Cancer is a serious and costly disease that affects millions of Americans every year. If you have been diagnosed with cancer or are at risk of developing it, you may wonder how the Affordable Care Act (ACA), also known as Obamacare, can help you access and afford quality cancer care. The answer is that Obamacare does cover cancer treatment, but the extent and cost of your coverage may depend on your specific situation and plan choices. Here are some of the main ways that Obamacare can benefit you if you have or may get cancer.
- Obamacare covers cancer treatment for people who have or may get cancer, regardless of their pre-existing condition.
- Obamacare offers financial assistance for people who buy health insurance through the Marketplace or enroll in Medicaid in some states, depending on their income and eligibility.
- Obamacare requires health insurance plans to cover essential health benefits, such as hospitalization, chemotherapy, radiation, surgery, prescription drugs, and preventive services, that are needed for cancer care.
- Obamacare gives people more options and protections to access and afford quality cancer care, but they should always compare different plans and providers, read the details of their coverage, and ask questions before making any decisions.
Obamacare Prevents Discrimination Based on Pre-Existing Conditions
One of the most important protections that Obamacare provides for people with cancer is that it prevents health insurance companies from denying you coverage, charging you more, or excluding benefits based on your pre-existing condition. This means that you cannot be rejected or charged more for a health insurance plan because you have cancer or a history of cancer. It also means that your plan cannot refuse to cover essential health benefits, such as hospitalization, chemotherapy, radiation, surgery, prescription drugs, and preventive services, that you may need for your cancer treatment.
This protection applies to all health insurance plans sold through the Health Insurance Marketplace, as well as most employer-sponsored plans and individual plans outside the Marketplace. However, it does not apply to some types of plans that are not considered major medical coverage, such as short-term plans, fixed indemnity plans, or healthcare-sharing ministries. These plans may still discriminate based on pre-existing conditions and offer limited benefits. Therefore, you should be careful and read the fine print before enrolling in any plan that is not regulated by the ACA.
Obamacare Provides Financial Assistance for Low- and Moderate-Income People
Another way that Obamacare can help you afford cancer treatment is by providing financial assistance for low- and moderate-income people who buy health insurance through the Marketplace. Depending on your income and household size, you may qualify for one or both of the following types of assistance:
- Premium tax credits: These are subsidies that lower the amount you pay each month for your health insurance premium. You can choose to receive them in advance to reduce your monthly bill or claim them when you file your taxes at the end of the year. To be eligible for premium tax credits, your income must be between 100% and 400% of the federal poverty level (FPL), which is $12,880 to $51,520 for a single person in 2021.
- Cost-sharing reductions: These are discounts that lower the amount you pay out-of-pocket for deductibles, copayments, coinsurance, and other expenses when you receive health care services. To be eligible for cost-sharing reductions, your income must be between 100% and 250% of the FPL, which is $12,880 to $32,200 for a single person in 2021. You must also enroll in a silver-level plan in the Marketplace to receive this benefit.
If you qualify for both types of assistance, you can combine them to lower your overall costs. However, if your income changes during the year, you may have to pay back some or all of the premium tax credits you received in advance when you file your taxes. Therefore, you should report any changes in your income or household size to the Marketplace as soon as possible to avoid any surprises.
Obamacare Expands Medicaid Eligibility in Some States
A third way that Obamacare can help you access cancer care is by expanding Medicaid eligibility in some states. Medicaid is a joint federal-state program that provides free or low-cost health insurance to low-income people who meet certain criteria. Under the ACA, states have the option to expand their Medicaid programs to cover more people who earn up to 138% of the FPL, which is $17,774 for a single person in 2021.
If you live in one of the 38 states (including Washington DC) that have expanded their Medicaid programs under the ACA, you may be able to enroll in Medicaid if you have cancer and meet the income and other eligibility requirements. Medicaid covers most of the essential health benefits that you may need for your cancer treatment, such as doctor visits, hospital stays, lab tests, imaging scans, prescription drugs, and preventive services. However, some states may impose certain restrictions or limitations on some benefits or require copayments or premiums from some enrollees.
If you live in one of the 12 states that have not expanded their Medicaid programs under the ACA, you may face a coverage gap if you have cancer and earn too much to qualify for traditional Medicaid but too little to qualify for premium tax credits in the Marketplace. In this case, you may have to look for other options to get health insurance or financial assistance, such as through your employer, a spouse, a parent, a charity, or a state program.
Obamacare does cover cancer treatment, but the extent and cost of your coverage may depend on your specific situation and plan choices. Obamacare prevents discrimination based on pre-existing conditions, provides financial assistance for low- and moderate-income people, and expands Medicaid eligibility in some states. These are some of the main ways that Obamacare can benefit you if you have or may get cancer. However, you should always compare different plans and providers, read the details of your coverage, and ask questions before making any decisions about your health care.