Lung cancer is the most common type of cancer worldwide. Each year, approximately 12% of all new cancer diagnoses in the United States are lung cancer.
Smoking is the most significant risk factor, but non-smokers can also develop the disease.
Lung cancer can take a tremendous toll on your physical and emotional health. For many people, cancer-related costs are a significant financial burden that can cause stress. Diagnostic/screening tests used to provide a diagnosis, treatments, the length of treatment, and the treatment setting all play a role in the overall costs.
In the United States, health insurance can help cover the costs of some of your cancer care to reduce your out-of-pocket expenses. Read on to learn about the best health insurance options for people with lung cancer.
Health Insurance Options & Lung Cancer Coverage
A wide variety of health insurance plans are available, including employer-sponsored plans, private health insurance, and government-sponsored insurance programs.
Each of these plans may require you to pay a monthly fee, known as a premium. Most programs also need you to pay a deductible—a specific dollar amount of your medical costs each year before insurance coverage kicks in. Depending on your plan, you may also be responsible for paying a flat fee for healthcare provider’s visits (copay) or a percentage of the cost of services (coinsurance).
The most common health insurance plans for lung cancer screening and treatment include employer-sponsored plans, state insurance marketplace plans, Medicare, Medicaid, and individual or private programs.
Companies offer employer-sponsored health insurance plans as a benefit of employment. These plans typically cover the employee, their dependents (and their spouses). A little over 55% of Americans have employer-sponsored health plans.
You can usually sign up for these plans when you start a new job. You can also add yourself, your child(ren), and your spouse to your work health insurance plan during the open enrollment period, which happens once a year.
Understanding your health insurance options is essential before opting into an employer-sponsored plan. Read through the details of the project (Summary of Plan Benefits) to ensure it provides the coverage you need for cancer care. Consider the following factors:
- Total benefits covered by the plan
- Your out-of-pocket expenses (e.g., deductibles, copays, coinsurance)
- Prescription medication coverage
- If your providers (e.g., primary care physician, oncologist, cancer treatment center) are in-network with the plan
- Whether or not there is a cap on what the insurance policy will pay for healthcare
State Insurance Marketplace Plan
The Health Insurance Marketplace is a government-run service that helps people enroll in affordable health insurance plans. All Marketplace plans provide coverage for treating pre-existing conditions, including cancer.
The federal government operates the Marketplace in many states, and other states run their Marketplaces. Depending on your income, you may qualify for free or low-cost coverage or subsidies to help cover theplaplan’sstt.
All health insurance plans offered in the Marketplace cover ten essential health benefits, including:
- Outpatient care
- Emergency services
- Hospitalization (e.g., surgery, overnight stays)
- Prenatal and postnatal care
- Mental health and substance use disorder treatments
- Prescription medications
- Laboratory services (e.g., bloodwork)
- Chronic disease management and preventative services (e.g., screening tests)
- Rehabilitative and habilitative services and devices (e.g., assistance for people with disabilities and chronic conditions)
Medicare is a government-funded health insurance program that covers 80% of the cost of cancer treatments. However, you will be responsible for paying 20% of the billed amount until you reach your annual deductible.
Who Is Eligible for Medicare?
Medicare is available for people ages 65 and over and some younger individuals, including those with disabilities, people who have been getting Social Security benefits for two years or more, and people with end-stage renal disease.
There are four parts of Medicare, and each piece covers different services related to cancer treatment:
- Part A (hospital insurance) covers inpatient care in hospitals, including any cancer treatments you receive while in the hospital. It includes hospice, home health, and skilled nursing facility care. Most peopldondon’tyn’y a monthly premium for Part A, but you must meet your deductible before coverage kicks in for Part A.14
- Part B (medical insurance) helps cover the cost of some cancer-related outpatient treatments and services. This includes healthcare provider visits, chemotherapy drugs, radiation treatments, diagnostic imaging tests (e.g., CT scan), medical equipment, nutritional equipment (e.g., feeding pump), mental health services, and outpatient surgery.
- Part C (Medicare Advantage) are private health insurance plans that bundle Medicare Parts A and B benefits and (usually) Part D. These private plans must cover everything that Original Medicare covers for healthcare services and prescription drugs, but they may have more expensive premiums. See a healthcare provider that is out-of-network with your plan may cost more.
- Part D (drug coverage) is an optional part of Medicare that helps cover the cost of prescription medications, including chemotherapy drugs, anti-nausea drugs, and other medicines used to treat cancer and its associated symptoms. Most Medicare Advantage plans provide drug coverage, but if youdoedoesn’troe’r dondon’tveon’s Part C), you can choose a Part D prescription drug plan.
Medicaid provides free or low-cost healthcare coverage for those who qualify based on income and family size.
Who Is Eligible for Medicaid?
Medicaid is available for some low-income adults, families, children, pregnant women, older adults, and people with disabilities. It is funded jointly by state and federal governments.
Though Medicaid benefits may differ from state to state, each program must cover certain cancer-related services, including inpatient and outpatient hospital services, physician services, laboratory and X-ray services, and prescription drugs related to cancer treatment. Some states also provide coverage for additional services, including hospice.
Individual plans offer health insurance coverage for people who do not have access to employer-sponsored or government health plans (e.g., self-employed individuals). With a personal project, you and your insurer will pay a specific dollar amount or percentage of the costs of your medical care. Therefore, your out-of-pocket costs will depend on the particular plan you have.
Individual plans cover the ten essential health benefits mandated by the Affordable Care Act, including inpatient and outpatient services, approved prescription drugs, screening tests, and other cancer-related treatments.
Questions to Ask Your Healthcare Provider
Navigating the healthcare and health insurance ecosystem can be confusing, even if you understand your insurance coverage well. Talking to your healthcare provider about the financial aspects of cancer care can help provide clarity and support when needed.
