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Five Medical Costs that Health Insurance Won’t Cover After a Cancer Diagnosis

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Here’s the bad news: Health insurance — even a “good” policy — is not going to cover every dollar of medical costs you incur if you are diagnosed with cancer. In fact, a typical health care plan is going to leave a cancer patient with a significant financial burden in addition to overcoming the disease itself.

What Doesn’t Your Medical Insurance Pay For?

Most people don’t think they’ll get sick with a critical illness until it actually hits, so they don’t look into exactly what their plan will pay for. There are five significant areas where you’ll have to make up the difference between what your health insurance covers and the final cost.

1. Cancer drugs.

The average cost of needed drugs to fight cancer can be as high as $10,000 a month, according to the American Society of Clinical Oncology. Some types of therapies can run as much as $30,000 a month. Not all health plans pick up the costs for these medications.

One example is oral chemotherapy. With oral chemo, you can take a pill in the comfort of your own home, rather than travel to a clinic where the drugs are slowly administered intravenously. But many health plans don’t pay for the oral medication, even though it’s more convenient for patients.

If a drug is considered “experimental,” your medical insurance may not pay for a cent — but if your doctor recommends it for your case, it’s hard to say no.

2. Deductibles.

You’ll have to pay for your deductible before your insurance plan will kick in. Got insurance on par with the Affordable Care Act’s “Silver” plans? The average annual deductible is nearly $2,700. That’s a big chunk of money for most families, and coming up with it all at once can mean that other needs are pushed to the back burner.

3. Co-pays.

Under most plans, you’ll have to pay a certain amount out of pocket each time you see a doctor, have a lab test administered or are admitted to the hospital. Unfortunately, cancer patients have literally hundreds of appointments over the course of their care. If you are responsible for co-pays — even if each one is just $25 — you’re going to be paying hundreds or even thousands of dollars.

4. Coinsurance.

Most health insurance plans only pay a certain portion of your bills. A typical plan may pay 80 percent of your bills after you’ve met your deductible and covered any co-pays. That means you’re responsible for 20 percent of the medical bills you have, and those bills could reach into the tens or hundreds of thousands of dollars depending on the type of cancer you have and the treatments your doctor prescribes.

If you should happen to use a medical provider who is out of network, your costs could be 40 percent, 50 percent or more of the total bill. There’s no easy way to know if everyone involved in your care is in network; for example, your hospital may be in your plan’s network but the radiologist may not be. Surprise bills can pile up that are much higher than you expected, even when you thought your insurance plan would take care of it.

5. Caps.

Most medical insurance plans are not unlimited, which means that they’ll only pay up to a certain amount for your care. Once you exceed that number, you’re on the hook for the rest of the bills. With the rising costs of cancer care, reaching $100,000 is no longer abnormal. And once you’re receiving treatment, you’re not going to stop — and you might not even know for weeks or months — once you’ve reached that cap.

Critical Illness Insurance Can Make Up the Difference

There is good news. You can get critical illness insurance that covers the costs that your medical insurance won’t. Critical illness insurance pays out after you receive a cancer diagnosis; you get a lump sum that you can use to pay the medical expenses that aren’t covered by your health plan.

Because you can use critical illness funds on just about any expense that comes up while you’re sick, you can also pay for any experimental or alternative therapies that your medical team suggests. You won’t need to worry about whether they’ll be covered by your health insurance.

Many people don’t consider critical illness insurance because, after all, they’re already paying sky-high health insurance cancer insurancepremiums. But critical illness insurance is much more affordable — plans start at $16 a month — and offer peace of mind that if you do get that dreaded diagnosis, that you won’t also have to stress over financial issues and unpaid medical bills.

Interested in knowing more about how critical illness insurance works? If you are diagnosed with cancer, you submit the medical paperwork and after a waiting period that is typically 30 days, you get your money. You don’t have to submit receipts or provide proof of what you spend the money on; the funds can pay for any medical or household expenses.

If you have a loved one and want them to know more about the costs of treating cancer and how critical illness insurance can help, please share the link to this article with them. You can text it, email it or post it via social media. Understanding critical illness insurance and its benefits can make you and your friends or family members less anxious about the future, no matter what it may bring.

And if you would like to know more about critical illness insurance for yourself, contact us. We’d be happy to answer your questions and find a plan that fits your individual circumstances.

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