The National Cancer Institute (NCI) defines financial toxicity as the problems a patient or patient’s family may face related to the cost of medical care. Lack of health insurance or high costs not covered by insurance can lead to financial difficulties, potentially resulting in debt or bankruptcy. Financial toxicity can also impact a patient’s quality of life and access to medical care. This term encompasses out-of-pocket expenses, such as copayments, deductibles, and coinsurance, which can accumulate when dealing with various late effects, causing financial strain for survivors and their families. Cancer survivors often report spending more on medical care than those who have not had cancer, with some spending over 20% of their annual income on medical care. STUPID CANCER addresses financial toxicity and provides a list of questions to help patients save money when dealing with their provider, billing department, and/or insurance company.

Out-of-pocket costs associated with cancer that you may need to pay include direct medical expenses, associated costs (transportation costs to and from the hospital and clinic, potential lodging, etc.), and basic living expenses. Cancer Care has broken down the process in their article, MANAGING THE COST OF CANCER into three parts to help you better understand and budget for the expenses associated with childhood cancer survivorship: organize yourself; understand your health insurance and the range of coverage options available to you; and control your spending. You may need to verify invoices and explanations of benefits (EOBs), meet with a financial counselor at your medical institution, work out payment arrangements, explore nonprofit assistance, and use available resources.

Unfortunately, it is all too common for people to borrow money to pay for cancer treatment and subsequent doctors’ visits when managing late effects. Lending institutions typically base their decisions on one’s credit score, but they also consider the 3 Cs – character, capacity, and capital – when determining the amount to lend. TRIAGE CANCER’S ONLINE TOOLKIT provides practical steps for survivors and their families to manage their finances.

Many different health insurance plans are available, each with varying features and levels of coverage. If you have multiple insurance plans, you should clarify which plan pays first and which pays second. This is called coordination of benefits (COB). TRIAGE CANCER’S QUICK GUIDE provides further information on COB, including a table that outlines primary and secondary payers for different types of health insurance plans.

Medicare is a government health insurance program that is typically available to individuals who are 65 years of age or older and those who meet the requirements for SOCIAL SECURITY DISABILITY INSURANCE (SSDI). Different parts of the program cover various expenses, such as hospital stays, standard coverage for clinic visits, and prescription coverage.  If you have qualified for SSDI, there is a 24-month eligibility period before receiving Medicare. Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources.  LEARN MORE about the program in your state.

The CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) is a joint federal and state program that provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private coverage.

Maintaining health insurance coverage is crucial to caring for your health and effectively managing late effects, both now and in the future. Your work status and state of residence can impact when you should consider obtaining your own policy. The Forbes article, HOW LONG CAN YOU STAY ON YOUR PARENT’S HEALTH INSURANCE? offers valuable advice for survivors considering an independent health insurance policy.

The SOCIAL SECURITY DISABILITY INSURANCE SSDI program provides benefits to individuals and certain family members once approved for the program. To qualify, one must have worked long enough – and recently enough – and also paid Social Security taxes on earnings. The SUPPLEMENTAL SECURITY INCOME (SSI) program pays benefits to adults and children who meet the requirements for a qualifying disability and have limited income and resources. Although these programs differ, the medical requirements are the same. If an individual meets the nonmedical requirements, they will receive monthly benefits if they have a medical condition that is expected to last at least one year, or result in death. SSDI benefits can provide a financial lifeline for cancer survivors who cannot work due to qualifying chronic issues. To increase the chances of approval, some survivors seek the assistance of an experienced social security disability attorney.