Health Care Assistance Programs
Health care access is very important for cancer survivors. Yet, many people cannot afford to pay for important health care services that are needed for health and recovery, such as visits with their health care team and certain medical procedures. Fortunately, a variety of health care assistance programs are available to help those who have a financial need. Knowing about the most common types of health care assistance programs can help you get the best and most affordable health care that is available for your situation.
Health Care Assistance Programs: Detailed Information
This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information.
Access to health care is very important for cancer survivors. Without enough insurance coverage, you may be responsible for some or all of the costs associated with medical procedures, visits with your health care team and other services needed for your well-being. Ongoing medical care may be needed for your health and recovery. Yet, many people cannot afford to pay for these important health care services.
Fortunately, there are a variety of health care assistance programs available. Many of these programs help eligible families or individuals obtain health care services at a reduced price or at no cost. Each program description defines the covered medical services as well as the requirements for benefit eligibility. Some programs may pay for examinations, diagnostic tests and preventive services. Knowing about health care assistance programs may help you get the medical care you need.
This document provides an overview of the most common types of health care assistance programs. It also discusses ways to get the best and most affordable health care coverage for your situation, including:
- Finding health care assistance programs
- Qualifying and applying for health care assistance programs
- Evaluating health care services found on the Internet
- Reporting concerns about online services
Finding Health Care Assistance Programs
Specific health care assistance programs for your area can usually be found in a number of ways, such as:
- Contacting your area cancer organization or hospital and speaking with a patient services representative.
- Searching on the Internet using key words and the name of your community. For example, search for "low-income health care, Austin, TX."
- Checking the listings in the government or business sections of your local telephone directory.
- Talking with a professional, such as a social worker or a representative from the Department of Health and Human Services in your area.
- Calling the United Way 2-1-1 telephone helpline that is available in many areas.
Health care assistance programs help people who have no health insurance, have only limited coverage or cannot afford to pay for the medical services they need. These programs may also be known as patient assistance, medical needs, reimbursement or compassionate care programs.
Some of these assistance programs provide both medical services and financial help. Assistance might include finding a health care program you can work with, supporting your application for benefits or providing discounts on health care services. Providers and resources for health care assistance include nonprofit organizations as well as local, state and federal government programs.
Many nonprofit organizations will help you find and apply to health care assistance programs at no charge.
Other good sources of information about health care assistance programs may come from:
- family members and friends
- hospital social workers, case managers, or other medical team members
- representatives from cancer organizations
The following table provides an overview of the most common types of health care assistance programs that are available as well as organizations that may provide them:
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Programs
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Health Care Assistance Program Information
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Medicaid
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Medicaid is a federally-funded program administered by the Medicaid offices in each state. Each state sets its own eligibility and service guidelines. Medicaid sends payments directly to the health care providers, such as doctors and hospitals. It is not meant to be a source of income.
Specific Medicaid coverage may vary from state to state, but is generally for people who are citizens or are lawfully admitted residents of the United States. Eligibility guidelines require that you are over 65 years of age, meet income guidelines or have certain disabilities. Children and pregnant women may also be eligible for benefits.
Many states provide Medicaid eligibility to people who qualify for Supplemental Security Income (SSI) benefits. However, a number of states use their own eligibility rules for Medicaid and some require a separate application. In addition, most states have additional state-only programs to provide medical assistance for certain people who have income needs but do not qualify for the Medicaid program.
Generally, you should apply for Medicaid if your income is low and you meet the requirements of an eligibility group. If you or someone in your family needs health care, a qualified caseworker for your state Medicaid program should evaluate your situation to see if you qualify for benefits. For example, despite income level or assets, someone who has had excessive medical expenses and is considered medically needy may be eligible for Medicaid benefits. Contact your state Health Department about eligibility requirements for Medicaid benefits.
The Web site for the Centers for Medicare & Medicaid Services (CMS) provides contact information for all state Health Departments.
Centers for Medicare & Medicaid Services
Phone: 1-800-633-4227
TTY: 1-877-486-2048
Web site: www.cms.hhs.gov
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Medicare
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Medicare is the federal health insurance program that includes coverage options for prescription medication, doctor services and hospital visits. Medicare services are for people with certain disabilities and for citizens or lawful residents of the United States who are 65 years of age or older.
The Medicare program has three parts:
Part A (Hospital Insurance): This benefit helps pay for certain types of hospital care, short-term skilled nursing care and some home health care. Most people get Part A automatically when they turn age 65, and they do not have to pay a monthly premium. If you are 65 years or older and are not entitled to Social Security because you did not work or have not paid enough Medicare taxes, you may be able to purchase coverage. A person with a disability who loses Medicare coverage because they returned to work may also be able to buy coverage.
Part B (Medical Insurance): This benefit helps pay for some preventive services and for medically necessary doctor services, outpatient care and other medical services not covered by Part A. Enrollment in Part B is not required. There is a monthly premium for Part B. If you choose not to enroll in Part B when you are first eligible, you may have to pay a penalty if you decide to join later.
Part D (Medicare Prescription Drug Coverage): This prescription drug plan option is available to everyone with Medicare. This coverage may lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance that is provided by private companies. Participants choose their drug plan and pay a monthly premium.
