Skin Cancer and Health Insurance


As the most common manifestation of cancer in our country, over 3.5 million skin cancers in more than 2 million people are diagnosed each year. There are several different types of skin cancer, the most common of which are basal cell carinoma (BCC), melanoma, and squamous cell carcinoma (SCC). The most common precancer is actinic keratosis, which affects more than 58 million Americans, is caused by sun damage, and can lead to SCC if untreated. Skin cancer usually develops in the epidermis, which causes tumors to be easily detectable at an early stage.

Melanoma skin cancers are the most dangerous, and although a small percentage of those diagnosed with skin cancer die from the disease, it is the most likely to cause death. The majority of cases are caused by overexposure to the sun’s harmful ultraviolet rays or indoor tanning. Non-melanoma skin cancers are the most common, the majority of which are basal cell carcinomas. An estimated 2.8 million cases of BCC are diagnosed annually in the U.S., while 700,000 new diagnoses of squamous cell are reported each year.

Symptoms of skin cancer include changes in the skin that do not heal, ulcering, discolored skin, and changes in existing moles, such as jagged edges and enlargement of the mole. Basal cell carcinoma usually appears as a raised, smooth, pearly bump on the head, neck and shoulder regions exposed to the sun. Squamous cell carcinoma is typically a red, scaling thickened patch on skin exposed to the sun. Melanomas appear as brown to black-looking lesions, though some can be pink, red or fleshy in color. Melanomas indicate themselves as malignant when changes occur in the size, shape, color, or elevation of a mole. Other symptoms may include are the appearance of a new mole as an adult, or unfamiliar pain, itching, ulceration or bleeding.

Basal cell carcinoma can be treated and eliminated, usually without scarring, as can squamous cell, even though it is more serious than basal cell. Malignant melanomas must be removed immediately. Preventing melanoma and squamous cell skin cancer is as obvious as wearing sunscreen, while it is unknown whether it has an effect on basal cell carcinoma. Wearing protective clothing when exposed to the sun, avoiding sunburn, and trying to avoid peak periods of sun exposure are also recommended. Avoiding the use of tobacco products and tanning beds are also effective.


Skin Cancer & Individual Health Insurance: Past and Present



Health Reform and Skin Cancer

The Affordable Care Act has already impacted those with skin cancer by providing a greater number of options for coverage. Since the law has fully taken effect, more states have offered Medicaid to a larger group of people, and all insurers provide coverage for people with a low income who have has this condition. The law will also eliminates all of the underwriting complications that used to prevent sick people from getting covered, allowing anyone with any stage or type of skin cancer to purchase a health plan from the carrier of their choice.

All health plans are no longer permitted to contain elimination riders or exclusion periods for coverage. Every type of covered service is available immediately, and insurers cannot cancel your benefits if you get cancer while you’re already covered. The ACA also helps those who are in between Medicaid income level and being able to afford a private health plan by providing subsidies to cover the cost of premiums and health care on the health insurance exchanges. Overall, this law will break most barriers between individuals with skin cancer and getting the coverage they should have — especially since it requires them to buy insurance or pay a tax.



Depending on your level of risk for further health problems or recurring incidences of skin cancer, as well as how recently your case of skin cancer occurred, health insurance would get more expensive or in some cases unavailable. Rate adjustment or decline may have also varied based on their insurer with which you applied. Some were more lenient than others in their underwriting, and allowed people with health conditions to obtain coverage. Even those that were more loose in their underwriting could issue an instant decline upon seeing a history of melanoma.

Based on the pre-ACA guidelines of an insurer in Florida (where skin cancer is surely prevalent), we can see that the intensity and type of cancer you have had was assessed in the underwriting process. If your skin cancer had been present in the past year to two years, you might expect increased rates or even a full rejection. However, those who have had melanoma without surgery or recurrence between 3 and 5 years prior to applying may be in the clear. Age was also a factor, as no one under age 19 can be declined for coverage, though they could have their rates increased up to 150 percent.

