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Healthcare and Insurance Resources

There are many different healthcare and insurance programs available to patients diagnosed with breast cancer.1 Hospitals may have social workers and patient advocates, who are often the best resources for information about government and non-profit programs that will assist with paying for breast cancer treatment.

In the United States, Medicare, Medicaid and Medigap are healthcare resources that may be available to qualified patients. In addition, patients that have served in the military may be eligible for Veteran’s Assistance.

Federal Programs

Citizens of the United States have the option to use federal health insurance programs to help pay for the cost of breast cancer treatment. Medicare is available to individuals who are disabled, have been on Social Security for at least 24 months, are over 65 years old or are considered to be permanently disabled at any age

Medicare often covers most hospital stays, home health care, hospice, nursing home treatment and basic health care for eligible individuals. Patients may also choose to participate in Part B coverage, which offers additional healthcare benefits for a premium. Medicare is a complex system that you must apply for and be accepted into, and does not supply comprehensive coverage for all types of treatments.2

Qualifying for Medicaid typically requires a low income and overall net worth. The state determines the maximum net worth someone is allowed in order to receive financial support for treatment coverage. Medicaid is not accepted by all hospitals and health care providers, which is important information to have when deciding on a treatment facility.

Medigap is a private insurance policy that is a supplement to Medicare. Individuals can purchase this additional coverage to help with any deficits in coverage offered on the standard Medicare program. States can opt in or out of the various Medigap policies.

Patients that are not eligible for Medicare or Medicaid coverage may still be eligible for a federal program known as the Hill-Burton program. This program is federally managed and covers fees for specific services that a hospital or treatment facility has agreed to cover for low income or unemployed patients. Call your local hospital or treatment facility of choice to see if they participate in the Hill-Burton program, should you need these services. 3

Veterans should consider treatment options through a VA Hospital, either in part or full depending on what they qualify for. This information can be obtained through the Department Of Veteran’s Affairs. If a VA Hospital does not treat cancer, especially breast cancer, they must refer you to a facility that will. However, treatment outside of the VA may require approval prior to starting treatment, in order for them to cover the maximum amount possible.

Senior citizens requiring treatment for breast cancer may be able to apply for funding and medical coverage through organizations supported by with the National Association of Area Agencies on Aging. This organization maintains a list of healthcare service providers and offers support services for the senior citizens that use the program.

Local Programs

State governments may also provide coverage for specific costs associated with breast cancer treatment. In most states, these programs have income eligibility requirements that change with different factors. Hospital social workers or patient advocates typically provide this information to patients during their initial pre-treatment meeting.

In addition, for those patients that are difficult to insure, are underinsured or uninsured, there are insurance brokers that may provide affordable insurance to cover some costs of treatment. This type of insurance may have clauses for pre-existing conditions, such as already having a diagnosis of breast cancer. They may only provide benefits for a limited amount of time and only for treatments relating to that pre-existing medical condition. The amount of lifetime benefits to cover all medical costs is typically capped and in most cases, high-risk individuals will pay a higher premium. However, this premium is typically capped by law.4

Applying for all types of local, state and federal healthcare insurance programs may seem to be a time-consuming activity, but the time it takes to complete these applications may be well worth it. Most applications will require proof of income, a current income tax return (if applicable) and declaration of assets as a way to assess need for financial assistance.

References

1 Anderson, B. O., Shyyan, R., Eniu, A., et al. (2006). Breaest Cancer in Limted-Resource Countries: An Overview of the Breast Health Global Initiative 2005 Guidelines. The Breast Journal , S3-S15.

2 Getting Started. (n.d.). Retrieved from Medicare.gov: www.medicare.gov/default.aspx

3 Hill-Burton Free and Reduced-Cost Health Care. (n.d.). Retrieved from U.S. Department of Health and Human Services: www.hrsa.gov/gethealthcare/affordable/hillburton/

4 American Cancer Society. (2004). 4 A Breast Cancer Journey: Your Personal Guidebook. Atlanta: American Cancer Society.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.