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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Your Cancer Care

When you're fighting cancer, you don't need any other battles. In the past, many people had to fight their insurance companies to get coverage for cancer treatments like chemotherapy and radiation. That problem ends with the health reforms of the Affordable Care Act.

Cancer & Insurance Coverage

Now, health plans have to help pay for your cancer treatment. You have many rights as a cancer patient under the Affordable Care Act:

  • Your insurance cannot be canceled because you have cancer.
  • Starting in 2014, 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 this. 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 your medical care. These start in 2014:

You will not have a dollar limit on how much an insurance company spends on covered expenses for your health care. Annual and lifetime limits go 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 for how much you'll have to spend on co-pays, co-insurance, and deductibles. This maximum is called a cap.

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 2014, these are your caps:

  • If you're single, your out-of-pocket costs are capped at $6,350 for one year.
  • For a family, the cap is $12,700 for one year.

Until 2015, your caps will likely be more than the above amounts if you get your health insurance from an employer and you:

  • Have one insurance card for your medical expenses and a different insurance card for your drug costs.
  • Have two vendor names on your insurance card -- one for health costs and another for medications.

You might be able to get financial help to pay for some costs if you're buying insurance through your state's Marketplace. You may be able to get a tax credit to help lower your monthly premiums if you're single and make between about $11,490 to $45, 960, or if you have a family of four and make between about $23,550 and $94,200.

If you enroll in a silver-level plan and fall in the income range, you may be able to get a cost-sharing subsidy to help lower your out-of-pocket costs.  

 If you're single, you can make about $28,725. If you have a family of four, you can make about $58,875.

You might qualify for Medicaid if the state where you live has agreed to expand it,  and you earn$15,856 as a single person or $32,499 for a family of four.

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