benefit limit for chemotherapy

Since 2005, the ACS has document the circumstances of >16,000 uninsured and underinsured cancer patients through the Health Insurance Assistance Service (HIAS), a program of the ACS National Cancer Information Center (NCIC). Paying for cancer treatment is a significant problem for a number of cancer patients. Even those who have private insurance have often faced substantial out-of-pocket costs associated with deductibles, copays, and annual or lifetime caps []. Typical scenarios include:

  • A woman who thought she had good insurance until she was diagnosed with stage IV breast cancer. Halfway through her scheduled chemotherapy, she was notified that she had reached her policy’s annual benefit limit for chemotherapy. Her treatment was stopped.
  • A man in his 30s who is diagnosed with melanoma. He has no insurance and cannot qualify for his state’s Medicaid program. He literally cannot find treatment.
  • A woman who is a 20-year breast cancer survivor who can afford only a catastrophic health insurance policy because of her “pre-existing condition.”

In early 2010, the ACS advocacy arm known as the American Cancer Society Cancer Action Network commissioned a nonpartisan study examining how families fared in the health system prior to implementation of the Affordable Care Act (health care reform) [].

Key findings were:

  • High health costs jeopardize the ability of families affected by cancer to afford the care they need. Half of the families with someone aged <65 years with cancer (49%) say they have had difficulty affording health care costs, such as insurance premiums, copays, and prescription drugs, in the past 2 years.
  • High health costs also prevent people with cancer and their families from affording basic necessities. In the past 2 years, nearly one third of families with someone aged <65 years with cancer (30%) have had trouble paying for basic necessities or other bills, and 23% have been contacted by a collection agency. About one in five (21%) has used up all or most of their savings, and one in six (18%) has incurred thousands of dollars of medical debt.
  • Affordability of care is a major issue for people aged <65 years, and for those most in need. As a result of costs, one in three individuals aged <65 years diagnosed with cancer (34%) has delayed needed health care in the past 12 months, such as putting off cancer-related tests or treatments, delaying cancer-related checkups, not filling a prescription, or cutting pills. Of those currently in active cancer treatment, one in three (33%) has put off some type of health care in the past year because of costs.
  • People with cancer and their families struggle to stay insured. One in three families (34%) with someone aged <65 years with cancer says that person has been uninsured at some point since their diagnosis.
  • The costs of coverage continue to rise. Four in 10 families (42%) with insurance say their premiums and/or copays have increased in the past 12 months for the family member with a cancer diagnosis, and one in four (25%) says his or her deductible has gone up.