Cancer Patients: Uninsured And Unprotected

Cancer is a leading cause of death and disease in the United States, and the costs of treatment can be devastating for those without insurance. In 2020, 8.6% of Americans had no health insurance, and those diagnosed with cancer but lacking insurance face significant financial stress. The costs of cancer treatment can quickly reach six figures, and even basic care and medication can be unaffordable for those without insurance. Uninsured cancer patients often have poor access to care and poorer outcomes, and are more likely to be diagnosed at a later stage when the disease is harder to treat. However, there are options available to help uninsured cancer patients lessen their financial burden, including government agencies, charitable organisations, and patient assistance programs.

Uninsured cancer patients face financial toxicity, with treatment costs reaching six figures

Cancer Treatment Costs

Cancer treatment is one of the most expensive medical procedures in the United States. Treatment costs for cancer patients without health insurance can reach six figures. The average cost of medical care and drugs is estimated to be over $42,000 in the year following a cancer diagnosis. Cancer patients may receive multiple treatments, including surgery, radiation therapy, and systemic treatment, and may require hospitalisation.

Financial Toxicity

The term "financial toxicity" refers to the financial burden and distress that patients experience due to the high costs of cancer treatment. Cancer survivors often report higher out-of-pocket spending than individuals without a history of cancer, with some spending more than 20% of their annual income on medical care. This financial burden can lead to debt, bankruptcy, and other adverse financial events.

Impact on Patients

Financial toxicity can significantly affect patient behaviour and outcomes. Many cancer patients delay or forgo medical care due to cost concerns. It can also lead to patients cutting back on essential needs such as food and utilities. Patients experiencing financial toxicity often report higher levels of anxiety and depression.

Impact on Caregivers

Informal caregivers, often family members, also experience financial toxicity by sharing the costs of the patient's medical care and other necessities. They may also need to take time off work, resulting in lost income and increased financial burden.

Addressing Financial Toxicity

There are several ways to reduce financial toxicity for cancer patients:

• Meeting with a financial navigator who can provide education on health insurance plans and cost-saving methods for treatments.
• Hospitals posting their prices to ensure transparency and allow patients to make informed decisions.
• Implementing value-based pricing to encourage patients to choose higher-value treatments with lower out-of-pocket costs.
• Reforming health insurance policies to better support cancer patients.

Uninsured cancer patients can get help from government agencies, charities, and patient assistance programs

Government Agencies

Uninsured cancer patients may be eligible for government-funded health insurance or health coverage. In the US, these include:

• Medicaid: a state-administered health insurance program that provides free or low-cost plans to millions of Americans. In "expanded" Medicaid states, it covers all children and adults below 138% of the Federal Poverty Level. In other states, it covers low-income families with children, pregnant women, the visually impaired, and those deemed disabled.
• Medicare: if you are 65 or over, or have been deemed disabled by the Social Security Administration for two years, you may be eligible for Medicare.
• The Affordable Care Act (ACA): ACA insurance plans cannot reject people with pre-existing conditions such as cancer. During the annual open enrollment period, you can find a health insurance plan, many of which offer premium subsidies.

Charities

There are several national and local charities that help people with cancer who are facing financial challenges:

• CancerCare: provides limited financial assistance for co-pays, transportation, home care, and child care. It also provides a list of sources for financial assistance and a database of organizations providing financial or practical help.
• Family Reach: a national organization dedicated to eradicating the financial barriers that accompany a cancer diagnosis.
• The Healthwell Foundation: an independent, non-profit organization that helps patients with a chronic, life-altering disease afford their medications when health insurance is not enough.
• The Leukemia & Lymphoma Society: the society's Co-Pay Assistance Program helps people covered by private and government insurance. It awards grants for premiums, copayments, coinsurance, and medication.
• The Assistance Fund: helps patients access FDA-approved treatments for covered diseases, including many cancers.
• United Children's Healthcare Foundation: parents can get grants for their child's cancer treatment. The child must be 16 or younger and have a Social Security number. Income limits apply.
• The SamFund: a non-profit organization that provides grants, financial education, and resources to young adult cancer survivors.
• Local service organizations: local service, volunteer, and/or faith-based organizations such as Catholic Charities, Jewish Social Services, the Lions Club, Lutheran Social Services, and the Salvation Army may offer financial assistance. Some offer grants to help cover the cost of treatment, while others help with specific services or products, such as travel or medications.

Patient Assistance Programs

Many drug manufacturers have patient assistance programs that provide medicine at low or no cost. These include:

• GSK: Blenrep, Jemperli, and Zejula
• Lilly Cares Foundation: Alimta, Cyramza, Erbitux, Portrazza, Retevmo, and Verzenio
• Pfizer Rx Pathways: Aromasin, Besponsa, Bosulif, Camptosar, Daurismo, Ellence, Emcyt, Ibrance, Inlyta, Lorbrena, Menest, Sutent, Talzenna, Torisel, Vizimpro, and Xalkori

Other Options

• Essential hospitals: sometimes called safety-net hospitals, these provide healthcare for the uninsured.
• Hill-Burton facilities: provide free or low-cost health services for people in poverty.
• St. Jude Children's Research Hospital: provides innovative care for childhood cancer cases. Eligible children receive free treatments as well as follow-up care during remission.
• Air Charity Network: provides free air transportation for cancer patients.

