Health Insurance Options & Lung Cancer Coverage
There are a wide variety of health insurance plans available, including employer-sponsored plans, private health insurance, and government-sponsored insurance programs.
Each of these plans may require you to pay a monthly fee, known as a premium. Most plans also require you to pay a deductible—a certain dollar amount of your medical costs each year before insurance coverage kicks in. Depending on your plan, you may also be responsible for paying a flat fee for healthcare provider’s visits (co-pay) or a percentage of the cost of services (co-insurance).
The most common types of health insurance plans that provide coverage for lung cancer screening and treatment include employer-sponsored plans, state insurance marketplace plans, Medicare, Medicaid, and individual or private plans.
Employer-sponsored health insurance plans are offered by companies as a benefit of employment. These plans typically cover the employee and their dependents (and often their spouse). A little over 55% of Americans have employer-sponsored health plans.6
You can usually sign up for these plans when you start a new job. You can also add yourself, your child(ren), and/or spouse to your work health insurance plan during the open enrollment period, which happens once a year.
It’s important to understand your health insurance options prior to opting into an employer-sponsored plan. Read through the details of the plan (Summary of Plan Benefits) to make sure it provides the coverage you need for cancer care. Consider the following factors:7
- Total benefits covered by the plan
- Your out-of-pocket expenses (e.g., deductible, copays, coinsurance)
- Prescription medication coverage
- If your providers (e.g., primary care physician, oncologist, cancer treatment center) are in-network with the plan
- Whether or not there is a cap on what the insurance policy will pay for healthcare
State Insurance Marketplace Plan
The Health Insurance Marketplace is a government-run service that helps people enroll in affordable health insurance plans. All Marketplace plans provide coverage for the treatment of pre-existing conditions, including cancer.8
The federal government operates the Marketplace in many states, and other states run their own Marketplaces.9 Depending on your income, you may qualify for free or low-cost coverage or subsidies to help cover the cost of the plan.
All health insurance plans offered in the Marketplace cover 10 essential health benefits, including:10
- Outpatient care
- Emergency services
- Hospitalization (e.g., surgery, overnight stays)
- Prenatal and postnatal care
- Mental health and substance use disorder treatments
- Prescription medications
- Laboratory services (e.g., bloodwork)
- Chronic disease management and preventative services (e.g., screening tests)
- Rehabilitative and habilitative services and devices (e.g., assistance for people with disabilities and chronic conditions)
Medicare is a government-funded health insurance program that covers 80% of the cost of cancer treatments. You will be responsible for paying 20% of the billed amount until you reach your annual deductible.
There are four parts of Medicare, and each part covers different services related to cancer treatment:13
- Part A (hospital insurance) covers inpatient care in hospitals, including any cancer treatments you receive while in the hospital. It also includes hospice care, home health care, and skilled nursing facility care. Most people don’t pay a monthly premium for Part A, but you must meet your deductible before coverage kicks in for Part A.14
- Part B (medical insurance) helps cover the cost of some cancer-related outpatient treatments and services. This includes healthcare provider visits, many chemotherapy drugs, radiation treatments, diagnostic imaging tests (e.g., CT scan), medical equipment, nutritional equipment (e.g., feeding pump), mental health services, and outpatient surgery.
- Part C (Medicare Advantage) are private health insurance plans that bundle Medicare Parts A and B benefits, and (usually) Part D. These private plans must cover everything that Original Medicare covers for healthcare services and prescription drugs, but they may have more expensive premiums, and it may cost more to see a healthcare provider that is out-of-network with your plan.
- Part D (drug coverage) is an optional part of Medicare that helps cover the cost of prescription medications, including chemotherapy drugs, anti-nausea drugs, and other medications used to treat cancer and its associated symptoms. Most Medicare Advantage plans provide drug coverage, but if yours doesn’t (or you don’t have Part C), you can choose a Part D prescription drug plan.