premium and require government assistance. Either of these should be sufficient if you have not already tried applying. If neither of these adhere to your life, give the PCIP a try.
Group Health Insurance
Like the plans East Coast Health Insurance sells, an employer plan is a private source of coverage through a company like Aetna, United, or Coventry. Yet, they operate differently as they are designed to cover a large number of employees, and are not permitted to decline anyone based on their health. Even if a worker has cancer, the insurance company cannot refuse to give you coverage, but they can and will increase the entire group rate. Group coverage is worthwhile to consider if you have it available, as you will not be declined.
As rates may increase, it is important to remember this plan may not be very cost effective, though it depends on the state of your condition. The majority of Americans have a group plan, which means they must be priced somewhat decently. Each insurer, employer, and employee changes the variables for cost, but at least you will have coverage. These plans cover a wide variety of services, and they will not deny a claim if your care is deemed medically necessary, and for cancer it certainly will be.
The gift to the sick from the Affordable Care Act, PCIP is a temporary high-risk pool ideal for anyone with lung cancer. In fact, they will have been expecting to see your application. The Pre-Existing Condition Plan is offered in each state, and will cover any kind of treatment you need. These health plans work like a PPO plan, as there is 80 percent coverage in-network, and 60 percent coverage for non-network care after deductible. Three different plan options of varying cost levels provide a few types of coverage, including an HSA.
To qualify for PCIP, you must have documentation of your condition and be uninsured for a six month minimum period of time. Once you have been accepted, your plan will expire in one year, as the health care law will take over and require all insurers to behave like a PCIP. For the moment, it is the top solution for individuals with cancer, or any other type of condition to stay insured during the most important times.
Medicaid, or Medical Assistance, is health insurance for people who have very little resources and income, and the program accepts anyone regardless of their health. If you fit into one of their eligibility groups, it does not matter if you have a life-threatening illness. Coverage will be offered to you as long as you are in your state’s income guideline. As a person with lung cancer, you will be able to get any kind of test, surgery, or procedure for free.
As this disease can technically target anyone of any age, it is great to know Medicaid is offered for children’s coverage, as well as assisting low-income Medicare members. Medications are also covered to a certain extent on Medicaid, and overall, it is the top form of coverage besides group health plans. In the future, the states who expand their programs will open eligibility to more adults and more individuals in general by adding a group, and raising income criteria.
Health Reform & Lung Cancer
People with lung cancer should be willing to credit health reform with enhancing access to insurance by creating the PCIP and changing the future of health insurance. Whether you agree with other aspects of the law is up to you, but for people with declinable conditions it is a most helpful landmark law. On January 1, 2014, anyone with a pre-existing condition will be able to obtain coverage from any insurer they choose without the worry of being declined. Additionally, the use of elimination riders and exclusion periods will be made illegal, and no rate increases over ten percent will be permitted.
If you were to get lung cancer in the midst of having an insurance policy, the ACA also helped people hold onto their coverage by outlawing rescissions. In hopes that there will be enough states to stand behind their poor and needy population, Medicaid will be expanded to include more individuals, which will connect uninsured people with the coverage that can help them get well. More options such as subsidies, will be available to help people get insurance. As lung cancer can affect all walks of life and all income levels, this is extremely important. Changes made thus far have only scratched the surface, but soon we will hopefully see a nation more confident in obtaining health insurance.
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1. U.S. National Library of Medicine. “Lung Cancer”. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004529/.