Does My Health Insurance Cover Mesothelioma Costs?

Mesothelioma health insurance coverage pays for medical expenses associated with cancer treatment, medications, and other care.  Patients have different options for selecting how they want their medical bills covered, including individual health insurance, employer-sponsored health insurance, or public health insurance.

The substantial costs of cancer care in the United States cost patients about $4 billion out-of-pocket for treatments in 2014. The total cost of healthcare spending in the U.S. that year was roughly $87.8 billion, mostly paid by employers, insurance companies, or taxpayer-funded public programs (Medicare and Medicaid).

Most mesothelioma patients use some form of health insurance coverage. Health care plans, however, do not typically fully cover treatments and screenings. Insurance methods pay different amounts of coverage. Employer-sponsored health insurance plans typically pay up to $6,000 each year to cover mesothelioma treatment costs, while individual plans pay up to $10,000. Medicare typically pays an average of $8,000 each year.

Insurance Options For Mesothelioma Patients

The first step in choosing what insurance plan meets your needs is to understand the differences between the types of insurance options for mesothelioma patients. Most Americans have private health insurance. In 2017, private health insurance coverage made up 67.2% of insurance coverage. Legal compensation for a mesothelioma diagnosis can help offset treatment costs.

Private Insurance

Private health insurance companies are private entities that offer health insurance coverage. Insurance brokers and companies are not state or federal organizations. Private companies consist of licensed agents that offer insurance plans differing in benefits. Benefits must meet the minimum essential coverage requirements in accordance with the Affordable Care Act (Obamacare). 

The costs of private insurance depend on the premiums and deductibles. A patient pays a premium each month to maintain coverage. They also pay a deductible or an out-of-pocket cost that a patient pays at the time of appointment. Premium and deductible costs vary based on age, gender, and overall health.

Employer-Sponsored Insurance

Employer-sponsored health insurance is a health policy selected and purchased by an employer. Eligible employees and their dependents can use group plans to access health care coverage. Employees and employers typically split the costs of the employer-sponsored health insurance premiums.

The Affordable Care Act, signed into law in 2010, mandates employers with at least 50 full-time employees must offer affordable, minimum value insurance coverage to employees working 30 or more hours per week. Employers that don’t meet the law requirements face tax penalties.

Medicare or Medicaid For Mesothelioma Health Insurance Coverage

Medicare is a federally funded health insurance program for senior citizens aged 65 and older. Most mesothelioma patients meet the age qualification for Medicare. Mesothelioma patients under 65 can still qualify for Medicare due to their specific illness. Medicare covers the costs of treatments, supplies, services, and medication for mesothelioma patients. 

Factors that determine what type of Medicare coverage a person needs includes:

  • Type of Care: Inpatient, nursing home, hospice, in-home care
  • Cost of Premium: Monthly costs that an individual pays (covers prescription drugs)
  • Additional Costs: Doctor visits, laboratory costs, medical equipment, ambulance services

Medicaid is a federally-funded insurance program designed to cover the cost of medical care for individuals that do not qualify for Medicare, who cannot afford individual insurance, and who do not qualify for employer-sponsored insurance. Medicaid coverage varies by state, but generally covers most mesothelioma treatments costs.

VA Benefits

More than 30% of mesothelioma patients in the United States are veterans. Congress established the first version of Veterans benefits during World War I in 1917. The program was consolidated in 1921 with similar programs that administered various benefits, including healthcare and loans.

Veterans who have been honorably or other-than-dishonorably discharged can apply for healthcare benefits through the VA. Hospitals in the VA system provide free or low-cost health care to veterans with mesothelioma. The national network of VA hospitals that specialize in mesothelioma are spread out throughout United States cities, including Los Angeles, Miami, Boston, and Houston.

Factors That Affect Health Insurance Coverage For Mesothelioma

With different options to choose from, it can be difficult to determine which type is best for mesothelioma patients. To understand your best options for your specific situation, your insurance company, social workers, or patient advocate can assist you. In general, these factors affect how you may pay for mesothelioma treatment.

Copays

A copay is a flat-rate fee a patient uses per service. Rather than the insurance provider, the patient pays the copay. A mesothelioma patient may pay the copay at the time of appointment.

Deductibles

A deductible is an out-of-pocket expense an individual pays each year before insurance coverage. For example, an individual may pay $500 in deductible before their insurance will cover any expenses.

In-Network vs. Out-of-Network

Each type of insurance specifies what hospitals, doctors, and pharmacies they will cover. In general, insurance will specify in-network providers in which they will cover. Receiving care from out-of-network providers can result in higher prices.

Out-of-Pocket Maximums

An out-of-pocket maximum is the amount of money an individual pays themselves before health insurance must cover the rest. Maximums can reach nearly $20,000 before insurance companies are required by law to cover the remaining medical bills for that year.

Premiums

A premium is a monthly payment an individual makes to be covered by health insurance. Patients with high premiums may pay lower copayments at the time of treatment. Contrarily, patients with lower premiums generally pay higher copays and may not be covered at certain treatment centers.

Mesothelioma Support Team

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