August 2015 Ask the Expert: Dealing With the Financial Impact of Metastatic Breast Cancer

August 1, 2015

Metastaticinfo-icon breast cancer requires ongoing care and ongoing costs. You may be worried about what insurance will and will not cover, what you will have to pay out-of-pocket and how you will manage your other financial obligations while paying for breast cancer treatment. Learning about what resources are available to you and making a plan can help you prepare for, and lessen, the costs of metastatic breast cancer.

In August, Living Beyond Breast Cancer experts Joanna L. Fawzy Morales, Esq, and Amy Niles, MBA, answered your questions about how to stay afloat financially while having ongoing treatment.

Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare providerinfo-icon because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counselinginfo-icon or medical advice.

Question: I was recently diagnosed with metastatic breast cancer and have no idea how to start making a financial plan. What are the first steps I should take to help me prepare for paying for all of this?

Joanna Morales: There are some practical steps you can take to manage your finances and the cost of your medical care.

First, make sure you understand your health insurance coverage. You want to know what your deductible is, any copayments that you have to pay when you get certain types of care, your co-insurance amount when you get medical care, and what your out-of-pocket maximum is for your plan.

Second, you want to talk to your healthcare team about what they know about your medical expenses and whether your insurance policy will cover those expenses. If you don’t have health insurance or you are not happy with your coverage, then you can look for options at triagecancer.org/services/health-care-options. You should also think about some of the unexpected expenses that you might have, like transportation and lodging to travel to treatment, childcare or eldercare, products to address the comfort and cosmetic side effects of treatment, mental healthinfo-icon care, and daily living expenses, including help with meal preparation and cleaning your home. Create a budget that includes these new expenses, in addition to your regular living expenses.

Third, once you understand what your expenses are, start to think about how to pay for those expenses. Here are some things to think about:

  • Do you have to take time off work? If so, do you have disability insurance options to help replace your wages? 
  • Do you qualify for any prescriptioninfo-icon assistance programs? Click here for more information.
  • Do you qualify for utility discounts? Ask your utility company.
  • Are these assistance programs available? Ask your healthcare team for local resources.
  • If you are unable to pay your medical bills, contact your providers and ask to set up a payment plan.

Amy Niles: A key thing to be aware of is that as an individual diagnosed with metastaticinfo-icon breast cancer, you may qualify for financial assistance from the Patient Access Network (PAN) Foundation, a national charitable foundation. PAN's Metastatic Breast Cancer fund specifically provides financial assistance for the out-of-pocket costs associated with your prescribed medical treatments.

If you have Medicareinfo-icon insurance coverage and Medicare covers the medication for which you seek assistance; you reside and receive treatment in the United States; and your income falls at or below 500 percent of the Federal Poverty Level, you may qualify for a grant of up to $7,500 over a 12-month period. To learn more, visit panapply.org, or call 1-866-316-PANF (7263). It is our hope that by providing eligible individuals with financial assistance to reduce the burden of the out-of-pocket costs for their prescribed treatments, we can help people living with critical, chronicinfo-icon and rare diseases to focus on what is most important – their health.

Question: Is there anything I can do to make my cancer costs lower in the first place?

Joanna Morales: There are a few ways to avoid higher medical bills:

  • Understand your health insurance coverage
  • Ask your healthcare team to make sure that any treatment is covered by your health plan
  • Group your medical appointments together to limit your copayments
  • Make sure that you are getting medical care and prescriptions from providers within your insurance company’s network
  • If your health plan is denying coverage, ask your healthcare team for help appealing the healthcare plan’s decision
  • You can also shop around for medical care. Different healthcare facilities charge different prices for medical care. It's possible to negotiate charges ahead of time.

Question: I am a single 55-year-old with stage IV disease and I have always been very independent. How do I plan for personal care as my health deteriorates? Do I qualify for long-term nursing care at home? How do I finance personal care?

Joanna Morales: There are different types of personal care that may be helpful to you. How you pay for personal care services depends on the type of service:

  • Private duty or custodial care can help you with transportation to medical appointments, preparing meals, grocery shopping and more. Private duty or custodial care is not usually covered by health insurance. However, your family members, friends, neighbors and co-workers may be able to help. Mylifeline.org has a calendar tool, where people in your support network can sign up to help you with preparing meals, picking up groceries, taking your kids to school, or other caregiving needs. Also, if you qualify for Medicaidinfo-icon in your state, then your family members may be able to get paid to serve as your caregiverinfo-icon. The names of this caregiver program vary from state to state. For example, in California and Colorado, the program is called In-Home Supportive Services, while in Texas it is the Family Care Program, and in Illinois, it is the Home Services Program. Contact your state Medicaid program for more information.
  • Home health care is health care provided at home by a skilled professional such as a nurseinfo-icon, social workerinfo-icon, or physical therapistinfo-icon. Health insurance policies will usually only cover home health care visits if the provider is delivering a skilled need, such as how to take a new medicineinfo-icon or change a bandage or dressing, or providing physical therapyinfo-icon.
  • Long-term care usually involves extended care at a nursing home or other specialized facility. Long-term care insurance generally only covers expenses not covered by health insurance. Long-term care insurance that you buy from a private insurance company usually covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer's facilities. Note that once you have a pre-existing medical conditioninfo-icon, it is often difficult to buy a long-term care insurance policy. Medicaid provides coverage for some long-term care in a facility and at home, but eligibility and services depend on the state in which you live. Visit Medicaid.gov for more information.
  • Hospiceinfo-icon is a type of home care that focuses on pain and symptom managementinfo-icon, usually near the end of life. Insurance coverage of hospice care varies. For more information about hospice, visit caringinfo.org.

Depending on your insurance coverage, you may be able to get help paying for these services. You may also have a supplemental insurance plan, such as a cancer plan, which may provide some additional benefits in this area. Investigate your current coverage and new options that might be available to you. You should also consider engaging your healthcare team, as they may be aware of valuable resources.

Question: What are flexible spending accounts and health savings accounts, how do people sign up for them, and what kind of cancer costs would they cover?

Joanna Morales: Flexible spending accounts or FSAs are special accounts that you put money into so that you can use that money to pay for certain out-of-pocket medical and dental expenses, including copayments and deductibles. You cannot use your FSA funds to pay your insurance premiums. You don’t have to pay taxes on money that you put into an FSA. You can put up to $2,550 in an FSA each year. FSAs are only available if your employer offers your health insurance coverage. To sign up for an FSA, talk with your employer’s human services representative or whoever handles employee benefits at your place of employment. Click here for more information.

Health savings accounts or HSAs are personal savings accounts available to people who are enrolled in high deductible health plans. In 2015, high deductible health plans are plans with annual deductibles more than $1,300 for an individual or $2,600 for a family. You don’t have to pay taxes on money that you put into an HSA, but money in an HSA must be used to pay for qualified medical expenses. Your employer may offer an HSA option or you can start an account on your own through a bank or other financial institution. Unlike an FSA, HSA funds roll over year to year if you don't spend them. Click here for more information.

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