Managing the Costs of Your Cancer Treatment
Cancer is costly. It can take a toll on your health, your emotions, your time, your relationships – and your wallet. There will be unexpected charges, and even the best health insurance won’t cover all your costs. Here are some tips on what costs you can expect and some ideas on how to plan for, ask about, and discuss treatment costs with your cancer care team. Don’t wait until you have financial problems to discuss cancer costs with your health care team.
You might feel as if you don’t have the energy to deal with cancer and talk about money, too. You might want to ask a friend or family member to keep track of costs for you. Ask this person to go with you to doctor visits and help with these discussions.
Planning for treatment
Learn as much as you can about cancer and your cancer treatment before it starts. This will help you know what to expect. It can also help you plan for and deal with the costs. Many people with cancer have medical expenses for things like:
- Provider visits
- Lab tests (blood tests, urine tests, and more, which are usually billed separately)
- Clinic visits for treatments
- Procedures (for diagnosis or treatment, which can include room charges, equipment, different doctors, and more)
- Imaging tests (like x-rays, CT scans, and MRIs, which may mean separate bills for radiologist fees, equipment, and any medicines used for the test)
- Radiation treatments (implants, external radiation, or both)
- Drug costs (inpatient, outpatient, prescription, non-prescription, and procedure-related)
- Hospital stays (which can include many types of costs such as drugs, tests, and procedures as well as nursing care, doctor visits, and consults with specialists)
- Surgery (surgeon, anesthesiologist, pathologist, operating room fees, equipment, medicines, and more)
- Home care (can include equipment, drugs, visits from specially trained nurses, and more)
What to ask about costs of cancer treatment
Talk with the people on your cancer team. They’ll usually know who can help you find answers. Here are some questions you can ask about costs. Choose the ones that relate to you and your treatment.
The overall treatment plan
Here are some ideas for ways to bring up the subject of cost as your treatment is planned:
- I’m worried about how much cancer treatment is going to cost me. Can we talk about it?
- Will my health insurance pay for this treatment? How much will I have to pay myself? (Discuss this for each treatment option.)
- I know this will be expensive. Where can I get an idea of the total cost of the treatment we’ve talked about?
Some related or follow-up questions you might want to ask:
- If I can’t afford this treatment are there others that might cost less, but will work as well?
- Is there any way I can get help to pay for this treatment?
- Does my health insurance company need to pre-approve or pre-certify any part of the treatment before I start?
- Where will I get treatment – in the hospital, your office, a clinic, or at home?
Today, more and more chemo drugs are taken by mouth. (This is often called oral chemo, and includes drugs known as targeted therapy.) In most cases, this means you get a prescription and take the drugs on your own, at home.
Chemo taken by mouth is as strong as the other forms and, when taken properly, works just as well. But oral chemo drugs cost a lot – sometimes many thousands of dollars each month. And most health insurance plans don’t pay for the oral drugs the same way they pay for the IV drugs (those put into a vein in the hospital, clinic, or office).
Oral chemo drugs are often treated like regular prescription drugs. You have to pay for them and, even if your insurance covers them, you might have a very high co-pay. For example, some insurance companies require a co-pay of 25% of the drug cost. This can be thousands of dollars. And this isn’t a bill that you can pay later – you have to pay when you pick up the drug at the pharmacy.
Make sure you know how much you’ll have to pay for each treatment. Many drug manufacturers have patient assistance plans to help people pay for their drugs. Ask your cancer care team about this.
Please see "If You Have Problems Paying a Medical Bill" from the ACS or call them to learn more about this.
Other prescription drugs used with cancer treatment
Many kinds of drugs are used to treat cancer. These may be drugs to prevent nausea, treat pain, help with anxiety, or control diarrhea. Drug prices vary a lot. You (or a family member) may want to call different pharmacies to get an idea of where you can get the best price.
When your doctor prescribes medicines or outpatient care, here are some questions you may want to ask:
- If I get outpatient treatment, how much of it will my health insurance cover?
- How much will the chemo drug that I take by mouth cost me? What about the nausea medicines and other drugs that go along with it?
- How much will I have to pay for this drug? Will my insurance cover it? (Ask this about each prescription you are given.)