These questions may be an excellent way to open the conversation with your healthcare provider:
- Can someone in this healthproprovider’sficeo’fice/hospital help me work with my health insurance provider?
- Is there someone who can help me review my medical bills to makethethey’rerrecte’rrect?
- Can someone help me file an appeal if an insurance claim is denied?
- Is there someone who can help me keep track of my expenses and incoming bills related to cancer care?
- How much is my copay for each healthcare provider visit?
- Do you offer payment plans to help me pay back the costs over time?
- How will I be billed for laboratory tests (e.g., blood work), and is it covered by my insurance?
- Does my insurance cover other healthcare provider visits (e.g., seeing a different provider for a second opinion?).
Cancer Treatment Costs
- Can someone help me estimate the total costs of the recommended treatment plan?
- Are there other treatment options that are effective but not as expensive?
- Do I need pre-approval from my insurance company before beginning treatment?
- Is the cancer treatment center/hospital in-network with my insurance plan?
- What expenses does my health insurance cover for hospitalization? Outpatient treatment?
- Are there copays for each treatment?
- Is there a place where I can get low-cost or free counseling to help me process and cope with my diagnosis?
Prescription Drug Costs
- What is my copay for prescription drugs?
- Can I switch to a generic or less expensive drug that works just as well?
- Can we review my list of medications to see if there are ways to reduce my drug costs?
- Are there over-the-counter medications that can help manage side effects from treatment?
- Can programs help cover the cost of my drug(s) for cancer treatment?
The Cost of Lung Cancer
In 2019, lung cancer patients in the United States paid $1.35 billion out of pocket for treatments, including chemotherapy drugs, radiation treatments, and surgical procedures.
Because lung cancer treatments and health insurance options vary so widely, the out-of-pocket costs can differ vastly from patient to patient. Several factors contribute to your overall cost of care, including:
- Insurance status/type of health insurance coverage (e.g., deductible, monthly premium, copays, coinsurance)
- Type and duration of treatment (e.g., chemotherapy, radiation, surgery)
- Geographic location (costs tend to be higher in areas where the cost of living is most increased)
- Treatment setting (e.g., hospital, cancer clinic, healproprovider’sficepro’fice)
- Travel and transportation (e.g., hotels, gas, public transport)
- Time (time spent waiting for/receiving care, missed work)
Many people with cancer find it difficult to pay their medical bills and typical expenses (e.g., mortgage, car payment). Talk to your healthcare provider about your financial concerns—they may be able to find less expensive treatment options or connect you with someone who can help you manage the financial aspects of cancer care.
Choosing the Right Plan
Trying to choose the right health insurance plan can be a complicated task. However, putting in some time and effort to compare the options available will help you choose the plan that fits your budget and ensures you get the health care you need.
Here are some tips for choosing the right insurance plan for cancer care:
- First, check to see if your healthcare providers are in-network: When shopping for a project, check to see if your primary care provider, oncologist, and hospital and treatment center are in-network for the plan(s) you are considering. Getting care from healthcare providers and facilities that are in-network with your insurance plan may help lower your costs.
- Consider all aspects of the plan: Monthly premiums are the amount you pay each month for insurance coverage. Bisnisn’tesn’tisn’te only out-of-pocket expense to consider. Look through the details of each project to check the deductible, coinsurance, copays, and out-of-pocket maximums. If you know you have a lot of healthcare provider appointments and cancer treatments, aheait’it’sst it’sit’st to choose a plan that provides the most coverage and lowest out-of-pocket costs.
- Talk with an insurance professional: It can be helpful to talk with an expert who can guide you through choosing a health insurance plan. Insurance brokers and provider customer service representatives know to help you understand plan details and determine which projects will best meet your needs. In addition, the Marketplace has a call center that is open 24/7 to help you compare plans, start your application, and answer your questions.
- Know when you can enroll: The federal health insurance exchange opens on Healthcare.gov each fall and runs until mid-December. This is your window to shop for insurance and enroll in a plan. Some states run their businesses, so checking and seeing when open enrollment begins where you live is essential. In addition, you may qualify for a particular enrollment period due to a life event (e.g., losing other coverage, getting married, having a baby) finally, if you have an employer-sponsored plan, talorgorganization’sation’sorg’ a department to find out when you can enroll.
A lung cancer diagnosis can affect your physical, emotional, and financial well-being. Health insurance can help cover the costs of cancer care and treatment to help relieve some of the financial burdens many people living with cancer face. In addition, understanding your options for health insurance can help you choose the plan that best meets your needs.
A Word From Verywell
Getting a lung cancer diagnosis can be a scary, overwhelming experience. Worrying about finances on top of concerns for your physical and mental well-being adds to the stress. However, the right health insurance plan can help cover the costs and relieve some financial burdens related to cancer care and treatments.
FREQUENTLY ASKED QUESTIONS
Does health insurance cover cancer treatment?
Most health insurance plans cover at least some cancer treatment costs, as the Affordable Care Act mandates.
You can expect out-of-pocket expenses related to cancer care and treatment, including meplaplan’sductiblepla’ductible, copays, and coinsurance amounts.
What if I can’tcan’tford cancer treatment?
The costs of cancer treatment can add up quickly. However, if you do not have the funds to pay for treatment, help is available. Your healthcare providers, nurses, and oncology social workers can provide referrals to financial resources and support services.
Does health insurance cover cancer screening?
Yes. The Affordable Care Act (ACA) requires all private health insurance providers and Medicaid to cover the costs of most cancer screening tests.25 If your health plan was in place before the ACA passed, it might not offer the same coverage. Contact your health insurer to verify cancer screening test coverage.