The Best Defense is Good Insurance

by Andrew Elder

Let’s face it; Chicken vs Egg philosophers have it easy. When thinking about money issues that come along with a cancer diagnosis, it’s hard to pick which emergency topic should come first: Should it be health insurance to cover all those expensive treatments? Should it be life insurance to provide security to those who may be left behind? Should it be fundamental personal financial concepts to get control of income and start putting out those debt fires?

There’s no bad place to start, so I’m going to tackle them in terms of chronological order. Since health insurance is the first stop on the cancer money train, we’ll begin there. Plus it plays to my credentials; unlike some other topics I’ll cover down the road, I’m a certified New York state health insurance professional and work for a large health insurance company in upstate NY.

Insurance Plan is Best Line of Defense

From the moment you first check into your doctor’s office or the hospital where you get The Diagnosis, your health insurance plan is your first line of defense. Good insurance sets up a wall between your finances and the monstrous bills coming your way. By paying insurance premiums, you transfer the financial risk of adverse health conditions to an insurance company. If the bad stuff hits, they pick up (at least some of) the bills. Most Americans working full time have some level of health insurance, usually provided by their employer.

Since March 2010 when it went into effect – and more recently last October of 2013 when the health care Exchanges opened – health care reform (aka: PPACA, Obamacare, ACA) has had a major impact on how health insurance is structured and paid for, and what it covers. Whether you like or hate the politics, there are several changes under ACA that have significant impact on cancer patients and their treatments.

Right off the bat you should know that colonoscopies are considered Preventive Care and as such are covered for FREE on all individual and group commercial health insurance plans, in every state (some private health care cooperatives and employers who self-insure are the exceptions). There are a few wrinkles (like the scope being free, but if polyps are found, there may be a charge for removal), but by and large it’s a great thing.

Beyond that bit of good bum news, I’ll cover the three biggest changes in brief, but believe me there’s much more to know!

Guaranteed Issuance

This somewhat seedy-sounding term simply means that no one can be denied health insurance due to a pre-existing condition. This is HUGE for cancer patients. Think of it like being able to buy home-owner’s insurance after your house burns down. If you already have insurance, this won’t matter, but if you have to buy it post-diagnosis just know that you can. Yes, you’ll likely pay more for the insurance than you would have otherwise, but compared to the guaranteed tens of thousands of dollars in bills you’d get hit with if you were uninsured, this is a phenomenal deal.

Federal Subsidies

If you already have (or will be getting) insurance through your employer, this won’t apply to you. But if you’re buying on your own through the Individual Exchange in your state, you may be entitled to a few financial incentives that help you pay for your insurance and/or your subsequent care.

Advanced Premium Tax Credit (APTC) is the first. This is most commonly referred to as “premium subsidy”. This is financial assistance that helps pay your monthly insurance premiums. That is, the cost to have insurance, whether you use it or not. Premium subsidies can be used to buy any “level” of plan on the Exchange (there’s “Bronze”, “Silver”, “Gold”, and “Platinum”). It’s based on your gross, taxable household income compared to the Federal Poverty Level: If you make less than $46,680 as a single person or $95,400 as a family of four in 2015 (slightly less this year), you’ll qualify for some level of assistance (see chart for a more complete breakdown). It sounds complicated (and it is), but it all gets calculated automatically when you buy through the Exchange. You can also choose to have the subsidy reduce your monthly premium bill or take it as a tax credit at the end of the year when you file taxes, or a combination of the two.

Cost Sharing Reductions (CSR) is the second. This is financial assistance that helps you pay your out-of-pocket costs. That is, the cost to use the insurance you’ve already acquired (by paying premiums). It’s less flexible than APTC – you have to buy a “Silver” level plan on the Exchange – and the income limits are even more strict, but you could end up with a Silver plan that covers like a Gold or even Platinum plan, depending on your household income.

ACA Federal Assistance Chart - MVP Health Care

Image source:

No Annual or Lifetime Limits on Care!

Again, an absolutely HUGE benefit. In the old days, health insurance could fade out just when you needed it most. At $200,000 or $400,000 in medical bills in a year – sometimes higher – your health insurance would cut you loose. That’d be bad news if you were fighting cancer. Then, if you reached another even higher threshold (the lifetime limit) at any point – your plan would effectively cease to exist. This change means that you can fight on without fear that your insurance will crap out on you.

Bottom Line – There’s No Reason NOT To Get Health Insurance

The bottom line is there’s no reason not to get health insurance. If you get it after your diagnosis, it can be obscenely expensive, but it’s way less than paying for surgery and chemo out of pocket! If you end up out of work, get coverage through your state’s Exchange where your lower income might well qualify you for financial assistance.

For more info and to get an estimate on what you might pay, check out your state’s Exchange website or start at, the Federal government’s primary site – now 40% less crashy!!

Good health insurance coverage will go a long way toward keeping you out of bankruptcy during cancer treatment, and toward keeping financial collateral damage from spilling over to your extended family. You can focus on fighting for your life, not fighting your bills.