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Hereditary Cancer Info > Privacy & Legal Issues > Patient Protection and Affordable Care Act (PPACA)

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Patient Protection and Affordable Care Act (PPACA)

There are laws that protect the rights of people with an inherited mutation or hereditary cancer.

Coverage for people 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. Routine costs include services that your insurance company would pay for even if you were not in a clinical trial, such as:

  • Visits to your doctors' office
  • Laboratory tests
  • Certain drugs associated with standard treatment or supportive care

Health plans are not required to cover visits to out-of-network providers, nor are they required to cover the cost for investigational treatments. 

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

The Center for Consumer Information and Insurance Oversight (CCIIO) at CMS is the agency consumers can contact for help when they feel they have been inappropriately denied services or were inappropriately charged a co-pay or deductible counter to the Patient Protection and Affordable Care Act. They run a helpline at (887) 267-2323 ext. 6-1565, or can be reached by email at: phig@cms.hhs.gov

updated 05/25/16

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