It may not be the first thing you think about when you’re diagnosed with cancer, but cancer treatment is often costly, even for people with government insurance like Medicare or Medicaid.
About 1.8 million new cases of cancer are diagnosed each year in the United States, and patients and their families foot the bill for an estimated $5.6 billion annually in out-of-pocket expenses for surgery, radiation therapy, chemotherapy and other treatments, according to the American Cancer Society (ACS).
And the high costs of cancer care are projected to grow, from $190.2 billion in 2015, according to the National Cancer Institute (NCI), to $246.6 billion by 2030, the ACS estimates.
Patients’ financial burden is staggering, with the NCI estimating the per-patient cost averages:
- $43,516 for initial care
- $5,516 for continuing care
- $109,727 in the last year of life
If you’ve been diagnosed with cancer, managing the expenses may be lead to financial toxicity, the term often used to describe the negative impact of the high cost of cancer care. But knowing what to expect and developing a sound financial plan are keys to covering your treatment without breaking your budget.
To help you plan and pay for your cancer care, this article provides information and resources to assist you in creating a financial strategy to cover unexpected living and medical expenses. Topics include:
- How much does cancer treatment cost?
- What your insurance policy covers
- Managing your cancer care expenses
- Resources to help you offset cancer outlays
If you’ve been diagnosed with cancer and are interested in a second opinion about your diagnosis and treatment plan, call us or chat online with a member of our team.
How much does cancer treatment cost?
Even for patients with a robust health insurance plan, out-of-pocket costs such as co-payments for hospital bills, prescription drugs, chemotherapy, other medications and doctor visits quickly add up.
That doesn’t even take into account costs for taking time off work, traveling to treatment centers, hiring caregivers and covering other related expenses.
Chart: The cost of cancer treatment
With more than 200 different types of cancer, there’s no one-size-fits all cancer treatment. That’s why costs of cancer treatment vary significantly from patient to patient.
For instance, the NCI estimates the following average per-patient costs for medical services and care by cancer type:
| Cancer type | Initial care |
Continuing care |
End of life care |
|---|---|---|---|
| Breast cancer | $43,516 | $5,518 | $109,727 |
| Cervical cancer | $58,716 | $3,956 | $97,026 |
| Colorectal cancer | $66,523 | $56,246 | $110,144 |
| Leukemia | $47,264 | $12,701 | $169,588 |
| Lung cancer | $68,293 | $12,389 | $110,248 |
| Prostate cancer | $28,109 | $2,603 | $74,227 |
What your insurance policy covers
Per-patient costs may also vary widely, depending on the type of insurance. But several consistent factors contribute to cancer patients’ overall health care costs.
If you don’t have insurance, you’re responsible for all your treatment costs. But you may qualify for charity care, or drug discount programs may be available to reduce your costs and/or allow you to negotiate discounts with providers. If you have insurance, the kind of policy you have will determine your ultimate out-of-pocket (uncovered) costs, based on several components of your plan, including those listed below.
Premium: This is the monthly amount you pay to stay covered by the insurance plan (in some cases, an employer pays at least some of this cost).
Deductible: This is the amount you must first pay out of pocket for care before your insurance plan will start covering costs. Some plans have separate deductibles for medical services, drugs and/or out-of-network services.
Co-payment or co-pay: You pay this flat fee per health care service, procedure or prescription.
Co-insurance: This is the percentage you pay of the total cost of a prescription, service or procedure.
Out-of-pocket maximum or out-of-pocket cap: These limits cap what you must pay each year before the health plan starts to pay 100 percent for covered, in-network benefits.
In-network vs. out-of-network: Many plans have networks of doctors, hospitals and pharmacies. If you use an in-network provider, the cost is usually lower because the insurer has negotiated rates with the provider.
Unexpected costs: You may also encounter unanticipated costs. This may be because your plan doesn’t cover a treatment you received, you may have used a provider who was not in-network, or your plan didn’t reimburse the provider the full amount billed, and you must pay the difference (sometimes called balance billing or surprise billing).
