Health Insurance Guidance & Tips for Survivors

Everyone needs dependable health-insurance coverage, but it's especially important for cancer survivors. Not only do you need to have health insurance, you need to understand your insurance policy and know your rights. Above all, it is extremely important to maintain continuous coverage, avoiding any lapses. As a cancer survivor, you may have trouble obtaining new coverage if your existing policy does lapse. If you are self-employed or unemployed and seeking private coverage, you may face high premiums, waived or excluded pre-existing conditions and extended waiting periods.

Below is information to help you understand the different types of health insurance that may be available to you.

Employer-Provided Insurance

Most health insurance provided by employers is a form of managed care. This approach provides healthcare services in the most cost-effective manner. Below are some descriptions of the more common managed-care models:

Preferred Provider Organization (PPO)
This model has a network of providers. You can receive care with providers who are not listed, but there may be more out-of-pocket expenses associated with it.

Point-of-Service Plan (POS)
This plan will encourage you to choose a Primary Care Physician (PCP). A PCP makes referrals for care within the network. Again, you can choose to go out of the network, but there may be additional costs associated with it.

Health Maintenance Organization (HMO)
In this model, the HMO has a contract with specific health care providers and provides prepaid, comprehensive services to its members. There is often a set fee or co-payment associated with office visits and other services. You must pick a PCP under this plan and you must be referred for specialty care within the HMO network.

Health Savings Accounts (HSA)
In January 2004, Congress passed a new law designed to allow consumers to pay for qualified medical expenses with pre-tax dollars. HSA's are tax-free accounts individuals can use to pay for routine medical expenses. They must be combined with a high deductible health-insurance policy.

Group Insurance

If your employer does not offer healthcare coverage, or if you are self-employed, investigate group health care policies through other organizations, such as labor unions, fraternal organizations, professional or business organizations, student associations, religious groups, or other special-interest groups. The Encyclopedia of Associations, found at most public libraries, includes information on groups that offer insurance coverage. Be sure to investigate any insurance carrier with your state's regulatory office; as in any industry, beware of fraudulent insurance providers.

State and Federal Programs

In addition, you may qualify for state or federal health insurance. Currently, state and federal laws offer cancer survivors very limited help in obtaining health insurance, but advocates are working toward improving this situation. Listed below are government-sponsored programs you may qualify for:

Medicaid
The Medicaid program pays for medical assistance for individuals with low income and limited resources. In addition to the financial criteria, you must fall into one of these categories: pregnant women, children and teenagers and those who are aged, blind and/or disabled. As a childhood cancer survivor, you may qualify under the disabled category. Each state administers its own eligibility guidelines and services.

Of special interest to childhood cancer survivors are the services provided under Medicaid's Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT). The services covered are designed to reduce physical and mental disability and assist the survivor in living at the most functional level possible. For more information, call 1-877-267-2323 or visit the Web site at www.cms.hhs.gov/medicaid.

Medicare
Medicare is the national insurance program for people 65 or older, some under 65 with disabilities, and those with end-stage renal disease. Individuals who are under 65 and who have received Social Security Disability Insurance (SSDI) payments for 24 months are eligible for Medicare. You must wait an additional five months (29 months total) before receiving Medicare benefits. For more information, call 1-800-MEDICARE or visit the Web site at www.medicare.gov.

State Children's Health Insurance Programs (S-CHIP)
This program, also known as CHIP in most states, offers free or subsidized coverage for children from low-income families up to age 19. S-CHIP is a part of the Medicaid program in some states and a separate program in others. It often allows a higher income level than Medicaid and is intended for working families whose employers do not offer Medicaid.

For more information on Medicaid and S-CHIP in your state, check the government pages in your phone book, or contact the Centers for Medicare & Medicaid Services through its Web site, www.cms.hhs.gov.

Drug-Coverage Programs

Recently both the private and public sector have introduced programs to assist with the ever-increasing cost of prescription drugs. Listed below is information on drug programs. Because the programs are being constantly updated, it is important to check their Web sites for specific and current information.

Medicare Prescription Drug Discount Card
Following the passage of the Medicare Prescription Drug Improvement and Modernization Act of 2003, the Medicare Approved Drug Discount Card Program was implemented. This program is designed to assist with Medicare recipients with the cost of prescription drugs. The Centers for Medicare & Medicaid Services has detailed information including drug-card sponsor lists (www.cms.hhs.gov).

Together Rx Access Card
Ten pharmaceutical companies united to provide access to a wide range of prescription products for people who do not have insurance or who lack prescription-drug coverage. Qualification guidelines and enrollment are available at www.togetherrxaccess.com or by calling 1-800-444-4106.

Barriers to Insurance

If you have not been able to obtain health insurance through your employer, a group or the state, you may have to purchase an individual policy. These policies can be extremely expensive. An insurance broker can help you find options. Below are a couple of things you should consider first.

• Can your parents extend their policy to cover you? You may qualify under their policy as 'disabled' or 'handicapped' because of your cancer history.
• Contact your state representative or congressperson. The majority of offices have case managers to serve as your advocate and answer your questions. Contact information for your representative can be found at the U.S. Senate (202-224-3121) or House of Representatives (202-224-3121).
• Contact the National Association of Insurance Commissioners. It can also provide contact information and details about state health-insurance programs. The association can be contacted by phone at 1-816-842-3600.