Navigating the ins and outs of health insurance can cause anyone stress. The challenges and complexity only increase with a cancer diagnosis. However, if you educate yourself about your options and the various rules and regulations, you can make the best decisions for you. Find advice on this page for managing the often-confusing world of insurance or the lack thereof:

• Working with the system
  
• I don’t have insurance
  
• Social security disability
  
• Supplemental security income
  
• Short-term disability
  
• Medicare
  
• Medicaid
  

Make the Most of Your Insurance

Ensure you get the most out of your health-insurance plan by informing yourself about your options. Understand all your plan’s benefits and policies. You will likely find answers to many of your questions on your insurance provider’s website or within your written policy. If you don’t have a copy, ask your employer or the insurance company for one.

Often, it’s easier to call your insurance company’s member-services department directly and ask the following questions:

• Are my current doctors, or the ones I plan to see, part of my insurance plan?
• Do I need pre-approval for a second opinion?
• Can I go out-of-network or out of my plan for care? Will that be covered?
• Do I need pre-approval for any treatment? If so, when?
• What services does my plan cover and to what extent?
• Can I switch doctors?
• Can I choose my own specialists?
• What is my deductible? What is my out-of-pocket maximum?
• Are there co-pays? For which services and how much?
• Should I know any expiration or renewal dates?

Keep your records: Remember - don’t throw away insurance mail or mail from your doctors. Be sure to look over all literature, documents and bills from your insurance company. Insurers do sometimes bill patients incorrectly or charge for things that should be covered—so it can pay to be your own advocate. Oftentimes you’ll receive multiple pieces of mail about one appointment or service. For example, you may receive the first bill from your doctor, followed by an explanation of benefits from your insurance provider, followed by a second doctor’s bill with the insurance payment noted all for the same service or appointment. Keep track of all bills and all payments—and all conversations with your insurance representatives. Utilize the forms and filing systems found in YSC’s Treatment or Metastatic Navigators to help you stay organized. All this information might sound overwhelming, but organization can pay off. It’s also a great way to involve a friend or family member who wants to help.

Your insurance company might be able to help you stay organized, too. Many have case-management departments to help members who have serious, chronic illnesses. These professionals can help coordinate all of your medical needs and give you the support of a consistent voice as you manage your breast cancer. Ask your member-services representative if you are eligible for a case manager and if he/she can assign you one.

If You Don’t Have Insurance

A breast cancer diagnosis brings enough challenges—young women who lack health insurance can face even more stress. Know, however, that you have options. Various resources can help you pay your bills. The following may help with diagnostic procedures and treatment:

• The National Breast and Cervical Cancer Treatment Act helps uninsured women who meet certain qualifications pay for treatment. Find out how the program works in your state here.
• Meet with a hospital financial-counselor or patient advocate and explain your situation. This professional might be able to help you arrange a payment plan or negotiate discounted fees. Keep records of the date and topics discussed in each conversation. Bring a family member or friend who knows your situation and can help take notes and ask questions.
• Seek out a hospital social worker to help you with your case. This professional can tell you about your eligibility for Medicaid, Medicare or other public assistance. A social worker can also connect you to aid available through the hospital or local charities.
• At your hospital, ask about the Hill-Burton Program, a federal initiative that requires hospitals to provide free or low-cost care. Not every hospital offers this program, and each has its own criteria. Contact your hospital or the Hill-Burton Program directly at 800.638.0742 (800.492.0359 in Maryland) or visit their website.
• Your state government might be able to help to you. Contact your State Department of Insurance to see what they offer. Find your state’s office here. Ask if they provide a “guaranteed issue” individual health plan. Guaranteed issue is a requirement by your state government (therefore varying) that a health plan must allow you to enroll regardless of your health, age, gender, or other factors that might predict your use of health services.
• The nonprofit group NeedyMeds, Inc. can help you pay for your medications if you can’t afford them. Visit their website for more information.
• Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free. They offer access to more than 475 public and private programs, including nearly 200 offered by pharmaceutical companies.
• Pharmaceutical companies can often help you, too. Many have patient-assistance programs that provide drugs to people who cannot afford them. Talk with your healthcare provider about ways to connect with the manufacturers of your medication.
• Check our ResourceLink database or call the ResourceLink program at 877-YSC-1011 for more financial assistance resources.

Social Security Disability Insurance

This government program helps those in need, and who qualify, cover their medical costs. You may qualify for Social Security benefits if your breast cancer fits at least one of these descriptions: inoperable cancer, inflammatory breast cancer, or recurrent cancer (except local recurrence that is controlled by prescribed therapy or comes in the form of distant metastases). Proving your disability can be very challenging and may take several months. Use the assistance of a social worker or other social service provider. Check your eligibility for this help and learn more about the benefits at the Social Security Disability website.

Supplemental Security Income (SSI)

This federal program helps disabled people with little or no income meet the basic needs of food, shelter and clothing. Those eligible may also qualify for additional state benefits, like Medicaid, food stamps and other social services. Check your eligibility at the SSI website.

Short-term Disability Insurance

This program can help you when breast cancer interferes with your ability to work. It replaces part or all of your pay when an injury or illness unrelated to work keeps you away from your job for a short time. For example, if a new chemotherapy regimen makes working difficult, you might be eligible. Typically, you’ll get a weekly benefit for 13-to-26 weeks. In five states (California, Hawaii, New Jersey, New York and Rhode Island –along with Puerto Rico), the state mandates this insurance program.

You also have the option of buying short-term disability insurance on your won. However, this often costs a lot and might not cover short-term disability caused by your cancer.

You might also have short-term disability insurance through your job. Work with your employer to review your policy’s terms and ensure you get the benefits you deserve. When and if you make a claim, do so as soon as possible after you stop working.

Long-term Disability Insurance

This program can also help you when breast cancer interferes with your job—in this case, for a longer period. If an illness or injury (again, unrelated to work) has already kept you away from work for some time and you can expect to be away for an extended time, this program can help. It will replace all or part of your pay. Typically, you get this insurance along with short-term disability, but you can also receive or buy it as a separate policy. As with short-term disability, you should work with your employer to receive your specific benefits.

Medicare

This federal, insurance program usually helps people older than 65, but it can also cover younger people if they are disabled. Different parts of the program pay for hospital care, home healthcare, doctors’ services and prescription medication. Keep in mind that, even if you have Medicare, you might have to pay for premiums, deductibles and copayments. For people with low-incomes, state Medicaid programs can cover these out-of-pocket payments. (See below.) Ask your Medicare representative if that option is available to you. Even you have commercial insurance; Medicaid can still cover out-of-pocket costs if you have low income.

Medicaid

This state program helps low-income people of all ages pay their medical bills. The program covers almost all of your medical costs, aside from some small copayments for emergency room visits and prescription drugs. These cost between $5 and $10. Eligibility requirements vary by state. You can find out more at the Centers for Medicare and Medicaid Services (CMS) website or at 1.800.MEDICARE (800.633.4227). This toll-free service is available 24 hours a day, 7 days a week.