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Is Financial Help Available for Cancer Patients?

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Published on June 11, 2020

Financial navigators are available to help cancer patients but what programs can they connect patients with? What's the difference between programs like COBRA and the Affordable Care Act (ACA)?

Host Andrew Schorr got the answers straight from oncology navigators, Dan Sherman of Mercy Health Saint Mary's and NaVectis Group and Aimee Hoch from Grand View Health. Watch as they compare options and how to find what's best for you.

Watch Parts 1, 3 and 4 of this series at How Can I Find a Financial Navigator?Financial Assistance for Cancer Patients and Navigating the Costs of Cancer Care

This program is sponsored by Incyte, Janssen and Pharmacyclics. These organizations have no editorial control, and Patient Power is solely responsible for program content.

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Transcript | Is Financial Help Available for Cancer Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on June 4, 2020

Andrew Schorr:

After you have met a patient or a family member who has a financial concern about their cancer care, and you've discussed with them their personal current situation, what sort of options do you start looking at? Give us the kind of options that would be considered.

Aimee Hoch:

Yeah. Everybody's different. If they have lost their income completely, and they have lost their insurance, we might look at medical assistance. If they lost their job, like we talked about earlier, and they might be eligible for COBRA or the Affordable Care Act. I look at the treatment costs and also all the other co-pays that they are facing for testing, doctors’ appointments. I really look at the whole picture and try to help guide them, keeping in mind all of those costs that they are going to encounter. The earlier that I can meet with them the better, because the whole entire situation is stressful enough. Having this financial stress is another layer for them and to start helping to relieve that earlier on is best, because then they can start focusing on their healing and their treatment while I put resources in place for them.

Andrew Schorr:

Dan, even before the pandemic, we were talking about the financial toxicity of a cancer diagnosis and whether it could be, in some cases, a cause for bankruptcy for a family. Pretty terrifying. Let's talk about that situation. Somebody worked for a company, let's say they're in Philly for 20 years. The company can't continue in the economic environment we've been going through now for months, so they have lost their insurance. What are their options?

After you have met a patient or a family member who has a financial concern about their cancer care, and you've discussed with them their personal current situation, what sort of options do you start looking at? Give us the kind of options that would be considered.

Aimee Hoch:

Yeah. Everybody's different. If they have lost their income completely, and they have lost their insurance, we might look at medical assistance. If they lost their job, like we talked about earlier, and they might be eligible for COBRA or the Affordable Care Act. I look at the treatment costs and also all the other co-pays that they are facing for testing, doctors’ appointments. I really look at the whole picture and try to help guide them, keeping in mind all of those costs that they are going to encounter. The earlier that I can meet with them the better, because the whole entire situation is stressful enough. Having this financial stress is another layer for them and to start helping to relieve that earlier on is best, because then they can start focusing on their healing and their treatment while I put resources in place for them.

Andrew Schorr:

Dan, even before the pandemic, we were talking about the financial toxicity of a cancer diagnosis and whether it could be, in some cases, a cause for bankruptcy for a family. Pretty terrifying. Let's talk about that situation. Somebody worked for a company, let's say they're in Philly for 20 years. The company can't continue in the economic environment we've been going through now for months, so they have lost their insurance. What are their options?

Aimee Hoch:

Every situation is an individualized situation, but we would look at whether or not COBRA is available to that person or not.

Andrew Schorr:

That's a federal program?

Aimee Hoch:

Yes, COBRA is, and it's usually for 20 or more employees of that organization. We have to ask first if that individual has COBRA available to them, then from there we also could look at the ACA or Affordable Care Act as an option for them. We can look at medical assistance if their income is low enough for that, or if their spouse or partner has group health insurance available to them through their employer. It's very individualized. Some is based on income. We would really start there. Also if the person is in the middle of treatment or just starting treatment, we want to consider also if with the COBRA and their current insurance, have they already met their out-of-pocket deductibles and is it, in their situation, best for them to continue on that insurance while they're in the middle of treatment and not have to change insurances?

Andrew Schorr:

First of all, we've mentioned COBRA several times. Let's understand that. I did that once before many years ago. I did have a large employer, so let me see if I've got this right. Rather than the employer paying for my health insurance, I got the benefit of that health insurance, but I have to pay the premium. Is that what COBRA is?

Dan Sherman:

Correct. It's a continuation of the current insurance that they have through their employer. But as you just stated here, they take over, the employee takes over the full price of that insurance policy. There was a statistic that just came out that the average cost of employer-based insurance for a family is now topping about $20,000 a year. It becomes expensive very quickly to take the COBRA route, but that's where it's so critical that you have financial navigators in place that can figure that out for patients, because in circumstances, especially for cancer patients, there are organizations out there that will pay those premiums for the patient. Aimee has done this, I've done this on a regular basis, of finding programs that will do that for a period of time for those individuals for as long as they're in treatment.       

I want to point out something else, too. I might be confusing people here, but you really need to be careful in regards to what choices you're making. A lot of people make the assumption that the Affordable Care Act is unaffordable. Well, that's true for some patients, and it's not true for some patients. The lower your income is the more affordable the Affordable Care Act becomes. The analysis that Aimee was talking about is this critical thing of figuring out what's your income going to be this year? Based upon that information, a good financial navigator will be able to figure out if the Affordable Care Act is right for you or if COBRA is right for you.

Andrew Schorr:

Okay. COBRA has a time limit, so how long can you continue, whether you're paying for it or somebody else is paying for it, you can maintain that insurance that you were originally getting from your employer?

Dan Sherman:

That would be 18 months, in general. Sometimes it can be extended to 36 months, but typically it's 18 months. That's another key point to understand as well is the timing of all of this. Right now it's June. If you're being faced with doing COBRA, because you've already met your out of pockets and you don't want to start the deductibles over again, you have a 60-day window to sign up for COBRA, or you have a 60-day window to sign up for the ACA.

If you choose the COBRA route and you're past the 60 days, and now three months later, you say, "I can't afford these premiums," losing your COBRA does not generate an open enrollment to sign up for the ACA. It's critical when you make that choice that you're going to be able to successfully get through the rest of the year paying those COBRA premiums. Now like I just said earlier, hopefully we can get a program to pay those premiums for the patient. We have done it successfully with many patients, but if you're not able to do that, it needs to be thought through that you can afford those premiums for the rest of the year.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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