Written By: Retired LCDR Carl Jewett
Mesothelioma Insurance Options
Mesothelioma insurance helps patients alleviate some of the burden of their diagnosis. Patients and their families endure emotional and financial strain starting the day of the diagnosis. They should understand their mesothelioma insurance coverage, which may lead to better treatment and a longer life.
Reviewed By
Troy E. Walton
Personal Injury Attorney
Reviewed By
Troy E. Walton
Personal Injury Attorney
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Health Care Options for Mesothelioma Patients
A patient’s health insurance plan often determines the treatment available to them. Patients should be aware of their insurance situation to pursue the best mesothelioma treatment possible.
Public and Private Insurance
There are private and public insurance options for mesothelioma patients. Private insurance includes employer and individual health care plans. Public insurance includes Medicare, Medicaid, state insurance pools and “Obamacare.”
Insurance Factors
Mesothelioma insurance depends on a number of factors, including:
- Current employment
- Age
- Location
- Gender
- General health (obesity, smoking, etc.)
- Family health history
Patients Without Insurance
Mesothelioma patients without health care at the time of their diagnosis can still receive affordable treatment. The Patient Protection and Affordable Care Act requires insurance companies to provide coverage regardless of pre-existing conditions. This allows patients to sign up for health care after their diagnosis.
This topic is an ongoing one within American politics, and some lawmakers have attempted to remove protections for patients with pre-existing conditions. As of 2021, the requirement still exists.
Types of Insurance
Health insurance is first categorized as public or private. Public insurance includes any insurance received from the government, such as Medicare or Medicaid. There are public insurance benefits available to many patients with mesothelioma.
Health insurance plans are sub-categorized by group and individual. Group plans are applicable to insurance gained through employment. These are called group plans because an employer negotiates a single premium that becomes available to all employees. Individual mesothelioma insurance plans, by comparison, cover one person.
Public
Private
Medicare or Medicade
State Health Insurance Pools
Group Plan
Employer Health Care
Private Plan
Individual Insurance
Employer Health Care
Employer health care plans are typically the most desirable. This is because the insurance company does not usually consider an employee’s health status. The employer negotiates a premium with the insurance company on behalf of all employees under the plan.
Medicare or Medicaid
Medicare and Medicaid are specifically designed to help senior citizens and those who cannot afford healthcare, respectively. Since mesothelioma primarily affects older individuals, many patients qualify for Medicare benefits. For those who have limited income, Medicaid is available. Visit the Centers for Medicare & Medicaid Services website for more information.
State Health Insurance Pools
Insurance pools are an option available to those who cannot get health care coverage. These plans help those who seek coverage after they’ve been diagnosed.
Private Individual Insurance
Private insurance plans can provide help paying bills. Unfortunately, many private individual health plans do not cover treatments or prescriptions associated with cancer.
HMO and PPO plans can limit a patient’s freedom when choosing a specialist. Therefore, mesothelioma insurance may not be viable under a private individual plan.
Employment and Treatment
Being unable to work as a result of mesothelioma is a major concern for many patients. Fortunately, there are several legal protections.
The Consolidated Omnibus Reconciliation Act (COBRA) is a primary legal protection for those who can no longer work due to a serious illness. Many patients are unable to keep their job or must work fewer hours because they are sick. COBRA helps these patients keep their insurance.
Other legal protections for those with serious illnesses include the:
- Americans with Disabilities Act
- Family and Medical Leave Act
- Affordable Care Act
These laws protect patients and family members from unfair treatment in the workplace.
Understanding Coverage After Diagnosis
Most people diagnosed with mesothelioma have some form of coverage. However, most health care plans do not fully cover treatments and screenings.
Traditional private health care and point of service (POS) plans usually let patients choose their physician. Health maintenance organization (HMO) and preferred provider organization (PPO) plans either choose a physician or limit patients to a network of doctors.
Employer health care plans offer the most benefits because they do not discriminate based on the status of your health. These plans are popular because the financial risk is divided among fellow employees, keeping costs lower than private plans. While these plans are more secure, patients may still be limited in the choice of a specialist.
New Coverage for Mesothelioma Patients
The Patient Protection and Affordable Care Act (known as “Obamacare”) provides insurance coverage options to millions of Americans.
While the policy urges people to have health insurance, as of 2019, there is no Shared Responsibility Payment. Therefore, the financial penalty for not having coverage no longer applies. Some states have their own individual mandate for health coverage and will impose a penalty if citizens do not have insurance.
