With the coming up of the Affordable Care Act, a major healthcare Reform took place, and cancer patients were given complete protection. They were protected against losing health insurance coverage, and the healthcare benefits, which they were receiving.
Insurance Coverage for the Cancer Patients under the Affordable Care Act
If cancer patients are having ACA compliant health plans, then their health insurance companies need to pay for their cancer treatment, as they have the right to receive treatment under the Affordable Care Act. Health insurance companies neither cancel the health plans of cancer patients, nor they can deny them health insurance, just because they are having cancer. Even children suffering from cancer cannot be denied health coverage. If cancer patients qualify and wish to take part in a clinical trial, then their plans have to pay for the routine costs associated with the approved clinical trials, which may further help them in getting new treatments for cancer.
Limits on Out-of-pocket Expenses for Cancer Treatment
As per the Affordable Care Act rule, there is a limit on the out-of-pocket expenses that insured are required to pay for the healthcare they receive from their doctors and the hospitals that are included in the plan. The limit on out-of-pocket expenses is available even for insured cancer patients. Cancer patients after paying their out-of-pocket limit need not pay any amount, and their insurance companies pay for the covered expenses for their healthcare. There are no more annual and lifetime limits available. People enrolling in a health plan through their state’s marketplace or their employers covering medical and pharmacy costs, then their out-of-pocket costs for in-network care in 2020 are capped at $8,150 for an individual and $16,300 for a family per year. The cap in the out-of-pocket costs even applies to cancer patients.
Financial Help to Pay for Some Healthcare Costs
People buying health insurance plan through their state’s marketplace become eligible for both tax credits and cost-sharing subsidies if they have qualifying incomes. People can check their eligibility on the government healthcare portal. People may even qualify for Medicaid even if they have not qualified in the past. Some of the states have expanded Medicaid to provide coverage to more and more people, and people can check with their state’s marketplace to find out if their state has expanded or not. These financial benefits apply to cancer patients having a health plan.
Mental Health Support
It is often discovered that cancer patients have depression and anxiety, so they can avail depression screening at no extra cost. Since, health plans sold through state marketplaces or the individual market, and through small employers cover mental health services. Besides, mental health services should be provided under the same terms and conditions as other healthcare services. Health plans cannot have limited health benefits compared to other healthcare benefits. The amount paid by the policyholders depends upon the type of plan in which they are enrolled.
Seniors can Save on Cancer Drug Costs
Before the Affordable Care Act, insured have to pay the full cost of their drugs after reaching their annual drug-spending limit. However, the Affordable Care Act has eliminated the gap in the prescription drug coverage or donut hole for seniors having a Medicare Part D plan. Medicare’s donut hole is closed in 2020 and insured are just required to pay 25% of the cost of the branded as well as generic drugs.
Essential Health Benefits
People buying health insurance plans through their state’s marketplace, or from their employer should know that their plan must cover essential health benefits. Individuals diagnosed with cancer might need some of these services like hospital care, emergency care, chronic disease care, mental health services, lab services, prescription drug coverage, rehabilitation services, and outpatient treatment. Perhaps people should keep in mind that each state determines what is exactly covered under these categories. Therefore, it is important to carefully read the plan’s summary of benefits to know the plan’s exact costs and benefits.