How Health Reform Affects Your Cancer Care
Cancer and Insurance Coverage
- Your insurance cannot be canceled because you have cancer.
- You cannot be denied insurance if you have cancer.
- Children with cancer cannot be turned down for coverage.
- If you qualify and want to take part in a clinical trial, your health plan must help pay for routine costs associated with approved clinical trials. A trial may help you get new cancer treatments.
Limits on How Much You Have to Pay for Cancer Treatment
The Affordable Care Act has rules about the most you have to pay out-of-pocket for the medical care you get from your doctors and the hospitals that participate in your plan. These protections are available if you have cancer:
There is no dollar limit on how much an insurance company spends on covered expenses for your health care. Annual and lifetime limits have gone away.
If you are sick, you cannot be charged more for health insurance.
Your out-of-pocket costs will be limited. There's a maximum amount, or cap, on how much you'll have to spend on co-pays, co-insurance, and deductibles.
If you enroll in a health plan through your state's Marketplace or have a health plan from your employer that covers medical and pharmacy costs for 2016, these are your spending caps or maximums:
- If you are single, your out-of-pocket costs for in-network care are capped at $6,850 for one year.
- For a family, the cap is $13,700 for one year.
You might be able to get financial help to pay for some costs if you're buying insurance through your state's Marketplace. Both tax credits and cost-sharing subsidies are available to people with qualifying incomes. Check on healthcare.gov to find out.
You might qualify for Medicaidif the state where you live has agreed to expand it. Check with your state’s Marketplace to find out.