What happens if you get cancer and do not have health insurance? Most patients can still get treatment but run out of money in a hurry.
Fortunately, the United States provides residents with a safety net. Nobody has to go uninsured for more than 12 months, and many people can get free coverage in far less time.
As always, the devil is in the details, and you do not want to miss a trick when you have a dread disease that requires immediate attention and expensive care.
Cancer patients without insurance can qualify for Medicaid and get immediate free coverage – provided they learn the obscure rules that can lead to approvals rather than denials.
Free Insurance for Cancer Patients
Many patients never have to worry about getting cancer treatment without health insurance because their medical condition allows them to qualify for free coverage that begins immediately: Medicaid.
The other low-cost option involves a possible delay.
Medicaid for Cancer Patients
Medicaid is free health insurance for specific families that meet the low-income guidelines established by their state. Cancer patients without insurance can get immediate treatment directly with zero premium costs – if they belong to one of these disadvantaged groups.
- Children under 21
- Parents or caretakers of dependent children
- People over 65, blind, or permanently disabled
- Pregnant women
For people in one of these groups, Medicaid has at least three pathways with distinct income-eligibility criteria that vary by state. Paying close attention to details is the best way to get quick approval.
Cancer patients without insurance can get treatment via regular Medicaid free if they meet the income criteria established by their resident state. Federal poverty guidelines have two critical components, and you do not want to jeopardize approval by making a careless mistake.
Uninsured cancer patients frequently qualify for regular Medicaid because their projected income is lower after diagnosis. Radiation, chemotherapy, and surgery often lead to disability, affecting their ability to work.
Avoid making these over-counting mistakes that hurt approval chances.
- Including last year’s higher-income instead of the lower expected earnings during the time you need coverage
- Overstating your income by including sources the government does not count, such as child support and some alimony
Uninsured cancer patients can qualify for Medicaid more readily when their household size grows. The federal poverty guidelines permit higher incomes as household members increase.
You do not want to undercount household members and hurt your approval odds. Medicaid determines your household size based on your plan to file a tax return, whether you submit one or not.
For instance, a divorced or separated person could modify their child custody agreement to boost their household size for the coming tax year.
Medically Needy Medicaid
Cancer patients without insurance can get Medicaid free because their illness might qualify them under the medically needy program. Ineligible individuals can spend down their income by subtracting their treatment expenses.
This option works well for people who paid 100% out-of-pocket for surgery, hospitalizations, chemotherapy, radiation, and other services (see below for funding options).
Cancer patients without insurance can get treatment via free pregnancy Medicaid if they expect a baby. Pregnant women have two enormous advantages that boost their approval odds considerably.
- Each state raises the income cutoff
- Unborn babies count as household members
Uninsured cancer patients who do not qualify for Medicaid can get private health insurance to cover treatment after diagnosis. The Affordable Care Act requires plans to cover pre-existing health conditions without waiting.
While not free, the federal government provides income-based subsidies to lower premiums and minimize unreimbursed costs. However, you might not be able to start coverage immediately.
The private health insurance begins on January 1 of each year unless you have a qualifying life event, which enables you to start your plan covering pre-existing medical conditions right away.
- Loss of other coverage within 60 days
- Getting married
- Recently released from jail
Avoiding Cancer Treatment Denials without Insurance
Hospitals and outpatient clinics can deny treatment to cancer patients without health insurance. They have no legal obligation to provide care to people without the financial capacity to pay for expensive services.
Therefore, you may need to take special steps to qualify for Medicaid if you do not meet the initial qualifications: the government does not think you have a permanent disability or your earnings exceed the income limits.
Below are some options.
File for Disability
Because providers can deny treatment to cancer patients without insurance when they lack the financial capacity to pay themselves, you may need to file for Social Security Disability as a first step. For instance, sighted adults under 65 without dependent children are ineligible for Medicaid until completing this task.
Once approved for Social Security Disability Insurance (SSDI), you meet the first Medicaid eligibility criteria: you have a permanent impairment. Please be aware that determinations can take a long time.
However, you could speed up the process through the Compassionate Allowance (CAL) pathway. Under CAL, Social Security reduces the waiting time for applicants with listed medical conditions, including many cancers.
On the other hand, providers cannot deny cancer treatment to patients without insurance when they have the financial capacity to pay the total charges upfront.
Then, your unreimbursed expenses for surgery, radiation, and chemotherapy can help you qualify for Medicaid via the Medically Needy pathway (see above for details) if you earn too much money.
These two options can help if you don’t have thousands of dollars set aside in savings to get the ball rolling.
Financing programs can help you pay for cancer treatment without insurance so you can qualify for Medicaid via the Medically Needy pathway. But do not worry about how to pay the lender back.
Medicaid may retroactively pay for three months of medical expenses after meeting the spend-down requirements. Use the hospital or outpatient clinic refund to retire the obligation quickly and keep your interest costs to a minimum.
Free money could help you pay for cancer treatment without insurance, making it easier to qualify for Medicaid through the Medically Needy pathway. People with bad credit might not be eligible for a loan, but their financial hardship makes them suitable for other government benefits.
Free government money you never pay back can arm you with the funding needed to self-pay the initial rounds of surgery, chemotherapy, or radiation out-of-pocket.
Use your unreimbursed medical expenses to spend down your excess income. Once approved for Medicaid, submit claims for retroactive benefits going back three months, and put the extra cash in a safe place. You may need it later.