Facts related to ACA-Compliant Plans For Cancer Patients

ACA-complaint health insurance plans

All the ACA-complaint health insurance plans available in the United States cannot discriminate or deny health coverage to individuals suffering from cancer or having any pre-existing condition. As per the Affordable Care Act, health insurance companies cannot refuse to cover cancer patients and they even cannot charge them with increase premium amounts. The ACA has not only paved the way for cancer patients to obtain coverage, but this act also made two significant changes that prove extremely beneficial for people suffering from critical health problems that require expensive medical treatments.

The first change was that annual and lifetime dollar limits on healthcare which a particular individual can receive were eliminated and secondly, a maximum annual limit was introduced on the amount that an individual can spend in out-of-pocket costs for their healthcare. In 2020, the annual limit on out-of-pocket costs for healthcare is $8,150. However, people should know that this does not include health insurance premiums. This is certainly good news for cancer patients currently undergoing intense cancer care and ongoing treatment. This is also beneficial for cancer survivors, who were worried whether they will be able to afford treatment again after remission.

Key Features of ACA-Plans for Cancer Patients

Every health insurance plan offers a different level of coverage for cancer-related healthcare. Thus, individuals need to familiarize themselves with their health plans if they are undergoing cancer treatment. Affordable Care Act Key Features for Cancer Patients are:

  • Individuals having cancer or their pre-existing condition can buy health insurance through an online insurance exchange, known as Marketplaces. Cancer patients looking for a health plan ca compare plans be benefits, price, drug coverage, and healthcare provider participation.
  • The plans should cover essential health benefits and should also include coverage for cancer treatments and follow-up care.
  • The plan should also cover for check-ups and preventative services for cancer screenings like mammograms and colonoscopies, and there are no co-payment or deductible costs. These tests may be considered diagnostic and not preventative for individuals having cancer history and so they will be responsible for the cost.
  • In cancer patients are having health insurance through private insurance companies, then these companies cannot limit the amount they pay for cancer care in the patient’s lifetime. Earlier, private insurance companies could stop paying after a certain amount. Since cancer care is expensive so some of the patients had to pay from their pocket for all their care after the coverage stopped. But now the private insurance company should keep paying for the care, even if the patients need a lot of healthcare.
  • A cancer diagnosis is expensive and people face unplanned expenses related to their care. Sometimes, due to cost people are unable to complete their cancer treatment, thereby increasing their health risks that may also increase their expenses in the future. Thus, the people need to identify their medical and non-medical costs, as this will help them adjust their budget and will also allow them to seek financial assistance if required.
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Different Types of Medical and Non-Medical Costs

Doctor appointments – Patients are required to pay for the care they receive at each doctor visit. Generally, their health insurer requires them to pay a co-payment before they start paying for it. It is the health insurance company that sets the co-payment amount, not the doctor. Patients may also have to pay for tests done like blood and urine during their appointment.

Cancer treatment

Payments for cancer care that patients are receiving as a part of their cancer treatment such as radiation therapy sessions, or chemotherapy infusion. However, patients participating in a clinical trial may have other cost-related factors to consider. The treatment duration varies from person to person, and so individuals need to check with their insurer about how long they may have these costs.


The cost of drugs prescribed during the cancer treatment and it includes the cost of chemotherapy or drugs to help manage side effects.

Transportation and Travel Costs

The coverage of these costs depends on where the individuals are receiving treatment and how they get there. Some of the travel and transportation expenses include gas, taxis, bus or train fares, airfares, parking, and tolls. However, patients need to pay for their lodging.

Home Care and Long-term Care

Cancer patients may require some extra care like they may require a person for meal preparation or provide transportation to visit doctor appointments, or they need to stay at a specialized facility for extended nursing care, or they hire a home health aide.

Family and Living Expenses

The family and living expenses costs are the costs incurred on the upkeep of the house and family care during undergoing the cancer treatment. These costs include childcare cost, eldercare cost, support for household tasks, or hiring a home health aide.

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Other Coverage Options, Medicare, Medicaid, and CHIP for Cancer Patients

Cancer patients if eligible can apply for Medicare, Medicaid, or Children’s Health Insurance Program any time, even outside the Open Enrollment period. If they qualify, they can immediately enroll and their coverage will instantly start. Cancer patients can apply for Medicare after turning 65 years of age.

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