Can I Get Health Insurance If I Have Cancer?

A cancer diagnosis can raise concerns about securing health insurance. Many people worry that a cancer diagnosis might prevent them from securing necessary coverage. Significant changes in healthcare laws have addressed this issue, ensuring a medical history does not become a barrier to accessing coverage. Having cancer does not automatically disqualify an individual from obtaining health insurance.

Protections for Pre-existing Conditions

A “pre-existing condition” refers to a health problem that existed before the start date of a new health insurance policy. Before the Affordable Care Act (ACA), health insurance companies could deny coverage, charge higher premiums, or impose waiting periods for individuals with such conditions, including cancer. This created substantial financial and health access challenges for many.

The ACA fundamentally changed this landscape by prohibiting insurers from discriminating against individuals based on their health status. Under federal law, health insurance plans sold on the Health Insurance Marketplace and most other individual and small group plans cannot deny coverage or charge more due to a pre-existing condition. This protection also extends to preventing insurers from imposing waiting periods before covering treatment for pre-existing conditions.

This protection is underpinned by two key provisions: “guaranteed issue” and “community rating.” Guaranteed issue requires health insurers to offer coverage to all applicants, regardless of their health status, during specified enrollment periods. Complementing this, community rating limits how much insurers can vary premiums based on factors like health status or claims history. While premiums can still vary by age, geographic location, and tobacco use, they cannot be inflated due to a cancer diagnosis or other medical history.

Major Health Insurance Options

Individuals with a cancer diagnosis have several primary avenues for obtaining health insurance.

Health Insurance Marketplace

The Health Insurance Marketplace, established by the Affordable Care Act, offers qualified health plans. These plans comply with ACA protections, meaning they cannot deny coverage or charge more due to pre-existing conditions like cancer. Eligibility for financial assistance, known as subsidies, to help lower monthly premiums and out-of-pocket costs, is determined based on household income.

Medicaid

Medicaid is a joint federal and state program providing health coverage to low-income individuals and families. Eligibility depends on meeting specific income thresholds, often tied to a percentage of the Federal Poverty Level (FPL), and other factors like family size or disability. Enrollment in Medicaid is generally available year-round for those who qualify.

Medicare

Medicare is the federal health insurance program primarily for individuals aged 65 or older. Younger individuals with certain disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS) may also qualify. Medicare consists of several parts:
Part A covers inpatient hospital stays and some skilled nursing facility care.
Part B covers doctor visits and outpatient care.
Part D assists with prescription drug costs.

Employer-Sponsored Health Plans

Employer-sponsored health plans, offered through a workplace, also adhere to ACA protections. They cannot exclude coverage for pre-existing conditions. These plans often present a cost-effective option as employers typically contribute a significant portion of the premiums. Enrollment usually occurs during an annual open enrollment period set by the employer.

COBRA

For those who lose job-based coverage, the Consolidated Omnibus Budget Reconciliation Act (COBRA) allows for a temporary continuation of that same employer-sponsored health plan. This option can be expensive, as individuals are typically responsible for the full premium, plus an administrative fee. COBRA coverage usually lasts for 18 months, though it can extend longer under specific circumstances.

Short-Term Health Insurance Plans

Short-term health insurance plans warrant caution for individuals with cancer. These plans are generally not regulated by the ACA and are not required to cover pre-existing conditions or essential health benefits. They are primarily designed as temporary coverage for healthy individuals between comprehensive plans and are typically unsuitable for someone managing a serious illness like cancer.

Enrolling in Coverage

Securing health insurance involves specific application periods and processes.

Marketplace Open Enrollment

For Health Insurance Marketplace plans, the primary enrollment period is Open Enrollment, which typically runs from November 1 to January 15 each year for coverage starting the following calendar year. During this window, individuals can enroll in a new plan, renew their existing coverage, or switch plans. Missing this period generally means waiting until the next Open Enrollment unless a Special Enrollment Period (SEP) is triggered.

Special Enrollment Periods

Special Enrollment Periods allow individuals to enroll in or change Marketplace plans outside of Open Enrollment due to specific qualifying life events. Common qualifying events include losing other health coverage, getting married, having a baby, or moving to a new area. A cancer diagnosis itself is not a qualifying life event, but related events, such as a loss of job-based coverage due to medical leave, might trigger an SEP. Individuals typically have 60 days from the date of the qualifying event to enroll.

Application Process

The application process varies by plan type.
For Health Insurance Marketplace plans, visit HealthCare.gov or your state’s health insurance exchange website.
For Medicaid, submit applications through the state Medicaid agency.
Medicare enrollment is handled by the Social Security Administration, typically three months before an individual’s 65th birthday, or at other times for those with qualifying disabilities.
For employer-sponsored plans or COBRA, the process is managed through the employer’s human resources department.

Required information typically includes personal identification details, such as name, date of birth, and Social Security numbers for all household members. Household income information is also necessary, especially for determining eligibility for Marketplace subsidies or Medicaid. After submitting an application, individuals can expect to receive confirmation, and in some cases, requests for additional documentation to verify eligibility.