Cancer and the Affordable Care Act
- The deadline to enroll in the ACA this year is December 15 in most states.
- Plan options and deadlines may vary by state.
- Doing your research on plans is extremely important.
- Ask for help navigating ACA options if you need it.
Open enrollment for coverage under the ACA is currently underway and runs through December 15 in most states. It's important to note that if you miss the open enrollment period for ACA, then you won't be able to enroll again until the following year, unless you have a qualified life-changing event, such as having a baby, moving to another state or losing employer-sponsored health care cover, that allows you to take advantage of a special enrollment period.
Read MoreCancer & the Affordable Care Act
Also known as ObamaCare, this law was enacted in March 2010 to make affordable healthcare coverage available to a greater number of people. In general, it allows people to buy health insurance through state or federal marketplaces. There are four important components of the law for cancer patients: 1. Those who apply can't be refused coverage based on pre-existing conditions, such as cancer. 2. There's no limit on the lifetime or annual coverage amount. 3. They can’t use genetic information when making decisions about coverage. 4. Cancer screenings, including mammograms and colonoscopies, are included as essential health benefits. Once a year, open enrollment allows people to enroll in one of the plans. These plans, including their dates for open enrollment, vary by state. Those who have employer-sponsored healthcare insurance may not need ACA coverage, however, it's an option to consider for those who don't have insurance or those who have a plan with extremely high premiums.Christina Bach, a clinical oncology social worker in Pennsylvania, says the ACA has done more to change our healthcare system than anything since the introduction of Medicare and Medicaid. And for some cancer patients, it's an incredible benefit because it's an option to get insured when previously they may not have been able to secure coverage. However, she stresses that you must do the research before enrolling.
"Read the fine print and do the math," Bach says. "Don't wait until the day that open enrollment ends. It takes more time to do the work involved."
For example, there are various levels of plans available to consider. In general, you pay higher monthly premiums for plans that provide the most coverage should you get sick.
They're categorized as Bronze, Silver, Gold and Platinum, based on the level of coverage they provide.
- For instance, the bronze plan is the least expensive, and it provides 60/40 coverage, meaning you pay 60 percent of your medical bills and the plan pays 40 percent.
- The platinum plan, on the other hand, is the most expensive and it provides 90/10 coverage.
- For all plans, there's a maximum out-of-pocket limit after which the plan pays 100 percent.
Bach says for people who are risk tolerant, one of the less expensive plans may be an option, since they have the lowest premiums. However, they require the highest payments if you get sick, so she cautions most cancer patients against choosing the cheapest one.
In-Network vs Out-of-Network Challenges
As many people as it has helps, the ACA isn't a panacea. For example, the healthcare plans only pay for coverage of in-network providers. So, if you love your oncologist, and sign up for a plan in which they're out-of-network, the costs can still be exorbitant.
If you have your heart set on a provider, you need to make sure they're in the network.
"If you have your heart set on a provider, you need to make sure they're in the network," Bach says. "A lot of people aren't paying attention and are looking at the sticker price. They want the cheapest plan, but they don't understand that the doctors they want to see aren't included in their plans."
She said in some cases, rare cancers should be treated at specialized cancer enters, which may not be included under a particular plan. Also, some states offer a wide variety of plans, while others offer only a few. So, where you live plays a big factor in whether ACA may meet your needs or not.
Help With How Affordable Care Act Works
Navigating the ACA and all the plans can be overwhelming for many people, especially when they're also undergoing cancer treatments. Fortunately, there are financial navigation specialists who specialize in oncology, like Bach, who can help. You can ask your treatment center if one is available to you, or contact a national cancer support organization for assistance, such as the Cancer Support Helpline who can put you in touch with a financial navigation specialist.
In any case, Bach says it's extremely important to know what you're signing up for.
"It gets very complicated, and I think clients get a little bit nervous about how to navigate this system," Bach said. "It's important to ask for help if you need it."
The Future of the Affordable Care Act
The future of the ACA is uncertain as the Supreme Court is reviewing the law. Bach said many are terrified about the potential impact of the ruling. For now, however, she says patients should proceed with enrollment if they deem it the right move for them.
"The exchange is still open," Bach says. "They're still selling plans. It's still the law of the land."
For more information on the ACA, visit the healthcare.gov website. You can also view a webinar series that covers the ACA and other health insurance topics at OncoLink.
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