Health Insurance & Legal Rights

Health Insurance

Having health insurance is especially important for cancer survivors, since you need to guard against your health and wellness more than most people.

It's especially important that survivors have health insurance coverage that is continuous (no lapses in coverage) regardless of changes in your age, school, or job situation.

For decades, cancer survivors have had problems getting or maintaining adequate health insurance. This has been especially true for survivors who have been recently diagnosed or treated. Survivors may no longer have coverage through their parents' policy because of their age, or having a preexisting condition may cause problems in getting insurance. Thanks to the recently signed health reform legislation, many of these barriers to coverage should be breaking down soon.

For instance, most childhood cancer survivors first have health insurance through their parents' insurance policy. Under the new legislation, unmarried adult children will soon be able to stay on their parents' insurance policies until age 26. Read on for a listing of other provisions in the health care bill that affect pediatric cancer survivors.

 Health Care Reform Legislation  (March 2010)

• No lifetime and annual limits:  Prohibits a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. Permits a restricted annual limit for plan years beginning prior to January 1, 2014. Declares that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits to the extent that such limits are otherwise permitted.
• Prohibition on rescissions: Prohibits a health plan from rescinding coverage of an enrollee except in the case of fraud or intentional misrepresentation of material fact.
• Dependent coverage: Requires a health plan that provides dependent coverage of children to make such coverage available for an unmarried, adult child until the child turns 26 years of age.
• Limits on pre-existing condition exclusions: Prohibits pre-existing condition exclusions. Prohibits discrimination on the basis of any health status-related factor. Allows premium rates to vary only by individual or family coverage, rating area, age, or tobacco use.
  
  • High Risk Pools: Requires the Secretary to establish a temporary high-risk health insurance pool program to provide health insurance coverage to eligible individuals with a pre-existing condition. Terminates such coverage on January 1, 2014, and provides for a transition to an American Health Benefit Exchange.
• Guaranteed Issue/Renewability: Requires health plans in a state to: 1) accept every employer and individual in the state that applies for coverage; and 2) renew or continue coverage at the option of the plan sponsor or the individual, as applicable. Prohibits a health plan from establishing individual eligibility rules based on health status-related factors, including medical condition, claims experience, receipt of health care, medical history, genetic information, and evidence of insurability.
• Prohibition on excessive waiting periods: Prohibits a health plan from: 1) applying any waiting period for coverage that exceeds 90 days; or 2) discriminating against individual participation in clinical trials with respect to treatment of cancer or any other life-threatening disease or condition.
• Essential Health Benefits: Defines "qualified health plan" to require that such a plan provides "essential health benefits" and limit cost sharing. Directs the Secretary to: 1) define essential benefits benefits and include emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care; 2) ensure that the scope of the essential health benefits is equal to the scope of benefits provided under a typical employer plan; and 3) provide notice and an opportunity for public commend in defining the essential health benefits. Package to be updated annually. 

For more on the impact of health care reform, watch the following presentation - with audio - given by Claire Fonteno, Director for Federal Relations at MD Anderson, was was presented at the April 2010 RTA-Houston conference.

 Federal and State Health Insurance Access Programs

Medicaid

Medicaid is a health insurance program, sponsored by the federal and state governments, that helps many people who can't afford to pay for some or all of their medical bills. To qualify for Medicaid, you have to have a small income and be eligible in other ways determined by federal and state law.

If you have a low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. Depending on your state's rules, you may also be asked to pay a small part of the cost (co-payment) for some medical services.

Medicare

Medicare is a federally run health insurance program for people 65 and older and also for people with disabilities. Your cancer history may make you eligible as having a disability so there may be circumstances in which you might qualify for Medicare.

State Children's Health Insurance Program (SCHIP)

SCHIP provides health insurance to children whose families earn too much money to be eligible for Medicaid, but not enough money to buy private health insurance. Families must meet other requirements to be eligible.

Hill-Burton Program

Under this program, the federal government gives funds to a number of hospitals and other medical facilities so they can provide free or low-cost services to those who are unable to pay. Each facility chooses which services it will provide for free or a lowered cost. Medicare and Medicaid services aren't eligible for Hill-Burton coverage. You may apply for Hill-Burton assistance at, before, or after you receive care. Call the Hill-Burton Program for more information at 1(800) 638-0742.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

COBRA is a federal law that gives you a way of continuing the health insurance plan your employer provides. It applies if you decide to leave your job, are in-between jobs, or reduce your work hours and are no longer considered full-time. COBRA can be especially important for survivors who, because of their cancer history, need to maintain their health insurance coverage.

COBRA applies to employers with 20 or more employees. There is also a time limit to how long you can remain on the group plan through COBRA as well as limits on what you can be charged for this coverage. For more details on COBRA provisions, visit the Department of Labor website as www.dol.gov.

For more information on the various health insurance options available to survivors, watch the presentation below (with audio) given by Ricki Hasou, a Senior Managed Care Analyst at MD Anderson at the April 2010 Rise to Action conference. Due to length (approximately 20 minutes), this is a two-part presentation.

Part One

Part Two

 Resources and News Articles

Cancer Legal Resource Center - A community-based joint program of the Disability Rights Legal Center and Loyola Law School (California). The CLRC provides information and education on a broad range of cancer-related legal issues, including health insurance. 

Patient Advocate Foundation - A national non-profit organization that serves as an active liaison between the patient and their insurer, employer, and/or creditors to resolve insurance, job retention, and/or debt crisis matters relative to their diagnosis through case managers, doctors, and attorneys.

• "Premiums for New 'High Risk' Pool Could be Steep" (Associated Press - 7/1/10)
• "Costs Cause Cancer Survivors to Skip Care" (Associated Press - 6/14/10)
• "Insurers Agree to Fix Gap in Sick Kids' Coverage" (Associated Press - 3/29/10)