Managing your cancer treatment expenses
For some patients, managing the financial costs of cancer care is nearly as stressful as receiving a cancer diagnosis. But your health care provider and care team may be able to work with you to plan for your coverage and direct you to resources to help. This is true whether you have an employer-sponsored health plan, individual insurance policy, prescription drug plan or government insurance like Medicare or Medicaid.
Some simple strategies are particularly useful, such as asking upfront about all out-of-pocket costs, requesting payment plans and saving money on medications through your prescription drug plan. It’s also important to know your insurance policy guidelines and charges (such as co-pays, deductibles, coinsurance, fee-for-service options, etc.) and how to dispute incorrect charges.
It’s important, if you can, to work directly with your health care provider to manage the cost of your treatment.
Below are some tips on reconfiguring your finances for unexpected living and medical expenses.
Find a financial counselor. Considering the expenses associated with cancer care, it may be a good idea to work with a financial counselor to help you plan and manage your costs. Your hospital’s financial counselor should be available to meet with you to review your insurance policy and explain what will and won’t be covered.
Review your Summary Plan Description. To understand what your health insurance plan covers and doesn’t, review this document, provided by your insurer or employer. It’ll tell you which services must be pre-certified, which prescription drugs are covered, whether your plan offers home health benefits and/or what the costs of a paid caregiver would be.
Consider tapping into your life insurance policy. Many companies allow employees to collect part of their death benefit—what’s known as a living benefit—early if they are diagnosed with a possibly terminal illness and need money urgently for unexpected living and/or medical costs. You may not get the full value, but it’s an option worth exploring.
Apply for financial assistance. National organizations such as CancerCare and the Leukemia & Lymphoma Society offer financial aid for those in need. Family and friends may also set up a free online fundraising page for a loved one who needs financial help for cancer treatment. Some groups offer programs, such as the American Cancer Society’s Hope Lodge, that provide free rooms for patients receiving treatment at cancer centers far from home. Certain hospitals, including some City of Hope facilities, offer on-site lodging for patients and caregivers at a lesser rate than a non-partnered lodging site.
Set up a payment plan. Many medical centers allow patients to arrange monthly payments over a certain period. Such a payment plan may be a better option than taking out a medical loan, which often requires costly interest rates.
Apply for Social Security benefits. If you’ve had to leave your job because of your diagnosis, you may qualify for disability benefits through Social Security. Many cancers are on the Social Security Administration’s Compassionate Allowances list, which means your application will be processed more quickly.
Resources to help offset cancer outlays
Several nonprofit organizations, pharmaceutical companies and the U.S. Centers for Disease Control and Prevention (CDC) have compiled lists and web-based links of resources designed to help people pay for cancer-related expenses.
Among them:
The CDC’s Paying for cancer treatment website provides a detail list of tips for managing care costs as well as links to federal cancer informational sites and government resources for veterans, seniors and disabled and low-income Americans.
Medicare and Medicaid offer online resources to help you sign up for Medicare, choose the right Medicare-approved prescription drug plan and assist people and families who have very limited incomes who qualify for Medicaid. Contact your state Health Department for more information on requirements and how to apply. To find your state Health Department, call the U.S. Department of Health and Human Services (HHS) at its toll-free number (877-696-6775) or visit the HHS website.
The Pharmaceutical Research and Manufacturers of America’s Medical Assistance Tool is a search engine designed to help patients, caregivers and health professions learn more about resources available to get assistance with the cost of medicines from public and private programs.
NeedyMeds Inc.’s Find help with the cost of medicine online clearinghouse provides information about many drug assistance programs and offers its own drug discount card that you can print out for free online.
RemediChain operates a nationwide program that takes donations of unused cancer medications and partners with cancer centers to make the drugs available to those experiencing financial hardships.
The National Council on the Aging’s BenefitsCheckUp website is an online resource for people aged 55 and older who need help paying for their medicines, health care, utilities, food and other basic needs in all 50 states and the District of Columbia.
If you’ve been diagnosed with cancer and are interested in a second opinion about your diagnosis and treatment plan, call us or chat online with a member of our team.
