Lung Cancer Insurance Coverage: Potential Barriers

A lung cancer diagnosis doesn’t just affect a person physically and emotionally. Costly tests and treatments can also put a strain on your finances, even if you have health insurance coverage. These unanticipated costs can be a source of stress and may discourage patients from pursuing potentially lifesaving treatment options.

Having health insurance can help reduce the amount you will pay for cancer care, which can include chemotherapy, radiation, surgery, and targeted drugs. But often, patients will also have to pay out-of-pocket costs. The amount you will owe greatly depends on the type of insurance plan you have and the treatments you receive.

This article discusses how gaps in healthcare coverage can create obstacles for lung cancer patients.

Factors That Affect Cancer Insurance Coverage

Many factors will affect how much your health insurance plan covers for your lung cancer treatment. Out-of-pocket costs can vary significantly from patient to patient. However, it's important to note that insurance can't be denied or canceled due to a person being diagnosed with cancer.

Private vs. Public Insurance

Most people in the United States obtain their health insurance coverage through one of the following two ways: 

• Private insurance: The plans are offered by an employer or purchased by an individual consumer.
• Public insurance: These plans are provided via a government-run program, such as Medicare or Medicaid.

Health insurance plans and coverage options are all different, so your costs will depend on your particular policy. Some plans will not cover:

• Unproven cancer treatments
• Therapies that aren’t medically necessary
• Providers who are out-of-network

Your premium (the monthly fee you pay), yearly deductible (the amount you pay before your insurance kicks in), and out-of-pocket maximum (the most you have to pay for covered services in a year) will all factor into how much you will owe for your care. 

In 2022, health insurance companies were first required to provide patients with information on costs before treatments are administered. Additionally, the current law requires many private insurance companies to limit yearly out-of-pocket spending for patients. For instance, the 2020 limit for an individual plan was $8,150.

Lung cancer patients with no health insurance coverage are fully responsible for paying for all of their treatments. Free and discounted assistance programs may be available to help these individuals reduce their expenses. Additionally, these patients may be able to negotiate discounts with their healthcare providers.  

Stage of Cancer

The stage of your lung cancer (how advanced your cancer is) is important in helping your healthcare provider decide on a treatment. Typically, late-stage, advanced cancer is more expensive to treat than early-stage cancer.

Treatment Options

The type of treatment you receive, whether it’s surgery, chemo, radiation, targeted drugs, or a mix of these, may affect your overall costs. Additionally, the number of treatments you need and where the treatments are given (such as a hospital vs. a provider's office) will determine the amount you pay. Tests to measure your response to treatments, such as imaging scans or blood draws, may also affect your costs.

Often, experimental therapies are more expensive and are not covered by insurance policies. Patients who participate in clinical trials may be able to access these medicines free of charge.

Barriers to Proper Care

People with lung cancer may encounter unexpected costs related to their care. Whether it’s due to a lack of coverage, a high deductible, or the use of an out-of-network provider, the bills can add up.

Some patients may decide that the cost of the treatment isn’t worth the price tag. Health expenses may keep them from receiving necessary cancer treatments, which can negatively affect their prognosis.

Additionally, research shows that outcomes are significantly worse in cancer patients who do not have insurance compared to those who do.

The following cancer patients are more likely to experience financial hardships:

• Younger patients
• People of color
• Patients with less education
• Patients with low income
• People who require more complex or advanced cancer treatment

Understanding Your Options

If you have lung cancer, your options for health insurance will typically include private or public plans. To qualify for a public program, you may need to meet certain age, income, or disability requirements.

Some people purchase supplemental plans, such as cancer insurance. These policies usually pay out a lump sum if you are diagnosed with cancer.

Flexible Savings Accounts (FSAs) and Health Savings Accounts (HSAs) are special bank accounts that might also be useful in some situations. They provide tax benefits and help you plan for medical expenses.

Another option is catastrophic insurance. This type of policy doesn’t cover routine medical expenses but helps if you are diagnosed with a serious illness, such as lung cancer.

Additionally, patients may be eligible for free or discounted medications through pharmaceutical companies if they are not paid by an insurer.

Summary

Most health insurance plans will cover some of your medical costs for lung cancer, but you may have to pay out-of-pocket for part of your treatment expenses. The amount you spend will depend on your coverage, the stage of your cancer, the treatments you receive, and other factors. Public and private insurance plans offer different benefits. It's important to research your policy carefully.

A Word From Verywell

A lung cancer diagnosis can be financially stressful. If you’re struggling to pay for your treatments, you might want to reach out to an expert, such as an oncology social worker, who can help you navigate your options. Don’t forgo critical therapies because you don’t think you can afford them. Assistance programs are available to help you get the treatment you need.