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MESOTHELIOMA INSURANCE OPTIONS

Getting mesothelioma treatment can be expensive. Learn more about insurance options that can help pay for treatment.

Health Insurance Types

There are three types of health insurance plans that can help mesothelioma patients pay for treatment. Although the actual amount each plan covers will vary between plans and from patient to patient, knowing the pros and cons of each can help patients understand what to expect financially.

Individual Private Insurance

Individual private insurance plans come in many shapes and sizes and can help pay for mesothelioma treatment costs.There are two main kinds of individual private insurance:

Managed Healthcare Plans

These plans include HMOs (health management organizations) and PPOs (preferred provider organizations). Typically, a patient is only covered if he or she uses a doctor who is under contract with the HMO or PPO network. This may restrict a patient’s choice of doctor for a disease like mesothelioma, which requires specialized treatment.

HMOs and PPOs usually require less paperwork and lower co-pays/premiums than most other individual private insurance plans. This makes the claims process easier and allows patients to focus more on getting treatment.

Traditional Health Insurance (Fee-for-Service Plans)

Traditional health insurance plans require patients to pay a monthly premium and yearly deductible. Patients must also file their own claims and may, under some circumstances, have to pay up front for treatment. These additional costs should be recorded so that the insurance company can reimburse patients for the exact amount they paid out-of-pocket.

Traditional plans are more flexible than HMOs or PPOs because the patient is not restricted to a network of doctors and has the option of choosing a specialist with mesothelioma experience.

Employee Health Insurance

Employee Health insurance plans are chosen, and sometimes purchased, by employers for their workers. They differ from individual private insurance in that the plan itself is negotiated by the employer for a group of people, namely the employees, and not for individuals.

This type of health insurance benefits mesothelioma patients in a number of ways. Because policies are typically negotiated by the company for employees as a group, the insurance company does not screen each individual employee for pre-existing conditions. Patients won’t be turned away for a pre-existing condition like mesothelioma or have to pay high premiums to obtain coverage.

Additionally, there is less paperwork when a claim is filed for a group plan, a feature which saves time and a considerable amount of stress. Another benefit is that federal regulations require employers to purchase full coverage for their employees. Full coverage helps patients get the quality of treatment mesothelioma, an aggressive disease, demands.

Medicare and Medicaid

Mesothelioma patients may also qualify for government health insurance programs like Medicare and Medicaid. Medicare is a program instituted by the government to help Americans over the age of 65 pay for health care. Since 60 percent of mesothelioma patients are over the age of 65, Medicare can serve as a resource to help older patients pay for treatment.

Medicaid is available for patients who cannot afford to pay for health insurance. If you are a low income earner or are unemployed, Medicaid can help you pay for treatment. Patients with questions about these government programs should contact the Centers for Medicare and Medicaid.

ACA and Insurance

The Affordable Care Act (ACA) made health care insurance available for millions of uninsured Americans. ACA is beneficial to mesothelioma patients in a number of ways:

  • Employers cannot discontinue coverage for employees who are diagnosed with a terminal or life-threatening disease, like mesothelioma.
  • As of January 1st, 2014, lifetime and annual benefits are unlimited. This means that insurance companies can’t limit the amount they pay out for a claim.
  • Insurance companies cannot discriminate based on pre-existing conditions or diseases. Being diagnosed with mesothelioma will not prevent a patient from signing up for a new plan.
  • Health plans offered on the individual market are required to provide benefits that can pay for treating serious diseases like mesothelioma.

An important detail to note is that ACA doesn’t require plans that are “grandfathered” to follow the new rules on unlimited lifetime and annual benefits. You have a grandfathered plan if you purchased the plan yourself on or before March 30, 2010. If you’re not sure whether or not you have a grandfathered plan, check with your insurance company.

Getting Financial Help

An estimated 20 percent of mesothelioma patients are uninsured. Unfortunately, these patients have to pay their medical bills out of pocket and deal with a seemingly endless amount of financial paperwork.

Uninsured patients do, however, have a number of options to help pay for treatment. They can speak to a mesothelioma specialist about clinical trials, where they may be able access cutting-edge treatments free of charge. There are also travel grants available that pay for all or part of a patient’s travel and housing expenses.

Veterans who’ve been diagnosed with service-connected mesothelioma are eligible for disability compensation and benefits from the VA. These benefits can go a long way to cover treatment costs.

Trust funds are also available to help patients pay for treatment. In the past few decades, courts have required companies who knowingly exposed employees and consumers to asbestos to compensation victims of exposure. Asbestos trust funds currently hold 35 billion dollars in compensation for victims of asbestos exposure.

If you’ve been diagnosed with mesothelioma and need help paying for treatment, we’re here to assist you. Contact a member of our Patient Help Team to learn more about financial assistance.

Sources:

1. Life and Annual Limits. Retrieved on September 8, 2014 from http://www.hhs.gov/healthcare/rights/limits/.
2. A National Cancer Data Base report on mesothelioma. Retrieved on September 8, 2014 from http://meetinglibrary.asco.org/content/118031-132.