Navigating the Coverage Experience and Financial Challenges for Cancer Patients

Navigating the Coverage Experience and Financial Challenges for Cancer Patients: Affordable Care Act Brings Improvements, But Challenges Remain

The Affordable Care Act (ACA) guarantees coverage to individuals with pre-existing conditions, offering cancer patients and survivors a lifeline to accessing treatment. And while the ACA ushered in important consumer protections, particularly for cancer patients who require high-cost care, patients continue to face high out-of-pocket costs and hurdles to obtaining recommended treatments. Financial Navigators are hospital or health-system staff that work with cancer patients to review their plan options, understand their coverage, and obtain treatment. Due to their close work with cancer patients as they obtain treatment, Financial Navigators provide insights into how private insurance coverage under the ACA is working to give their patients access to care.

Financial Navigators reported:

• Accessing comprehensive coverage has significantly improved with the ACA marketplaces and reform, particularly for people who are uninsured and for those who unexpectedly lose their health care coverage. However, obtaining coverage is still difficult for those who live in states that haven’t expanded Medicaid or are ineligible for ACA-related financial assistance.
• Costs related to using coverage—not premiums—remain the most common financial barrier for their patients.
• While the annual limit on out-of-pocket costs provides security to patients against catastrophic costs, meeting that limit annually can take a financial toll.
• Even with the help of a Financial Navigator, it’s difficult to get information on what a patient can expect to pay out-of-pocket for treatment.
• Although cancer treatment is more likely than ever to be covered, the practice of “medical management” has become more prevalent.
• Network adequacy varies, depending on local market dynamics, but when patients lose access to a covered provider, ensuring continuity of care is critical.
• Limited health literacy and high-level plan summaries make it difficult to understand plan rules for obtaining treatment.