- Are there programs to help me get the drugs I need?
- Are there less expensive drugs or a generic form that work as well?
- Is there any other way I can get help paying for this drug?
Hospital, surgery, and clinic treatments
If you must have surgery, chemo, radiation, or will be in the hospital for part of your treatment, here are some questions you might want to ask:
- Do we need to get my insurance company’s approval (sometimes called pre-certification) before the test, surgery, treatment, home care, etc.?
- Is there a co-pay for each treatment? (The co-pay is the cost you will be charged each time you get outpatient treatments in an office or clinic. Your health insurance company sets the co-pay amount.)
- If I must go into the hospital, how much will it cost? How much will my insurance cover?
- Is there a way to know beforehand if the doctors who will see me in the hospital are in my health plan network?
- Counting all the charges (hospital, anesthesia, surgeon, pathologist, and more), how much will this surgery cost me? How much will my insurance cover?
- Should I plan for rehab, home care, or long-term care (such as nursing home or hospice care)?
Out-of-pocket costs are costs you have to pay because your health insurance doesn’t. They can add up quickly and may make it hard for you to pay for other things you need.
You’ll want to be sure that your health insurance company pays or reimburses the bulk of your medical expenses. This means you’ll need to
- Know the terms of your policy
- Be aware of preferred or network doctors, hospitals, or clinics
- Keep careful records
If any of your treatments might be done by out-of-network doctors or providers, find out about those costs, too. Even when you know the terms of your policy, getting payments can mean re-submitting claims, appealing denials, and much more.
Usually, doctors’ offices and clinics have someone who handles health insurance concerns and problems. Ask your doctor if that person can help you with claims and codes on the bills that are sent to the insurance company.
You can find out more about health insurance and other costs at "Understanding Health Insurance" from the ACS.
The specialists at ACS are also available to answer your questions 24 hours a day, 7 days a week. You can reach one of them by calling 1-800-227-2345.
American Society of Clinical Oncology (ASCO)
Web site: www.cancer.net
Has a special section for patients on the costs of cancer care at www.cancer.net/managingcostofcare. Also offers cancer and cancer-related information (including many in Spanish), on things like treatment, side effects, coping, and survivorship, as well as a database to help find an oncologist
Patient Access Network Foundation (PANF)
Toll-free number: 1-866-316-7263
Web site: www.panfoundation.org
Helps under-insured patients with certain cancer diagnoses cover out-of-pocket costs related to cancer care.
Patient Advocate Foundation (PAF)
Toll-free number: 1- 800-532-5274
Web site: www.patientadvocate.org
Works with the patient and their insurer to resolve insurance problems; also provides direct financial support to insured patients who are financially and medically qualified for drug treatments and/or prescription co-pays, co-insurance, and deductibles related to certain cancer diagnoses.
*Inclusion on this list does not imply endorsement by the American Cancer Society.
American Society of Clinical Oncology. Managing the Cost of Cancer Care. Accessed at www.cancersupportcommunity.org/MainMenu/About-Cancer/Understanding-Cance... on October 30, 2015.
Bestvina CM, Zullig LL, Yousuf Zafar S. The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature. Future Oncol. 2014;10(14):2189-2199.
Bullock AJ, Hofstatter EW, Yushak ML, Buss MK. Understanding patients’ attitudes toward communication about the cost of cancer care. J Oncol Pract. 2012;8(4):e50-58.
Cancer Support Community. Frankly Speaking About Cancer: Coping with the Cost of Care, 5th edition. Accessed at www.cancersupportcommunity.org/General-Documents-Category/Education/FSAC... on October 30, 2015.
Peppercorn J. The financial burden of cancer care: do patients in the US know what to expect? Expert Rev Pharmacoecon Outcomes Res. 2014;14(6):835-842.
Tangka FK, Trogdon JG, Richardson LC, et al. Cancer treatment cost in the United States: has the burden shifted over time? Cancer. 2010;116(14):3477-3484.
Ubel PA, Abernethy AP, Zafar SY. Full Disclosure – Out-of-Pocket Costs as Side Effects. N Engl J Med. 2013;369(16):1484-1486.
Information provided by American Cancer Society.