patients can face even when they
do have insurance.”
That’s not to say that cancer
patients who find themselves
facing significant medical bills
and difficulty keeping insurance
have no recourse. While far from
perfect, advocacy organizations,
co-pay assistance programs and
other public and private assistance
programs do help patients manage
the cost of cancer care. Such
aid, however, needs to be knitted
together on a case-by-case basis.
period between obtaining Social
Security disability benefits and
qualifying for Medicare.
CR | Page No. 57 | www.CRmagazine.org
DAMIeN SAATDJIAN
HEALTH INSURANCE PITFALLS
Nabhan’s financial struggles show
how limited benefits can render an
insurance policy virtually useless
in the face of cancer. And although
she has individual coverage, cancer
patients with employer-sponsored
plans can also find their coverage
inadequate or quickly bump up
against annual or lifetime benefit
limits that result in medical debt.
Debra Gauvin, a breast cancer
survivor in Connecticut, ran
into such a cap in her employer-sponsored plan in 2008. She
chose to delay radiation therapy
until the following year, when the
insurance would once again help
defray the cost of her treatment.
Although Gauvin’s plan has proven
inadequate, her cancer diagnosis
makes it difficult for her to obtain
health coverage in the individual
market because individual insurance
in Connecticut is medically underwritten, which means an applicant
can be denied a plan due to a
pre-existing condition. Had she
lived in one of the five states that
preclude the practice, she may have
been able to find coverage.
Another reason patients frequently
stick with employer-sponsored
insurance is to maintain continuous
coverage. This is a critical issue for
survivors to keep in mind—not only
for their health, but also to avoid
pre-existing condition exclusions if
they change employers.
Cancer patients who find themselves too disabled to work can
continue their employer-sponsored
health coverage for up to 18 months
through the Consolidated Omnibus
Budget Reconciliation Act of 1985
(COBRA). But this option doesn’t
come cheap: The employee usually
pays the contributions of the
employee and the employer plus a
2 percent administrative fee.
(See the box on page 56 about
COBRA assistance.) Medicare—a
federal health insurance program
for people 65 or older, some people
under 65 who are disabled, and
people of all ages with end-stage
renal disease—is another alternative, but with it, too, there are
limitations: a two-year waiting
FINDING FINANCIAL HELP
Despite the restrictions, patients
should investigate whether they
qualify for government assistance
(and not just Medicare). In fact,
seeking such assistance is one of
the primary recommendations
offered by Diane Blum, the
executive director of CancerCare, a
national nonprofit group that offers
free cancer support services.
It’s a lesson Joni Lownsdale
learned after her breast cancer
diagnosis. A self-employed Illinois
graphic artist and entrepreneur,
Lownsdale had been paying for
an individual insurance policy for
years. In August 2002, she was
diagnosed with stage I breast
cancer. Her insurance adequately
covered her lumpectomy, chemotherapy and radiation. But a year
and a half after diagnosis, her insurance company raised her monthly
premium from $300 a month to
$1,000 a month. “I remember crying,” she says, “because there was
no way I could afford it.”
