Federal, State and Other Medical Programs
Updated April 24, 2014
If you weren’t insured before your diagnosis or lost your insurance for any reason, you may be feeling scared and overwhelmed at the thought of paying for breast cancer care. Remember, you deserve the best possible care and there is help out there – you just have to know where to look.
A patient navigator or social worker from your doctor’s office should be able to help you find coverage. You can also ask a friend or family member to help you explore options if you don’t feel up to doing it yourself.
There are a number of federal and state programs available to help get some or all of your expenses paid if you meet their eligibility requirements.
Medicare and Medicaid
To find out if you may be eligible for Medicare or Medicaid, please read our section on private, state and federal insurance. Apply for Medicaid,even if you don’t think you meet the income criteria. Many financial assistance programs require that you apply to Medicaid before they consider you, so keep records of your application.
National Breast and Cervical Cancer Early Detection Program
Through this program, the Centers for Disease Control and Prevention (CDC) provides screening and diagnostic services to low-income, uninsured or underserved women for free or very little cost. The program is funded in 50 states, the District of Columbia, five U.S. territories and 12 American Indian/Alaskan Native tribes or tribal organizations. If you were diagnosed through this program, you are eligible to have your treatments covered by Medicaid.
State Health Insurance Marketplaces/Exchanges
As of October 1, 2013, if you are uninsured or underinsured, you are able to buy private insurance through your state's Health Insurance Marketplace/Exchange. Trained navigators are available to help you find the best plan for you and your family and to help you determine if you are eligible for any financial assistance in the form of premium tax credits or cost-sharing subsidies, for example. Visit healthcare.gov to learn more.
To find out if you or a loved one qualify for health care through the Department of Veterans Affairs (VA) visit va.gov or call (877) 222-8387.
Children’s Health Insurance Program (CHIP)
You may be eligible for CHIP if you are pregnant or have children. CHIP eligibility requirements vary by state. Contact a social worker at your doctor’s office or your state’s department of health and human services to learn about enrollment criteria. Information can also be found at Medicaid.gov.
Disability insurance may be available to you through the federal government, your state government, or your employer.
Other Insurance Options
In addition to state and federal health insurance programs, you may find coverage through
- some unions, civic groups and associations. These kinds of groups sometimes offer members guaranteed-issue group insurance (health plans available to you regardless of your health history). You may still have a pre-existing condition waiting period before your plan will cover claims related to your breast cancer diagnosis.
- employers. Many employers offer their employees sponsored group health coverage.
- health insurance extension programs, like COBRA and others offered by individual states.
- HMOs in your area. Some HMOs will offer a period of time when applicants are accepted regardless of health history.
- State health insurance marketplaces and expansions to Medicaid programs, made possible by the Affordable Care Act.
Learn more about lead reviewer Joanna L. Fawzy Morales, Esq, and the other providers who helped us write this page in our Guide to Understanding Financial Concerns, 1st ed., 2010.