Uninsured cancer patients can negotiate bills and apply for charity care

Cancer treatment can be extremely expensive, with medical bills quickly reaching six figures. This can be especially difficult for the uninsured, who have to pay the full cost of treatment. In 2018, the average cost of cancer treatment was around $150,000, with some drugs costing upwards of $100,000 per patient per year.

If you are an uninsured cancer patient, there are options available to help reduce your financial burden. Firstly, you can negotiate your bill with the hospital. Hospitals are often open to negotiating payment plans or discounts, especially for uninsured patients. Another option is to apply for charity care. Nonprofit hospitals are legally required to provide charity care, also known as indigent care, to needy patients. Each hospital has its own eligibility rules, so be sure to inquire about their specific requirements.

In addition to negotiating bills and applying for charity care, there are other resources available to help with the financial burden of cancer treatment. Government agencies, charitable organizations, and patient assistance programs can provide support. For example, the American Cancer Society offers a 24/7 cancer helpline and resources such as the Hope Lodge program, which provides free lodging for cancer patients receiving treatment away from home. There are also national organizations like the Cancer Financial Assistance Coalition (CFAC) and local organizations like Catholic Charities and the Salvation Army that offer financial assistance or grants to help cover treatment and other expenses.

It is important to seek financial help as soon as possible after a cancer diagnosis to avoid letting bills pile up. Oncology social workers, case managers, doctors, and nurses can provide referrals to support services and financial resources. Additionally, patient advocacy organizations like the Patient Advocate Foundation can offer education, legal counselling, and referrals related to insurance, financial issues, and job discrimination. They can be reached at 800-532-5274.

Remember, you don't have to navigate these challenges alone. Reach out to the resources and organizations mentioned above for assistance in managing the financial aspects of your cancer treatment.

Uninsured cancer patients can access free or low-cost care at government-funded health centres and essential hospitals

A cancer diagnosis can be stressful, and facing it without health insurance can be even more challenging. However, uninsured cancer patients in the United States can access free or low-cost care at government-funded health centres and essential hospitals. These options help reduce financial stress and ensure that patients receive the necessary treatment. Here is some information on how uninsured cancer patients can access affordable care:

Government-Funded Health Centres:

Government-funded health centres across the country provide free or low-cost basic care to people in need, regardless of their insurance status or ability to pay. Fees are charged on a sliding scale, making healthcare more accessible to those who need it. These centres can be located by searching for government-funded healthcare facilities in your state or area.

Essential Hospitals:

Also known as safety-net hospitals, essential hospitals provide healthcare services specifically for the uninsured. They can be located through resources such as America's Essential Hospitals website, which offers information on hospitals in your state that cater to uninsured patients.

Hill-Burton Facilities:

Hill-Burton facilities are another option for uninsured cancer patients, as they provide free or low-cost health services for individuals living in poverty.

Medicaid:

Medicaid is a state-administered health insurance programme that offers free or low-cost plans. In "expanded" Medicaid states, it covers all children and adults below 138% of the Federal Poverty Level. In other states, coverage is provided for low-income families with children, pregnant women, the visually impaired, and those deemed disabled.

Charity Care:

Non-profit hospitals are required by law to provide charity care, also known as indigent care, for patients in need. Each hospital has its eligibility criteria, and patients can apply and negotiate their bills to reduce costs.

Patient Advocate Foundation (PAF):

The PAF is a valuable resource that provides education, legal counselling, and referrals to cancer patients and survivors regarding insurance, financial issues, and job discrimination. They can be contacted through their website or a dedicated helpline.

Local Community and Religious Organisations:

Local community or religious groups may also offer guidance and resources to help uninsured cancer patients access affordable care.

Oncology Social Workers:

Oncology social workers are professionals who understand the challenges of obtaining treatment without insurance. They can be contacted through organisations like CancerCare, which provides a dedicated helpline to help explore insurance options and navigate available resources.

While facing cancer without insurance can be daunting, these options for free or low-cost care at government-funded health centres, essential hospitals, and other resources can provide much-needed support and ensure that patients receive the care they need during a difficult time.

Uninsured cancer patients can receive support from organisations like St. Jude Children's Research Hospital and the Leukemia and Lymphoma Society

Cancer treatment can be extremely expensive, with costs reaching six figures for people without health insurance. The Leukemia and Lymphoma Society (LLS) offers several types of financial assistance to help individuals with blood cancer. LLS provides support for non-medical expenses, including transportation, housing, utilities, food, and clothing. They also offer specific programs such as the Co-Pay Assistance Program, which helps with the cost of insurance premiums, and the Susan Lang Pay-It-Forward Patient Travel Assistance Program, which assists with transportation and lodging expenses for treatment.

St. Jude Children's Research Hospital is another organisation that provides support for uninsured cancer patients. St. Jude is a specialty research hospital for children, focusing on providing care for patients with pediatric cancer and other catastrophic diseases. They do not send bills to patients or their families and cover all treatments, copays, deductibles, and coinsurance. St. Jude also provides additional support such as travel and housing accommodations, daily food credits, psychosocial help, and translation services.

Uninsured cancer patients can also explore other options for support, such as government agencies, charitable organisations, patient assistance programs, and negotiating bills with hospitals. It is important to note that nonprofit hospitals are legally required to provide charity care to needy patients. Additionally, the Affordable Care Act (ACA) insurance plans do not reject people with pre-existing conditions like cancer, and many offer premium subsidies.

Frequently asked questions