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Health Insurance Coverage for Breast Cancer


We know that navigating the health insurance world can be stressful. Educating yourself about options and policies will help you make the best decisions for you.

Review Your Insurance Policy

Look at your insurance provider’s website to see what kind of coverage you will have for services and procedures. It’s a good idea to have your written policy on file, so request a copy if you don’t have one. A case manager is often available to you—just call the phone number on your insurance card and ask. This person is likely to be a nurse or social worker, and she or he can help you coordinate your medical needs and provide support.

Questions to Ask Your Provider

Your policy should answer all of the questions in the list below, but if the answer isn’t obvious, ask! Your case manager should be able to answer these questions and more, and it never hurts to double-check. You are your own best advocate.

  • Are my current doctors, or the ones I plan to see, part of my insurance plan?
  • Do I need pre-approval for a second opinion?
  • Can I go out-of-network or out of my plan for care? Will that be covered?
  • Do I need pre-approval for any treatment? If so, when?
  • What services does my plan cover and to what extent?
  • Can I switch doctors?
  • Can I choose my own specialists?
  • What is my deductible? What is my out-of-pocket maximum?
  • Are there co-pays? For which services and how much?
  • Should I know any expiration or renewal dates?

Keep Your Records

Sometimes doctor’s offices or insurance companies mess up, and patients are billed incorrectly or charged for things that should be covered. Create a dedicated folder for a copy of your written policy, correspondence from the health insurance company, claim forms and bills. You should also document any phone calls you have with your provider, including a date, time and summary of the call. This way, you’ll be able to review and provide any documentation.

Our Newly Diagnosed or Metastatic Navigator can help you stay organized. Remember, we are always here to help, and you can reach us at 877.972.1011 or [email protected].

If You Don’t Have Health Insurance

The Affordable Care Act requires individuals to obtain health insurance and helps people obtain coverage through exchanges and subsidies. If you don’t have coverage, it adds more complex challenges, but you do have options.

The National Breast and Cervical Cancer Treatment Act helps uninsured women who are eligible pay for breast cancer treatment. Find out how the program works in your state. You can also contact your State Department of Insurance to see what they offer. Most states offer a “guaranteed issue” individual health plan that you can enroll in regardless of your health, age, gender or other factors that might predict your use of health services.

You can also talk with an oncology social worker or a financial counselor at your medical center. These professionals may be able to help you determine your eligibility for public assistance like Medicaid or Medicare, or help you arrange a financial plan that works for you.

Other non-profits offer resources, too: the Cancer Legal Resource Center has a telephone assistance line and a ton of online tools to help you understand your insurance options, along with other legal issues. NeedyMeds, Inc. and Partnership for Prescription Assistance can help you apply for prescription medication assistance.

Remember, we are always here to help, and you can reach us at 877.972.1011 or [email protected].

Federal Health Insurance Programs

Medicare is an insurance program for people older than 65, but it can also cover younger people if they are determined to be disabled. You would be eligible to receive Medicare 24 months from date of disability. Even with Medicare, you may have to pay for premiums, deductibles and copayments.

Medicaid is a state program helping low-income people of all ages pay their medical bills. The program covers almost all medical costs, and eligibility requirements vary by state.

For more information and tools to help you keep track of your health insurance information, download our Newly Diagnosed Navigator or Metastatic Navigator.

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