Can You Get Health Insurance After Being Diagnosed With Cancer?

A cancer diagnosis no longer prevents individuals from securing health insurance coverage. A prior diagnosis does not lead to denial of coverage or increased premiums. Navigating the various pathways to obtain or maintain health insurance requires understanding available options and preparing for the application process. This ensures individuals can focus on their health with comprehensive medical support.

Understanding Your Eligibility and Coverage Options

Individuals diagnosed with cancer have several avenues for obtaining or continuing health insurance. The Affordable Care Act (ACA) ensures that health insurance plans offered through the Marketplace are “guaranteed issue.” These plans are categorized by metal tiers—Bronze, Silver, Gold, and Platinum—which indicate the percentage of healthcare costs the plan covers on average. Bronze plans typically have lower monthly premiums but higher out-of-pocket costs, while Platinum plans have higher premiums but cover a greater share of expenses.

Medicaid offers another pathway, providing health coverage to eligible low-income individuals and families. This joint federal and state program covers a wide range of medical services, including those related to cancer treatment, without regard to pre-existing conditions. Eligibility for Medicaid is primarily determined by household income and family size, though specific income thresholds vary by state. Some states have also expanded their Medicaid programs to cover more adults.

Medicare serves as a health insurance option for individuals aged 65 or older, and for some younger individuals with certain disabilities, including those whose cancer leads to a qualifying disability. After receiving Social Security Disability Insurance (SSDI) benefits for 24 months, individuals with qualifying disabilities become eligible for Medicare. Medicare consists of several parts:
Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services.
Part B (Medical Insurance) covers certain doctor’s services, outpatient care, medical supplies, and preventive services.
Part C (Medicare Advantage Plans) are private plans that offer an alternative to Original Medicare.
Part D (Prescription Drug Coverage) helps cover the cost of prescription drugs.

Employer-sponsored health plans are a common source of coverage, and individuals can often maintain or obtain this coverage even after a cancer diagnosis. If actively employed, individuals generally continue their existing group health plan coverage, which cannot discriminate based on health status. For those who lose or leave their job, the Consolidated Omnibus Budget Reconciliation Act (COBRA) allows for temporary continuation of group health coverage, typically for up to 18 months, though the individual is responsible for the full premium. The Family and Medical Leave Act (FMLA) also requires employers to maintain health coverage for employees on approved leave under the same conditions as if they were actively working.

Preparing for Application and Enrollment

Before applying for health insurance, understand the enrollment periods and gather necessary documentation. Most health insurance plans, particularly those through the ACA Marketplace, have a specific Open Enrollment Period each year, during which individuals can sign up or change plans. Outside of this period, a Special Enrollment Period (SEP) may allow enrollment due to certain qualifying life events, such as losing other health coverage, getting married, having a baby, or moving to a new area. These SEPs usually allow for a 60-day window to select a new plan.

Applicants need to compile personal and financial documents. These include Social Security Numbers for all household members, federal tax returns to verify income, and proof of U.S. citizenship or eligible immigration status. Current or expected household income information, such as recent pay stubs, employer statements, or self-employment ledgers, is necessary to determine eligibility for financial assistance. Details about any current health insurance coverage are also required.

Making informed decisions about plan choice before applying impacts healthcare access and costs. This involves understanding financial terms such as deductibles, which are amounts paid out-of-pocket before insurance begins to cover costs, and copayments or coinsurance, which are shares of costs for specific services after the deductible is met. Consider the out-of-pocket maximum, which is the most an individual will pay for covered services in a plan year. Evaluating whether current doctors, specialists, and hospitals are within a plan’s network helps avoid higher out-of-network costs.

The Application and Enrollment Process

Once prepared, the application and enrollment process involves submitting information through official channels. For ACA Marketplace plans, individuals apply through Healthcare.gov or their state’s equivalent health insurance marketplace website. Medicaid applications are processed through state Medicaid agencies, while Medicare enrollment is handled by the Social Security Administration.

Applications can be submitted online, by phone, or through mail. Assistance is available from trained navigators or brokers. After submitting an application, individuals receive a confirmation, followed by an eligibility determination indicating which programs or financial assistance they qualify for.

Upon eligibility confirmation, select a plan and pay the first premium directly to the chosen insurance company. Coverage typically begins after this initial payment is processed. Promptly report any changes in income, household size, or other relevant circumstances to the Marketplace or relevant agency. This ensures eligibility for subsidies or programs remains accurate and helps maintain continuous coverage.

Managing Costs and Financial Assistance

Understanding available financial assistance programs helps make health insurance affordable. Premium Tax Credits, also known as subsidies, are available through the ACA Marketplace to help eligible individuals and families lower their monthly health insurance premiums. Eligibility for these credits is based on household income, with assistance available to those with incomes between 100% and 400% of the federal poverty level. Temporarily, there is no upper income limit if the benchmark plan costs more than 8.5% of household income through 2025. These credits are typically paid directly to the insurer, reducing the monthly premium amount an individual pays.

Cost-Sharing Reductions (CSRs) provide savings for eligible individuals enrolled in Silver plans on the Marketplace. CSRs lower out-of-pocket costs such as deductibles, copayments, and coinsurance, and reduce the annual out-of-pocket maximum. These reductions are available to individuals with incomes up to 250% of the federal poverty level. Unlike premium tax credits, CSRs are automatically applied to the Silver plan, providing enhanced benefits and lower cost-sharing.

Medicaid and the Children’s Health Insurance Program (CHIP) offer low-cost or free comprehensive coverage for those who meet specific income and eligibility requirements. Many hospitals and healthcare providers also offer financial assistance or charity care programs for patients who cannot afford their medical bills. These programs have eligibility criteria based on income and assets. Individuals can inquire directly with the hospital’s financial counseling department to explore these options.