04/28/2021 By Chris Chamars
This program was co-hosted by GRYT Health and Triage Cancer
Madison McMahon Ward, MPH, from Triage Cancer joined us on April 15th to explain everything finances when it comes to health insurance, employee rights and other resources vital to navigating the cancer journey. Triage Cancer is a national nonprofit that provides education on the practical and legal issues that may impact individuals diagnosed with cancer and their caregivers. Their resources are available in English and in Spanish.
This article is a text summary of the program that took place in April 2021. Below you can find the hour-long program, if you would rather watch.
We started the program by discussing financial toxicity: “Out-of-pocket expenses related to treatment are akin to physical toxicity, in that costs can diminish quality of life.”
There are many contributing factors to financial toxicity including, but not limited to, health insurance status, employment changes and life changes. You can download a checklist here to see how to best protect yourself, or someone you love, from financial toxicity.
A big component of navigating financial toxicity is finding the best health insurance for your needs. From premiums, deductibles, co-payments and out of pocket maximums, Madison broke down the terminology and provided examples of how the terms can be applied to real scenarios. So we can all learn how to pick the best health insurance for our medical needs, whether we get it from our employers, the government, or directly from insurance companies.
- Premium: The cost you pay each month to have health insurance.
- Deductible: The amount you pay each year before your health insurance kicks in; this is a fixed amount.
- Co-Payment: The amount you pay each time you get care/see a healthcare professional; this is a fixed amount.
- Co-Insurance or Cost-Share: The amount you pay each time you get care; often this is a percent of the total amount.
- Out-of-Pocket Maximum: This amount is the most you will pay within a year. It is the deductible + co-payments + co-insurance. Note: this is for in-network providers.
Case Study: Dan
In this case study we look at Dan. Dan’s health insurance has a $2,000 deductible, a co-insurance of 80%/20% and an out-of-pocket maximum of $8,000. In this scenario Dan has a car accident and is left with a $102,000 hospital bill. What does he have to pay?
Dan will pay his deductible of $2,000, leaving him with $100,000. Here his insurance plan kicks in and pays for 80%, leaving Dan with $20,000 bill. However Dan’s out-of-pocket maximum is $8,000, and since he already paid his $2,000 deductible, he is left with a $6,000 hospital bill.
This example highlights the importance of looking beyond the monthly premiums when selecting health care plans. Other important aspects to keep in mind are:
- The network of doctors and hospitals
- Prescription drug coverage
- Coverage for NCI designated cancer centers
In her presentation, Madison goes into more details about enrollment period and other medical benefits offered by employers. Some additional resources to check out are:
- CoPatient: A professional billing review service that helps with appeals and negotiation of payment plans
- Upsolve: A free service that makes filing for bankruptcy easier
In the second half of the program Madison covered employment rights. From Fair Employment Laws, to Leave Laws and Employment & Union Contracts, there are many legal resources to help you navigate this journey.
It’s important to look at the benefits offered and utilize the resources available. Madison provides many examples of how this could play out. Some high-level examples include:
- Short-term or long-term disability insurance
- Life and/or accidental death insurance
- Sick time
- Vacation time or paid time off (PTO)
- Pool of donated time off
- Flex time/job sharing/telecommuting
- EAP and financial counseling programs
- Medical Leave
- Reasonable Accommodation
If you would like to learn more check out Triage Cancer’s Practical Guide to Cancer Rights, their Animated Videos, and their Cancer Finances Toolkit. Additionally, visit their Chart of State Laws to learn more about employment, disability and health insurance, estate planning, and more, specific to your state.