Navigating the Cost of Cancer Care

The financial costs of cancer care are a burden to patients diagnosed with cancer, their families, and society as a whole. National expenditures associated with cancer (medical costs, insurance costs, lost wages/productivity, and living expenses) have been steadily increasing in the United States. The medical costs for cancer survivors were an estimated $137.4 billion in the United States in 2010. In the near future, cancer costs may increase at a faster rate than the overall medical costs for other conditions. As the US population ages, the number of patients diagnosed with and treated for cancer will increase. Cancer costs are also likely to increase, as new and more expensive treatments, such as targeted therapies that are specifically directed at the tumor, become the standards of care.

Patients’ Financial Burden

For a patient who receives a diagnosis of cancer, the financial impact can be significant. The magnitude of the financial burden is determined by household income, socioeconomic status, insurance status and the type of insurance, and the disease stage. Cancer-related costs can include the costs of chemotherapy, radiation, and surgery, as well as home healthcare and transportation. Patients who are employed may experience a loss of work-related benefits and loss of employment. Household finances may suffer if the patient’s caregiver or family members take time away from work to help with their care. Child care, domestic help, medical equipment, and nutritional supplements can also affect the cost burden. The financial impact of cancer care can be profound. A study by the Fred Hutchinson Cancer Research Center found that patients with cancer are 2.5 times more likely to declare bankruptcy than people without cancer. By knowing your health insurance plan, talking with your healthcare team about cancer-related costs, planning and managing a budget, determining what type of financial assistance you may need, and using the resources of nurse or patient navigators, you can take control of your financial situation. One study shows that 33% of families of seriously ill patients, such as patients with cancer, lose most or all of their family’s savings. Patients who are economically affected by cancer are more likely to delay further medical treatment and avoid filling their prescriptions, thus putting their health in jeopardy.

Underinsured and Uninsured Patients

Underinsured patients or patients with no insurance may be eligible for copay assistance programs sponsored by advocacy organizations. Organizations such as CancerCare (www.cancercare.org), the Patient Advocate Foundation (www.patientadvocate.org), and the Leukemia & Lymphoma Society (www.lls.org) can assist you with copays for chemotherapyrelated medication. Many pharmaceutical companies also have patient assistance programs for their cancer drugs, as well as groups offering financial support, such as Needy Meds (www.needymeds.org) and RxAssist (www.rxassist.org), that can assist patients without prescription coverage. Navigators can assist patients and their families with resources for copay and prescription assistance, as well as resources for nutritional supplements (see Patient Resources box). Patients who are not able to work during their cancer treatment or as a result of their cancer may be eligible for Family and Medical Leave, Social Security Disability Insurance, or Supplemental Security Income. Patients who are employed should check with their employer and human resources manager regarding their Family and Medical Leave benefits.

Ask Your Navigator

Your nurse or patient navigator can be helpful in directing you to financial services. Several federal laws, such as the Americans with Disabilities Act and the Genetic Information Nondiscrimination Act, offer financial benefits, protect patients from losing their health insurance, and guard against discrimination on the basis of health. Navigators can also assist you by providing referrals and resources for estate planning, advance directives, power of attorney, and other legal services.

5 Important Things You Should Know About Your Costs

To deal with common financial concerns related to cancer care, patients and caregivers should be armed with information about their health insurance plan. Important things you should know about your health insurance plan include:

1. What is the deductible rate in your specific plan
2. What are the copays for medical appointments and special procedures
3. What is your plan’s out-of-pocket maximum
4. The calendar year of your health insurance plan
5. What are the terms of your prescription drug plan

With the introduction of the Affordable Care Act, many patients with low income are now eligible for health insurance coverage through Medicaid. To qualify, you (and your family) must have an income level of 138% below the federal poverty level ($15,856 for an individual, $32,499 for a family of 4). If your income is low, you can apply for Medicaid at your local county assistance office, or at your state’s website. For more information, visit www.medicaid.gov. Nurse or patient navigators and patient advocates are trained experts who can help lead you through many challenges in the healthcare system, including insurance and financial issues. Navigators offer assistance with many services, including assistance with insurance forms, referrals to financial support services, and financial resources. These experts are knowledgeable about national and local service organizations that help patients with cancer who are facing financial challenges.