Health Insurance Coverage for Mesothelioma

Receiving a diagnosis of mesothelioma can be devastating. For most patients, it is a death sentence as there is little hope of a cure. Mesothelioma patients also have to worry about care and treatment expenses. Attempting to pay for it without health insurance is almost impossible for most people. However, mesothelioma patients may have several options, including group health insurance through work, private insurance through state marketplaces, public programs like Medicare, or veterans’ benefits.

What Health Insurance Covers for Mesothelioma Patients

Health insurance is important for everyone. However, it is especially important for those fighting aggressive cancers like mesothelioma. Care is expensive, and most individuals cannot afford it without help.  Uninsured patients may not receive the care and treatments they need.

Insurance coverage for a mesothelioma patient depends on the details of their specific plan. In general, insurance plans cover costs of diagnostic tests and of treatment for the cancer. However, most plans will not cover 100 percent of these costs. Most patients will have to cover copays and deductibles, which can be expensive. Even with these costs, insurance can make a significant difference. For example, the cost of a cycle of chemotherapy, without insurance, may cost as much as $30,000. Surgery can be even more expensive.

Private Health Insurance Types

Private health insurance is any kind of plan that is not a government program. People with private insurance may be part of a group plan through their workplace, or may have purchased an individual plan. Much of the population is covered through a group plan where their employer covers part of the cost of premiums. The benefit of a group plan is that costs are lowered because there are more people enrolled in the plan. Often, these plans also cover an employee’s dependents.

Private health insurance plans come in many different forms. Managed care plans, like HMOs, and preferred provider plans are all private plans. This may mean having a limited network of health care providers or requiring a primary care provider to coordinate other care.

In addition to these comprehensive types of insurance, there is specialized and supplemental insurance. For example, catastrophic coverage is a low-cost plan with high deductibles. Enrollees pay low premiums, but coverage only kicks in after high deductibles have been met. Supplemental plans can be bought to add extra coverage and often include supplemental insurance for cancer.

Government Programs

Many people rely on public insurance plans. Public insurance plans include those funded by the federal government, like Medicare and Medicaid. Medicare is a health insurance plan for people over age of 65. These older retirees paid into the system over the course of their working lives and then later benefit from the insurance program. Part A Medicare is available to all who qualify for Medicare. It covers basic care. Medicare Part B has an additional premium cost and covers more care. Part C is a combination of parts A and B. Part D covers prescription drug costs.

Medicaid is a health insurance plan for people who fall below a minimum income level and do not qualify for Medicare.

The Affordable Care Act

The president signed the Affordable Care Act (ACA) in 2010 and it went into effect in 2014. The law makes it easier for low-income individuals and families to purchase health insurance plans. It also outlawed pre-existing condition limits and denials of coverage, an important change for cancer patients in need of coverage. Individuals without private insurance, or who do not qualify for Medicare or Medicaid, can buy insurance through state- or federal-run marketplaces. Individuals whose workplace group insurance plans are too expensive, can also opt to purchase a plan through a marketplace. There may also be assistance for those unable to pay for a plan.

In addition to the limit on pre-existing condition exclusions, the ACA has helped cancer patients in other ways. For example, the law set minimum standards for health insurance that includes screenings, treatment, and follow-up care for cancer patients. The law also ensures health care plans will cover clinical trials. Patients are often responsible for some care costs during a clinical trial, so not having insurance could prevent participation for some.

Health Insurance and Pre-Existing Conditions

The ACA changed the rules regarding pre-existing conditions. Before the law was enacted, health insurance plans could deny coverage for a diagnosed condition, like mesothelioma, before joining the insurance plan. Those insurance plans that did accept pre-existing conditions could impose an exclusion period. This meant the patient would not receive payment for health care costs related to the pre-existing condition for a certain period of time. For patients with mesothelioma, time is of the essence, that exclusion period could cost someone their life.

The ACA has prohibited pre-existing condition exclusion periods and has made it illegal for health plans to deny coverage due to a pre-existing condition.  “Grandfathered” plans are an exception. Grandfathered plans were those already in place when the ACA was signed into law. All new plans must follow the new rules regarding pre-existing conditions. As time passes, the number of grandfathered insurance plans will decrease. This is because these plans lose their grandfathered status if they make coverage or pricing changes.

Veterans Insurance and Benefits

The U.S. Veterans Health Administration provides health benefits for many veterans. The national network for veterans includes specialists who treat mesothelioma patients, which is important because many veterans were exposed to asbestos while serving. Coverage for veterans eligible for VA benefits is extensive, covering most of the cost of diagnosis, treatment, and care.

Insurance Scams

Unfortunately, there are criminals who will take advantage of vulnerable people looking for affordable health insurance. Beware of discount health insurance, stripped-down policies, and medical discount cards. Scammers also create fake websites that appear to be official insurance marketplaces. If you are purchasing through a marketplace, always start with healthcare.gov. Healthcare.gov is the only official site for marketplaces. Always be wary of someone who contacts you to sell you insurance. Real insurance plans do not sell aggressively.

If you have mesothelioma and have found an insurance plan, make sure you understand the benefits, coverage, and whether you need supplemental insurance. The costs of treating mesothelioma are high, but it is a life or death matter. If you are ever unsure of your options or coverage, talk to your doctor.

Page Edited by Patient Advocate Dave Foster

Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available.

Connect with Patient Advocate Dave Foster