Mesothelioma Insurance Options
Written by Retired LCDR Carl Jewett
Mesothelioma patients and their families endure emotional and financial strain starting the day of the diagnosis. However, there are resources available to alleviate some of the burden placed on them. Patients should understand their mesothelioma insurance coverage, which may lead to better treatment and a longer life.
Health Care Options for Mesothelioma Patients
The health insurance plan a patient has often determines the type of treatment available to them. Mesothelioma patients should be aware of their insurance situation to successfully pursue the best mesothelioma treatment possible.
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Types of Insurance
Health insurance is first categorized as public or private. Public mesothelioma insurance includes any insurance received from the government, such as Medicare or Medicaid. There are public insurance benefits available to many patients with mesothelioma.
Health insurance plans are subsequently categorized by group and individual. Group plans are mostly applicable to insurance gained through employment. These are called group plans because an employer negotiates a single premium with the insurance company that becomes available to all employees on the plan. Individual mesothelioma insurance plans, by comparison, only cover one person.
Medicare or Medicade
State Health Insurance Pools
Employer Health Care
Employer Health Care
Employer health care plans are typically the most desirable because the insurance company does not usually consider an employee’s health status. The employer negotiates a premium with the insurance company on behalf of all employees under the plan. Mesothelioma is rare so you should check with your employer health care regarding the mesothelioma insurance options.
Medicare or Medicaid
Medicare and Medicaid are specifically designed to help senior citizens and those who cannot afford healthcare, respectively. Since mesothelioma primarily affects older individuals, it is likely that many patients qualify for Medicare benefits. For those who have limited income, Medicaid is available. Visit the Centers for Medicare & Medicaid Services website for more information.
State Health Insurance Pools
Insurance pools are another option available to those who cannot get health care coverage. These plans help those whose seek coverage after they’ve been diagnosed, which labels them with a pre-existing condition.
Private Individual Insurance
Private insurance plans can provide help paying bills. Unfortunately, many private individual health plans do not cover treatments or prescriptions associated with cancer. HMO and PPO plans can limit a patient’s freedom when choosing a specialist or accepting special treatment during clinical trials. Therefore, mesothelioma insurance may not be viable under a private individual plan.
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Employment and Treatment
Being unable to work or losing a job as a result of mesothelioma is a major concern for many patients. Fortunately, there are several legal protections for those diagnosed with cancer.
The Consolidated Omnibus Reconciliation Act (COBRA) is one of the primary legal protections for those who can no longer work due to a serious illness. Patients with serious medical conditions risk losing their employer health care when they are unable to keep their job or are forced to work fewer hours because they are sick. COBRA allows these patients to keep their insurance.
Other legal protections for those with serious illnesses include the Americans with Disabilities Act, Family and Medical Leave Act and the Affordable Care Act. These laws provide patients and family members with protection from unfair treatment in the workplace and make better treatment more accessible. Being aware of newly available legal benefits is important to maximizing the financial and insurance assistance patients can claim.
Understanding Coverage After Diagnosis
Most people diagnosed with mesothelioma have some form of coverage, but most health care plans do not provide full coverage for essential treatments and screenings. Understanding the available options is important because private individual health care plans can place limits on access to specialists.
Traditional private health care and point of service (POS) plans usually let patients choose their physician. Health maintenance organization (HMO) and preferred provider organization (PPO) plans either choose a physician or limit patients to a network of doctors.
Employer health care plans offer the most benefits because they do not discriminate based on the status of your health. These plans are popular because the financial risk is divided among fellow employees, keeping costs lower than private plans. While these plans are more secure, patients may still be limited in the choice of a specialist depending on the type of group plan.
Get Access to Trust Fund Money
$32 billion is available to mesothelioma patients and their families.
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New Coverage for Mesothelioma Patients
The Patient Protection and Affordable Care Act (also known as “Obamacare”) provides insurance coverage options to millions of Americans who otherwise likely would be uninsured.
While the policy urges people to have health insurance, as of 2019, there is no Shared Responsibility Payment and the financial penalty for not having coverage no longer applies. Some states have their own individual mandate for health coverage and will impose a penalty if citizens do not have insurance.
According to the United States Census Bureau, around 28 million people (9% of the population) were uninsured in 2016. Uninsured patients pay their medical bills out of pocket or are forced to negotiate with the hospital on their own.
More than 30% of all mesothelioma patients are U.S. military veterans. The Veterans Administration Hospital provides health care to the veterans.
Another option is seeking mesothelioma compensation. There are trust funds set up to help compensate mesothelioma patients who were exposed to asbestos. These funds were set up by liable companies who knowingly exposed individuals to asbestos products. There are billions of dollars in these funds, all set aside to mesothelioma patients.
Last Edited: June 23, 2020.