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Cancer: Dealing With Insurance And Home Health Care Concerns

Cancer: Dealing With Insurance And Home Health Care Concerns

woman with cancer wearing head scarf while being hugged

The financial impact of cancer is one the most stressful aspects of this illness. Below are some issues that may arise, with ideas on how to deal with them.


“Will my insurance cover cancer treatment?”

People who had health and life insurance before treatment generally are able to keep it, although costs and benefits may change. Review your insurance policies to find out exactly what your coverage includes. Talk to your insurance provider to make sure you understand the extent of your coverage and its limitations. Also check your disability insurance or benefits to see if you are eligible to maintain your income during times when you may not be able to work.

It is very important that you keep careful records of all your covered expenses and claims. If a claim is turned down, you do not have to simply accept it. Ask your doctor to explain to the company why the services meet the requirements for coverage under your policy. If you are turned down again, find out if the company has an appeals process.

Cancer patients may find assistance with health care costs or applying for new policies in the following ways:

  • Cost and extended payment options may be negotiated with health care providers.
  • Medicare offers coverage to people 65 or older and to those who are permanently disabled, after two years of collecting disability payments.
  • Medicaid covers people who are in low-income brackets.
  • The U.S. Department of Veterans Affairs (VA) may be able to help with health care costs if a cancer patient or spouse is, or has been, a member of the Armed Forces. Any VA health care facility can provide information about these programs.
  • The Federal Government’s Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS) helps pay for civilian medical care for spouses and children of active duty Uniformed Services personnel, retired Uniformed Services personnel and their spouses and children, and spouses and children of active duty or retired active duty personnel who have died. For further information, contact the Information Office of CHAMPUS, Aurora, CO 80045.
  • If you want to apply for a new policy, health maintenance organizations often have open enrollment periods when you may be accepted regardless of your history.
  • You may be eligible for group insurance through a professional, fraternal or political organization to which you belong.

You also have the option of seeking medical advice or treatment from physicians or hospitals not affiliated with your health maintenance organization (HMO) or preferred provider organization (PPO). Out-of-pocket costs are higher if you decide on this option.

When Health Insurance Doesn’t Cover The Bills

Cancer and cancer treatment require careful financial planning, whether or not there is health insurance to cover some of the costs. The financial burdens of cancer are much more difficult for someone with no health insurance, but a lack of insurance should not mean a lack of competent medical care and treatment.

If you do not have health insurance, you will usually be expected to use as much of your own assets as possible to pay for your care and treatment. There may be other sources of financial assistance available, as your own assets become limited. Discuss this with your social worker.

The federally backed Medicaid program provides health coverage for the elderly and for people with no insurance and limited means. Your local or state office of social services (or welfare office) can supply information on eligibility and coverage. Requirements vary from state to state, so be sure to check the current regulations for your state of residence. In most cases, Medicaid covers direct medical costs, as well as home health care, when needed.

Some hospitals are required to provide treatment for needy patients under special federal aid construction programs. Speak with your physician, your local social services or welfare office, and your hospital’s social worker to see what help may be available.

Some pharmaceutical manufacturers have patient assistance programs. To learn if your specific drug might be available at reduced cost or free of charge, ask your doctor to contact the drug manufacturer through such a program.

Home Health Care

“The professionals that came to my home helped so much with my recovery. I don’t know what I would have done without them.”

At different stages of your cancer treatment, you may want to use the services of a home health care agency. Home health care agencies provide home visits by registered nurses to check on wound healing after surgery, to administer intravenous (IV) antibiotics or chemotherapy, or to monitor your condition between visits to your doctor. Some also can provide physical therapists to help with your recovery, or trained aides who can help with your personal care.

Health insurance coverage varies for these services, so it is important to find out exactly what your health insurance will pay for. Also, be sure to ask the agency a few key questions: the qualifications of its staff and whether they are bonded and insured; whether there is a minimum number of visits; whether they offer discounts for multiple visits; and the amount of notice required to have someone at the home.

If your health insurance is limited or does not cover this type of assistance, check with your local or state social services office to find out if you are eligible for state programs providing such assistance. In addition to medical assistance, there may be special programs in your area, such as Meals on Wheels, to help with the challenges of everyday living during the times when you may need it. Your local social services or welfare office, or your hospital social worker, should be able to provide information about these services and how to apply for them.

If you reside in an assisted living community, you may have access to home health care services. Call the management office to find out what services are available to residents of the community.

AICR – American Institute for Cancer Research

The American Institute for Cancer Research is the nation’s third largest cancer charity and focuses exclusively on the link between diet and cancer. The Institute provides a wide range of consumer education programs that have helped millions of Americans learn to make dietary changes for lower cancer risk. AICR also supports innovative research in cancer prevention and treatment at universities, hospitals and research centers across the U.S. The Institute has provided over $50 million in funding for research in diet, nutrition and cancer. Visit the Institute online at www.aicr.org

American Institute for Cancer Research
1759 R Street NW
Washington, DC 20009