Troy E. Walton
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Health Care Options for Mesothelioma Patients
A patient’s health insurance plan often determines the treatment available to them. Patients should be aware of their insurance situation to pursue the best mesothelioma treatment possible.
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Types of Insurance
Health insurance is first categorized as public or private. Public 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 sub-categorized by group and individual. Group plans are applicable to insurance gained through employment. These are called group plans because an employer negotiates a single premium that becomes available to all employees. Individual mesothelioma insurance plans, by comparison, 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. This is 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.
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, 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 an option available to those who cannot get health care coverage. These plans help those who seek coverage after they’ve been diagnosed.
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. Therefore, mesothelioma insurance may not be viable under a private individual plan.
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Employment and Treatment
Being unable to work as a result of mesothelioma is a major concern for many patients. Fortunately, there are several legal protections.
The Consolidated Omnibus Reconciliation Act (COBRA) is a primary legal protection for those who can no longer work due to a serious illness. Many patients are unable to keep their job or must work fewer hours because they are sick. COBRA helps these patients keep their insurance.
Other legal protections for those with serious illnesses include the:
- Americans with Disabilities Act
- Family and Medical Leave Act
- Affordable Care Act
These laws protect patients and family members from unfair treatment in the workplace.
Understanding Coverage After Diagnosis
Most people diagnosed with mesothelioma have some form of coverage. However, most health care plans do not fully cover treatments and screenings.
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.
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$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 (known as “Obamacare”) provides insurance coverage options to millions of Americans.
While the policy urges people to have health insurance, as of 2019, there is no Shared Responsibility Payment. Therefore, 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.
More than 30% of all mesothelioma patients are U.S. military veterans. The Veterans Administration Hospital provides free health care to veterans.
Frequently Asked Questions About Mesothelioma Insurance
What is the difference between public and private insurance for mesothelioma?
Private insurance for mesothelioma is usually employer-run health care plans. Some people prefer to find their own private insurance plan, although it’s often more expensive than through their employer. Public insurance for mesothelioma includes government-funded programs, which are intended for people meeting specific criteria.
What is Medicare for mesothelioma?
Medicare is the most likely public insurance option for someone with mesothelioma. This health care coverage is for people older than 65, plus younger individuals with specific disabilities. Mesothelioma usually affects elderly Americans, which is why Medicare coverage often helps people with this cancer.
Does Obamacare cover mesothelioma treatment?
Obamacare provides Amercans with private insurance options at a cheaper rate than if they sought their own private insurance plan. Your coverage for mesothelioma depends on the plan and carrier you choose. Obamacare protects Americans against:
- Rising rates or canceled coverage due to pre-existing conditions
- Discrimination based on race, gender or age
What factors affect how much I pay for mesothelioma insurance?
Your private insurance costs depend on your premiums and deductibles. Your premium is the monthly fee and the deductible is the out-of-pocket costs you’ll pay for medical care. These vary based on your age, gender and health. Mesothelioma primarily affects elderly males, which is a factor insurance companies consider.
Sources & Author
- National Institutes of Health. Economic Impact of Cancer. Retrieved from: http://www.cancer.org/cancer/cancerbasics/economic-impact-of-cancer. Accessed: 11/01/18.
- Pre-Existing Conditions. U.S. Department of Health and Human Services. Retrieved from: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html. Accessed: 04/02/19.
- Health Plans & Benefits: Continuation of Health Coverage — COBRA. U.S. Department of Labor. Retrieved from: https://www.dol.gov/general/topic/health-plans/cobra. Accessed: 04/02/19.
- FMLA (Family & Medical Leave). U.S. Department of Labor. Retrieved from: https://www.dol.gov/general/topic/benefits-leave/fmla. Accessed: 04/30/19.
- High-Risk Pool Plan (State). Healthcare.gov. Retrieved from: https://www.healthcare.gov/glossary/high-risk-pool-plan-state/. Accessed: 05/30/19.
- Minimum Essential Coverage. Healthcare.gov. Retrieved from: https://www.healthcare.gov/glossary/minimum-essential-coverage/. Accessed: 05/31/19.
- No insurance? See if you’ll owe a fee. Healthcare.gov. Retrieved from: https://www.healthcare.gov/fees/fee-for-not-being-covered/. Accessed: 05/31/19.
- Types of Health Insurance Plans. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/health-insurance-options/types-of-health-insurance-plans.html. Accessed: 04/02/19.