October is breast cancer awareness month, and in pondering what to write about it became clear that many people search online for “Cancer Insurance after diagnosis”. This question may be asked for several reasons, and unfortunately it may be too late for many people – or not.
Allow me to explain.
Some people may have purchased a policy years ago, were recently diagnosed, and need to understand how the policy works, and how to file a claim. If this describes your situation we will walk through:
- Filing a claim after diagnosis
- Purchasing a policy after diagnosis
- Buying traditional health insurance
Cancer Insurance Claim After Diagnosis
Cancer insurance is a specified disease policy that works by making benefit payments after a covered policyholder is diagnosed with internal cancer. There are many policy types and configurations, but below are some of the primary features:
- Wellness benefits: Payments are made when specified cancer screenings are performed.
- Initial diagnosis benefits: Lump sum is paid directly to the policyholder upon diagnosis of internal cancer.
- Inpatient benefits: Daily payments are made for hospital confinement, ambulance services, and private nursing services.
- Treatment benefits: Defined payments are made for chemotherapy, radiation, surgeries, anesthesia, experimental treatments, blood transfusions, and more.
- Transportation and lodging benefits: Payments are made when the patient must travel a specified distance from home to seek care.
- Extended care benefits: Specified payments are made for utilization of skilled nursing facilities, family care, hospice, and home health care services.
A positive pathological report showing evidence of internal cancer is needed to file a claim. Cancer insurance after diagnosis helps with the unreimbursed medical expenses, non medical expenses, and lost income.
Contact your insurance company to download a claim form. Keep track of all your records both for direct and indirect costs associated with your cancer treatments. Know how your policy works.
Buying a Cancer Policy after Diagnosis
Another segment of people may have been diagnosed in the past, have been in remission, and would now like to purchase a policy. People who were diagnosed with skin cancer may also want a policy. We will explain the underwriting criteria associated with people in this group.
The largest segment may consist of people who were recently diagnosed, but don’t currently have policy in place. Those diagnosed with internal cancer will find it is too late to buy a specified disease policy for now. But other options do exist, which will be explored in detail.
Many people seek to purchase cancer insurance after diagnosis, and sometimes just before. There are four distinct scenarios to address: remission, skin cancer, suspicious test results, and existing conditions.
Cancer in Remission
Cancer is no longer the death sentence it was many years ago. People can and do beat cancer. Those who experienced the exhausting treatments, and left over expenses know first-hand that cancer insurance is worth it.
You can purchase cancer insurance after diagnosis once you have been cancer free for five years. You will be asked if you received medical advice or sought treatment for cancer in the last five years, or if you received hormonal therapy in the last twelve months. You may need to show that you were examined by a physician during the last twelve months.
Skin Cancer Diagnosis
Even if you recently received treatment for skin cancer, you may still be able to purchase cancer insurance after diagnosis. The policy may be issued with a skin cancer rider. The rider would exclude treatments from skin cancer, and may automatically drop from your policy after five years.
If you were diagnosed and/or treated for skin cancer in the last five years you may be asked about the severity of your condition. You may be asked if you were diagnosed with basal cell carcinoma, squamous cell carcinoma, or melanoma of Clark’s level I or II.
Suspicious Test Results
Suspicious test results are one of the primary motivators for people to purchase a policy – in a hurry. You get the dreaded call from the doctor saying something is not quite right with a test result, and they want to rule out cancer with further testing. Suddenly, buying a cancer insurance policy before diagnosis becomes a priority.
Buying cancer insurance before diagnosis when suspicious test results are pending may not work. It depends upon the carrier, the policy, and the channel of purchase. Some carriers will ask questions about pending test results. You may be asked:
- Has a test for the presence of cancer been performed for which you are awaiting results?
- Has a doctor recommended a follow up test for cancer?
- Has an abnormal cancer test result been received within the last ninety days?
Other policies may omit these questions if you have not been diagnosed with cancer. But the policy may contain a preexisting condition clause that excludes coverage for any cancer diagnosis that occurs within a specified number of months of the policy effective date – if you had received advice from a doctor six or twelve months prior to the policy start date.
Policies purchased as employee paid benefits often have the most lenient underwriting. Those purchased directly may have the most questions about pending tests.
Purchasing Health Insurance after Diagnosis
The need for coverage becomes most pronounced for many after it’s too late. Almost every type of insurance plan attracts people looking to begin coverage after the event. It is not possible to purchase cancer insurance after diagnosis of internal cancer.
If this describes your situation there are more options than in the past. With passage of the Affordable Care Act (ACA), you can no longer be denied coverage for any preexisting health condition. Coverage for the policy must begin immediately with no waiting period. This means you can purchase health insurance that will cover your treatments even after diagnosis.
New Affordable Care Act Rules
Supplemental insurance policies like cancer insurance are not subject to the ACA preexisting condition rules, so it will not be possible to get the extra coverage.
When choosing a health plan subject to ACA mandates remember that your cancer diagnosis probably means you will be utilizing healthcare more than the average person. It may pay to choose the platinum metal level plan (the option with the highest actuarial value, and highest premium). Carefully consider the plans network coverage and verify that leading cancer centers in your area are included as in-network providers.
Speak with your doctor to review your treatment plan and estimate your out-of-pocket medical expenses. Increase your flexible spending account contribution for tax savings assistance with these expenses.