According to the United States Census Bureau, around 28 million people (9% of the population) were uninsured in 2016. Uninsured patients pay their medical bills out of pocket or are forced to negotiate with the hospital.
More than 30% of all mesothelioma patients are U.S. military veterans. The Veterans Administration Hospital provides free health care to veterans.
Another option is seeking mesothelioma compensation, which helps patients exposed to asbestos. There are billions of dollars set aside for mesothelioma patients.
Frequently Asked Questions About Mesothelioma Insurance
What is the difference between public and private insurance for mesothelioma?
Private insurance for mesothelioma is usually employer-run health care plans. Some people prefer to find their own private insurance plan, although it’s often more expensive than through their employer. Public insurance for mesothelioma includes government-funded programs, which are intended for people meeting specific criteria.
What is Medicare for mesothelioma?
Medicare is the most likely public insurance option for someone with mesothelioma. This health care coverage is for people older than 65, plus younger individuals with specific disabilities. Mesothelioma usually affects elderly Americans, which is why Medicare coverage often helps people with this cancer.
Does Obamacare cover mesothelioma treatment?
Obamacare provides Amercans with private insurance options at a cheaper rate than if they sought their own private insurance plan. Your coverage for mesothelioma depends on the plan and carrier you choose. Obamacare protects Americans against:
- Rising rates or canceled coverage due to pre-existing conditions
- Discrimination based on race, gender or age
What factors affect how much I pay for mesothelioma insurance?
Your private insurance costs depend on your premiums and deductibles. Your premium is the monthly fee and the deductible is the out-of-pocket costs you’ll pay for medical care. These vary based on your age, gender and health. Mesothelioma primarily affects elderly males, which is a factor insurance companies consider.
Can I still claim benefits on my employer health plan if I work fewer hours, quit my job, or was fired?
Yes. The Consolidated Omnibus Reconciliation Act (COBRA) allows you to retain your health insurance with a previous company after quitting, being fired or laid off, or having a reduction in hours and losing full-time employment status and health care eligibility. This program was created to assure workers can maintain their current health coverage in the case of a life-changing event.
What is my option if I cannot get health coverage?
Thanks to the Affordable Care Act, most people can get health care coverage. For those who cannot because they are unable to afford coverage, there are public options such as Medicare (for senior citizens) and Medicaid (for low-income citizens). These public options have limitations, and anyone considering these options should consult with their doctor. You can visit the Centers for Medicare and Medicaid for more information about these programs.
Can the type of health coverage I have limit my ability to choose a mesothelioma specialist?
The answer depends on the health insurance you have. Some insurance plans may limit the in-network specialists and procedures available to you. The high cost of mesothelioma treatment leads many patients to file a legal claim, which helps pay for treatment. Find the best available specialist for help.
Can I be dropped by my insurance company after diagnosis?
No, in most cases. As a patient, you cannot be removed from your insurance carrier after diagnosis, except in rare circumstances. However, your insurance premium payments may increase in some specific scenarios. Each insurance provider is different and may vary in how they react to news of a mesothelioma diagnosis.
Sources & Author
- National Institutes of Health. Economic Impact of Cancer. Retrieved from: http://www.cancer.org/cancer/cancerbasics/economic-impact-of-cancer. Accessed: 11/01/18.
- Pre-Existing Conditions. U.S. Department of Health and Human Services. Retrieved from: https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html. Accessed: 04/02/19.
- Health Plans & Benefits: Continuation of Health Coverage — COBRA. U.S. Department of Labor. Retrieved from: https://www.dol.gov/general/topic/health-plans/cobra. Accessed: 04/02/19.
- FMLA (Family & Medical Leave). U.S. Department of Labor. Retrieved from: https://www.dol.gov/general/topic/benefits-leave/fmla. Accessed: 04/30/19.
- High-Risk Pool Plan (State). Healthcare.gov. Retrieved from: https://www.healthcare.gov/glossary/high-risk-pool-plan-state/. Accessed: 05/30/19.
- Minimum Essential Coverage. Healthcare.gov. Retrieved from: https://www.healthcare.gov/glossary/minimum-essential-coverage/. Accessed: 05/31/19.
- No insurance? See if you’ll owe a fee. Healthcare.gov. Retrieved from: https://www.healthcare.gov/fees/fee-for-not-being-covered/. Accessed: 05/31/19.
- Types of Health Insurance Plans. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/health-insurance-options/types-of-health-insurance-plans.html. Accessed: 04/02/19.