Here is an example of this carrier’s 2012 underwriting guidelines for skin cancer, which includes general skin cancer, specific cases related to melanoma, as well as BCC and SCC. They firstly mention that a pathology of skin biopsy, history of treatment, and current status are required before proceeding with further assessment. Once they have received medical records from an oncologist, the insurer would evaluate your eligibility according to their guidelines. As indicated, certain cases may result in a mild premium increase, while others were fully declined.



Health Plan Options for Skin Cancer

Individuals who have a history of skin cancer will be accepted by all insurance companies, whether you purchase a plan on the exchange or the private market. Public health insurance for low-income Americans is available to specific groups of people through Medicaid, and for those who are above the threshold and can afford a moderate payment, there is the exchange (if you qualify for financial assistance). Also, if you have not yet considered getting health benefits through your employer, it is an opportune time to investigate that possibility. Here are the coverage options available to people of different ages and income levels with skin cancer.


Individual Health Insurance

Private health plans feature a provider network with access to certain doctors and hospitals in the area, and some out-of-network providers. Every applicant is accepted for individual coverage and will not have any type of necessary care made unavailable to them, or have to wait to receive certain benefits under health reform. Once enrolled, all covered care is offered upfront, and can be accessed through any participating provider. Preventive care is free, though payment is required for other medical care through copays, coinsurance and deductibles. You can choose from any company that serves your region, all of which offer comprehensive plans that include essential health benefits to keep you healthy without paying the whole medical bill out-of-pocket.

For more information on individual plans from private insurers, contact us at 888 803 5917, or compare rates and plans in your area through our secure quote engine.


Employer-Sponsored Coverage

Those who have access to insurance through their employer may or may not be able to qualify for a plan on the exchange based on the amount of coverage they are offered. If your job offers a robust health plan, it is worth considering. A group plan cannot discriminate against any applicant for their health, and therefore have to accept you and cover your care. There will be a screening process which can take up to several months initially, which may be a good time to buy an individual health insurance plan. This is to make sure you are not simply going to run off to the hospital with your coverage, run up the bill, and quit your job.

Once you are enrolled, many types of treatment you may require may be covered by your plan. Prior to receiving a medical service, make sure your doctors are in-network and the service will be covered. At times, going to specialists for conditions as specific as skin cancer is required. Check your plan’s list of providers and covered benefits. Being charged in full for any health care service is obviously not ideal when you pay for coverage, so staying in-network is usually a good choice.


Medicaid & CHIP

Those who have a very low income may be able to receive Medicaid coverage if they fall into an eligibility group. Medicaid’s covered groups usually include children, families, pregnant women, aged, blind, and disabled persons. The program is different in every state, some of which have a wider range of acceptance, while others restrict their benefits to a smaller population. In select states that have complied with health reform, adults without any children are able to apply, as well. You must earn up to 138 percent of poverty in most cases to qualify for Medicaid in states that have expanded the program. Medicaid will cover many medical needs a person has, including treatment and surgery for skin cancers.

Though the disease usually affects older individuals, the Children’s Health Insurance Program (CHIP) will also accommodate any child under age 19 who has skin cancer. This program is open to children whose families have a higher income than Medicaid allows, with the same Medicaid benefits. If skin cancer is a recurring problem and leading to unmanageable medical bills, the Medically Needy program may be able to offer assistance through Medicaid. This program does not offer a full health plan, but will help pay for your expenses if you meet the criteria.



If you are spending your later years soaking in the sun and growing leathery, skin cancer may have made its way into your life, and Medicare is the most viable option for health insurance. Private insurers will not sell plans to anyone over 64, as Medicare is the most widespread option for the elderly. Any surgeries, consultations, and other health care will be provided through your provider network, whether you have a fee-for-service plan or Medicare Advantage through AARP or another carrier.



Individual Health Insurance Quotes

Medicaid Information

Health Insurance Exchanges

Skin Cancer Foundation