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Health Care Reform:

Health Insurance & Affordable Care Act

How Health Reform Affects Your Cancer Care

If you have cancer, the Affordable Care Act gives you greater protection against losing insurance coverage and protects the care benefits you have.

Cancer and Insurance Coverage

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

  • Your insurance cannot be canceled because you have cancer.
  • As of January 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 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. The following new protections started in 2014:

You no longer have a 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 2014, these are your spending caps or maximums:

  • If you are single, your out-of-pocket costs for in-network care 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 care 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. Both tax credits and cost-sharing subsidies are available to people with qualifying incomes. Check on to find out.

You might qualify for Medicaid if the state where you live has agreed to expand it. Check with your state’s Marketplace to find out.

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