A cancer diagnosis comes with one certainty: medical bills. Even with health insurance, you may have out-of-pocket expenses. Putting together a payment plan up front can help you avoid stress and financial instability.
A job with good healthcare benefits isn’t always enough when it comes to covering the cost of cancer treatment. Health insurance will cover the bulk of the direct expenses, but you’ll still have to pay a certain percentage until the maximum out-of-pocket amount is paid. Depending on your plan, some direct expenses (like name brand prescriptions) may not be covered at all. There’s also the issue of paying for indirect costs that can eat away at your monthly budget.
Planning ahead and projecting the potential costs can help you create a more accurate budget, so you can stress less about finances and focus more on improving your health.
Finding Help to Cover Cancer Costs
It’s no surprise people worry about cancer treatment costs. In 2017, it was reported Medicare patients saw out-of-pocket expenses to average between $2,116 and $8,115 every year.
However, assistance is available, but you have to know who to ask. Luckily, there are plenty of places to get help with the financial aspects of cancer treatment.
Your Cancer Center
Many cancer centers have social workers available who can help find free or low-cost transportation, assist in filing for disability or Medicare benefits and direct you to support foundations.
Your center may also direct you to a financial advisor who will review your health insurance and answer financial questions. Those who have difficulty managing money or have cognitive side effects can also get assistance planning a monthly budget. “It’s easy to lose periods of time and lose track of things,” says Amy Horyna, a patient and family support manager at the Huntsman Cancer Institute in Salt Lake City. A financial advisor can provide peace of mind by teaching you how to track your budget, explaining how insurance coverage works and suggesting solutions for covering the costs.
Patient advocate groups have also become essential. Some advocacy groups specialize in helping people navigate the healthcare claims system, while others assist people in finding resources for covering the out-of-pocket expenses. There are also organizations providing direct financial assistance for people who don’t have the funds to pay for treatment and the related costs.
IRS Help With Tax Deductions
“The IRS website has some great free publications on deducting medical costs if you can’t afford a professional,” says Martin Shenkman, an attorney who specializes in planning for chronic care. Shenkman also notes you should carefully consider which funds you use to minimize tax costs. For example, there are strict requirements about using funds from an individual retirement account (IRA). “If you have to sell stocks, try to balance gains and losses to avoid an increase in taxes,” he adds.
Developing a Financial Plan for Treatment
How much treatment will cost is ultimately driven by several factors, including your:
- Health insurance coverage
- Treating physician
- Treatment facility
- Type of treatment provided
- Response to treatment
Most of these are beyond your control, but that doesn’t mean you have to watch bills mount.
Planning for Direct Costs
The first element to look at is projecting direct costs. These are the expenses directly related to your treatment. In addition to doctor visits, you should consider prescriptions, scans, lab tests and hospital stays. For many cancers, it’s common to be treated by a team of surgeons, radiologists and medical oncologists. Depending on your health insurance plan, each of these costs may be governed by a different co-pay and deductible scheme. Co-pays can add up quickly, so you need to understand your policy right from the start.
- Out-of-network versus in-network care. For many medical insurance plans, out-of-network care has to be paid out of pocket, which can come at a steep price, but may be a necessity, depending on your situation. Costs and coverage also vary in a hospital versus an outpatient facility.
- Supplemental Care. Cancer treatment can lead to expensive supplemental care, including physical or occupational therapy to recover from surgery or treatment side effects. You may need medical devices to assist in your day-to-day recovery or counseling to deal with the emotional impact of your disease. Coverage for these benefits varies widely.
- Estimated treatment costs. When developing a treatment plan, ask your medical team and your insurance company to estimate the total cost. Sometimes costly scans and other tests can be reduced with little or no impact. Always ask if there are less expensive options that are equally effective. Oncologists may favor a more expensive treatment simply because of their patients’ experiences, rather than efficacy. If they know cost is an issue, they may be able to offer less expensive options.
- Treatment coverage. Medications can quickly shatter even well-planned budgets. The key factor is whether the drug is on your insurance company’s preferred drug list. If it isn’t, talk to your doctor or the oncology pharmacist. They often manage millions of dollars in medication and may have a creative alternative. High prices aren’t just associated with chemotherapeutic agents. Supportive drugs to treat nausea and other side effects can quickly bust the budget, whereas less expensive generic or over-the-counter drugs may work as an alternative. Ordering some drugs through the mail may also cut down costs.
Thanks to data on inpatient and outpatient procedure costs from the Centers for Medicare & Medicaid Services, it’s now possible for patients to price check and shop around for services. Visit the cms.gov Research, Statistics, Data & Systems section to start price checking.
Estimating Indirect Costs
Indirect costs that are not a result of your cancer diagnosis and treatment can be harder to predict. Many of these expenses fall into the non-medical realm and won’t come with a bill. Common indirect costs include:
- Transportation to and from appointments
- Parking fees
- Lodging during long-distance trips
- Wigs or hairpieces
- New clothing (if weight changes significantly)
- Nutritional supplements and special dietary requirements
- Legal help preparing your estate or challenging a disability ruling
- Loss of income (if you can’t work or don’t have paid time off available)
- Increased cost for childcare
Horyna notes “Cancer has become more of a chronic condition. You don’t know when it’s going to end.” It’s important for patients to remember to keep living their pre-diagnosis lives. Money may be tight, but spending it on a family trip or a special meal could be a great investment in your happiness.