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 isn’t difficult for individuals with lung cancer to get health insurance anymore, although it is a serious illness requiring much treatment and medical care. If you still smoke, however, you will see a rate increase. The Affordable Care Act made it so that everyone can receive health insurance and covered care, regardless of your health status or medical history. Before health reform, however, unless the cancer was long gone and you were cured, you could expect an obstacle course when getting coverage on the individual market. Now, your health plan of choice is likely available, there are other solutions for finding health insurance with lung cancer, as you won’t be declined.
How Lung Cancer Affects Insurability: Past and Present
Health Reform & Lung Cancer
The ACA enhanced access to insurance by first creating the Pre-existing Condition Insurance Plan (PCIP) and further changing the scope of health insurance with fewer freedoms for insurers and more for consumers. For people with declinable conditions it is a most helpful landmark law, as anyone with a pre-existing condition can obtain coverage from any insurer they choose without the worry of being declined. Additionally, the use of elimination riders and exclusion periods is not permitted, and rates cannot increase based on your health status, history of illnesses, or your gender. These provisions apply to all private health insurance plans, both group and individual.
The ACA also helps people hold onto their coverage by outlawing rescissions, or the cancellation of your policy. If you were to get lung cancer in the midst while insured, an insurer could stop covering you before this part of the law took effect. Medicaid has expanded to cover more individuals, which will connect uninsured, low-income people with coverage that can help them afford to get well. More options for lower income households are also available health insurance exchanges available to help people get insurance. As lung cancer can affect all types of people and all income levels, this is extremely important.
Lung cancer typically created a barrier when applying for an individual health plan, as with most cancers, before the ACA took effect. As everyone’s medical history and disease are different, and all underwriting guidelines were as well, the outlook was highly variable. A number of health plans would 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 wanted to apply for individual coverage.
The underwriting process was the similar in every state, though the specific look back periods varied depending where you live. In Florida, the maximum look back period was two years. Therefore, if you had two years of being cancer-free your chances of approval were higher, if not guaranteed. If you were accepted for coverage and you had cancer in the time frame the insurers were looking, you would likely be declined. Applicants were declined immediately if they had cancer recur or spread to other areas of the body. Even the most laid back underwriting guidelines were strict in that way.
Based on your risk level with lung cancer in your past, you might receive an elimination rider or an exclusion period on your plan, indicating the insurer did not plan on paying to treat your illness should it return. Preventive care would be available, and you would have no problem receiving coverage for screenings to ensure your cancer does not return. Those who were diagnosed at with any form of lung cancer at the time of application would be declined by any insurer, as they did not accept people with the greatest risk, highest expenses, and a need for frequent medical care.
Health Plan Options for Lung Cancer
Lung cancer will not leave you uninsured any longer, as health insurance companies are required to accept you as an applicant. The best way to find coverage the works for you is to consider your budget and health needs. 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 you don’t have these options, try the individual market. Keep in mind that no insurer can turn you down, so as long as a plan is affordable, you can get insured.
The individual market now consists of plans sold privately and those sold through private companies on an exchange. The advantages of either are that you can get a comprehensive plan with plenty of covered services and not have your rates increased for being sick. Private plans have more flexibility in their design, which means they might feature more or less benefits than an exchange plan. Policies on the exchange feature every category of essential health benefits, most of which can be found on the private market, as well.
A few differences would be cost and guaranteed coverage for services not always included in private plans such as disease management, mental health and maternity. For lower income individuals and families, the exchange offers financial assistance with premiums and covered medical expenses. If you are unable to afford coverage and care with a private insurer, plans sold on the exchange work on a sliding scale and premiums adjust according to your income. For individuals earning poverty-level income, this is a good option as you will be connected to various health care providers and can choose your carrier and plan.
Group Health Insurance
Like the plans we sell to individuals at East Coast Health Insurance, an employer plan is a source of coverage through a private insurance company like Aetna, United, or Coventry. Yet, they operate differently as they are designed to cover a large number of employees, and your employer pays a percentage of the premium. Group plans are also 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 can cover a wide variety of services, and they should not deny a claim if your care is deemed medically necessary, and for cancer it certainly will be. If your employer’s plan doesn’t offer a comprehensive set of benefits, check your options on the individual market.
Medicaid, or Medical Assistance, is health insurance for people who have very few 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.
Research your Individual Health Insurance options
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1. National Institutes of Health. “Lung Cancer”. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004529/.