If you have lung cancer, treatment may come with a hefty price tag. But health insurance -- including government programs like Medicare and Medicaid -- can help cover the bills.
How much you end up paying for things like doctor visits, tests, chemotherapy, radiation therapy, or surgery depends on the kind of insurance you have and the type and stage of your cancer. Your age and income level can be factors, too.
Breakdown of Medical Costs
Even if you have health insurance, you'll still have to pay for part of your medical costs. Insurance companies call the amount you pay "out-of-pocket" expenses. These can include things like:
Premiums. The fee you pay to the insurance company, usually monthly, for your health coverage.
Deductibles. The amount you pay for medical bills before your insurance plan kicks in with coverage.
Co-pays. A fixed amount you pay for a particular health care service after you've paid your deductible.
Out-of-network costs. The costs you pay if you use a health care professional who doesn't have a contract with your insurance company.
To get an idea of the kinds of costs you might have to pick up on your own, the American Cancer Society, in its 2020 report on cancer costs, looked at one case study of a women with stage IV lung cancer that had spread to her bones. The woman had health insurance from her state's Marketplace.
She had several screenings for a diagnosis, including CT scan, biopsy, PET/CT scan, and a brain MRI. She also had treatment that included chemotherapy, immunotherapy, a biomarker test for a clinical trial, and palliative care.
The total cost for her medical treatment was $140,247. The health insurance company paid $132,097 of the costs. The woman had to pay the remaining $8,150. She also had to pay monthly premiums to her insurance company that came to nearly $4,000 for the year.
If she had been uninsured, she might have had to pay all the expenses upfront.
Medicare Coverage
If you're 65 or older, or if you have certain disabilities, you may qualify for Medicare -- a federal health coverage program. Ninety-seven percent of Americans over 65 are covered by Medicare.
Medicare covers lung cancer treatment in the same way it covers other kinds of medical bills. The program has four parts:
Invisible Costs
Besides treatment costs, you may also run into expenses that you may not have seen coming. They can include things like:
- Traveling to and from medical appointments, regular scans, and doctor visits
- A place to stay if you're having specialized treatments at a different site
- Specially cooked meals, fertility problems, and wigs
- Childcare help or home health aide
Another indirect cost for those living with lung cancer can be money lost in wages as they deal with cancer. Some people quit work or reduce their workload to make time for treatment and lifestyle changes that come with cancer.
Surprise Medical Bills
Even if you get treatment at a facility covered by your health insurance, which is called in-network, it's possible for you to get unexpected medical bills. This happens when you're billed by a provider whose services are out-of-network, such as a lab test, even when the facility is covered by your insurance. Your insurance company may only pay for part of that treatment, leaving you with the remainder of the charge.
You may also discover that the expense doesn't count toward your out-of-pocket maximum. This may happen with certain doctors, like anesthesiologists, surgeons, and emergency room doctors. To avoid this, it's best to check with your provider before your treatment.
Tips to Ask About Lung Cancer Costs
It may help to ask your health care team about treatment costs -- and any less-expensive alternatives. They may be able to suggest assistance programs that may help you manage or reduce your costs.
Ask:
- How much will the treatment cost?
- Are there cost-effective treatment options?
- What are the key terms of your insurance policy?
- How much of the costs will insurance cover?
- How much does a hospital stay cost?
- What does rehabilitation after treatment look like? How much will it cost?
