Without affordable insurance, patient costs could skyrocket

Report looks at staggering financial impacts of a cancer diagnosis

By Marissa Harshman, Columbian Health Reporter

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Cancer patients faced nearly $4 billion in out-of-pocket costs for their treatment in 2014. And those are people with insurance.

“Four billion out of pocket for consumers to spend on health care is a tremendous amount,” said Kirsten Sloan, vice president of public policy for the American Cancer Society’s Cancer Action Network. “Without affordable insurance, that number could be double or triple.”

For patients facing a Stage 1 breast cancer diagnosis, the out-of-pocket costs can range from $5,819 for someone with an employer-provided insurance plan to $10,114 for those who purchase individual health plans. Patient costs for Medicare enrollees totaled $8,793, according to a new report.

The Cancer Action Network, the nonprofit policy arm of the American Cancer Society, released in April its Costs of Cancer report. The report looks at the out-of-pocket costs for three of the most common cancers — breast, lung and colorectal — for those with the three different types of insurance coverage.

For all three cancer types, those with employer-sponsored plans had the lowest out-of-pocket costs, while those who purchased their own plans paid the most. In all cases, cancer patients incur the highest out-of-pocket costs in the first two to three months after a their diagnosis.

The report used hypothetical cases to illustrate typical scenarios for each cancer and insurance type. A breast cancer patient with an employer-sponsored plan, for example, pays $154 per month in premiums. In the first two months of cancer treatment, that patient pays another $3,900 out of pocket before her deductible and out-of-pocket maximums are met.

The hypothetical patient’s total health care costs for 2016 were $144,193, with her insurance paying the vast majority ($140,218), according to the report.

Those with individual plans often have higher premiums, deductibles and out-of-pocket maximums than those with employer plans. That results in higher out-of-pocket cancer costs.

A breast cancer patient with an individual plan, for example, spends nearly twice as much on premiums as someone with an employer-sponsored plan. The same is true with co-pays and co-insurance costs, according to the report.

The hypothetical cases in the report are based on diagnoses made in January, which was also the first month of the patients’ health plan calendar. But that means people diagnosed later in the year — November, for example — could be forced to meet deductibles for two or even three years in a row.

“All of the co-pays and deductibles, the cap that you might have reached in the previous year, you have to hit it again,” Sloan said. “For somebody that is a mid-year or end-of-the-year diagnosis, meeting caps again can be prohibitive.”

Something else to consider, Sloan said, is indirect cancer costs.

The report looks only at the direct costs of cancer care — doctors, surgery, chemotherapy, radiation, medication — but doesn’t include the indirect costs, such as lost wages and transportation and child care costs, Sloan said. For example, someone undergoing cancer treatment will likely miss work time for medical appointments, chemotherapy and radiation treatment and surgery recovery, she said.

All of that combines to create a “tremendous burden” for patients, Sloan said.

“That’s why when you look at the reasons why Americans file for bankruptcy, medical costs are always at the top,” she said.