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Paying for Cancer Treatment

Locate medical experts and find information on insurance coverage and financial assistance for risk management, treatment and follow up care.

Patient Protection and Affordable Care Act (PPACA)

Signed into law in March 2010, PPACA contains several provisions that impact individuals and families affected by cancer:

  • access to health insurance for all Americans—including those who are uninsured
  • elimination of pre-existing conditions as barrier to coverage
  • elimination of annual and lifetime caps on insurance coverage
  • capping out-of-pocket healthcare expenditures
  • coverage of young adults up to the age of 26 on their parent’s plan
  • coverage for screening and preventative services including breast, colorectal and cervical cancer screenings—without a co-payment
  • coverage for those enrolled in clinical trials

Below are further details on relevant provisions:

Elimination of pre-existing conditions
PPACA will eliminate the use of pre-existing conditions to deny or impose waiting periods on insurance coverage. 

Elimination of annual and lifetime limits
PPACA eliminates annual and lifetime limits on insurance coverage. PPACA bans insurance plans beginning on or after September 23, 2010 from cutting off policyholders when a lifetime benefit was reached. The law phases out annual limits over a period of three years and will completely ban annual caps on January 1, 2014.

Capping out-of-pocket healthcare expenditures
PPACA places caps on how much money insured people will have to spend out of their own pockets for healthcare services that are covered in the new law’s essential health benefits package. These caps on out-of-pocket spending will go into effect in 2014. The out-of-pocket spending caps will follow a sliding scale: Those with lower and middle incomes will pay less out of pocket than those with higher incomes. The new caps guarantee that consumers will not have to pay more than a set amount annually in out-of-pocket expenses for covered services. 

Coverage for those enrolled in clinical trials
The law requires health plans to pay the routine care costs of patients who participate in clinical trials for the prevention, detection and treatment of cancer and other life-threatening conditions.

For more information on the Patient Protection and Affordable Care Act, visit healthcare.gov.

Updated 12/23/16

FORCE:Facing Our Risk of Cancer Empowered