Contact the Centers for Medicare & Medicaid Services (CMS) through their Web site or by phone. Generally, you or your spouse must have worked for at least ten years in Medicare-covered employment to qualify for benefits.
Centers for Medicare & Medicaid Services
Phone: 1-800-633-4227
TTY: 1-877-486-2048
Web site: www.cms.hhs.gov
If you have limited income and resources, your state may help you pay for Part A and Part B coverage. Contact your local Social Security office or the national Social Security Administration for more information.
U.S. Social Security Administration
Phone: 1-800-772-1213
TTY: 1-800-325-0778
Web site: www.ssa.gov
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2-1-1 services
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2-1-1 is a United Way program that is available in certain areas in many states. Services vary by community, but generally provide information and referrals to human services programs for day-to-day needs and for emergencies. 2-1-1 services may include referrals to physical and mental health resources, transportation, food banks, financial assistance programs, health insurance and childcare. Contact the program through the United Way Web site or by dialing 2-1-1.
2-1-1 Services
Phone: 211
Web site: www.211.org
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Dental assistance programs
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Dental assistance programs are available in most states to help people with limited incomes and no dental insurance get the care they need. These programs may be run by volunteer or nonprofit organizations, such as state dental associations, as well as by dental schools, state, county or city programs. Each dental assistance program has its own rules for eligibility, services and fees. Contactdental schools in your area and your city or county Health Department for information about the programs that exist in your area. You can also go online to the Bureau of Primary Health Care Web site for help finding free or low-cost dental care.
Bureau of Primary Health Care
Web site: www.bphc.hrsa.gov
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Health insurance programs for children
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Many states offer low-cost or free health insurance for children. Some states also offer coverage for parents at an additional fee. The Insure Kids Now! program, sponsored by the Department of Health and Human Services (DHHS), helps families find health insurance for children. For little or no cost, the coverage includes doctor visits, prescription medicines and hospitalizations. Contact the Insure Kids Now! program in your state to learn more about this program.
Insure Kids Now!
Phone: 1-877-543-7669
Web site: www.insurekidsnow.gov
State Children's Health Insurance Program (S-CHIP) is available in most states to provide free or subsidized health care coverage for children (to age 19) from low-income families. Your local Department of Health and Human Services may also provide information about assistance available to pay for medical care for families who meet low-income eligibility. Contact your local Medicaid office or the Centers for Medicare & Medicaid Services (CMS) through their Web site or by phone for information about S-CHIP.
Centers for Medicare & Medicaid Services
Phone: 1-800-633-4227
TTY: 1-877-486-2048
Web site: www.cms.hhs.gov
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Hospital financial assistance programs
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If you need hospital care and have little or no insurance, you may be eligible to receive financial assistance. Federal and state laws require certain hospitals to provide free medical care or reduced prices to people who are income eligible. In addition, some hospitals have their own programs to help those in need.
If you have no insurance or cannot pay, find out if it is possible to arrange for reduced charges and/or set up a payment plan. You can contact your state or county Health Department, a hospital financial counselor, social worker or a patient advocate program for more information. You can also contact a cancer organization, such as the Patient Advocate Foundation through the LIVESTRONG SurvivorCare program, for help finding financial assistance.
LIVESTRONG SurvivorCare
Phone: 1-866-467-7205
Web site: www.LIVESTRONG.org/SurvivorCare
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Financial assistance for medical treatments
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Information about financial aid for medical treatments can be obtained from cancer and patient advocacy organizations. The services may include referral to programs for insurance co-pay relief or prescription assistance programs for those who medically and financially qualify. Support programs may offer counseling and referrals to local resources as well as help address financial and insurance concerns. Contact a cancer organization, such as the Patient Advocate Foundation through the LIVESTRONG SurvivorCare program, for more information.
LIVESTRONG SurvivorCare
Phone: 1-866-467-7205
Web site: www.LIVESTRONG.org/SurvivorCare
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Clinical trials
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Clinical trials are studies to test treatments that are in development. These may include new methods of prevention, medications or combinations of medications, new surgical practices or other procedures to treat diseases and improve a patient's quality of life. Many hospitals participate in clinical trials after laboratory studies define the safety of a new treatment or procedure. One of the advantages of a clinical trial is that patients often do not have to pay anything to participate.
Talk with your doctor about whether participation in a clinical trial would be a good way to obtain treatment. The following programs can assist you if your doctor recommends clinical trial treatment:
LIVESTRONGClinical Trials and Matching Service: TheLIVESTRONG SurvivorCareprogram has partnered with EmergingMed to offer a free and confidential cancer clinical trial matching and referral service. The purpose is to increase treatment options for people with serious illnesses and to facilitate the development of medication options through the process of clinical trials. You can contact this program through the LIVESTRONG SurvivorCare program.
LIVESTRONG SurvivorCare
Phone: 1-866-467-7205
Web site: www.LIVESTRONG.org/SurvivorCare
U.S. National Institutes of Health (NIH): The NIH provides updated information about federally and privately supported clinical research for patients, family members and the public. You can learn about clinical trials, eligibility, locations and phone numbers for more specific information. Information developed by the National Library of Medicine is provided through the NIH Web site.
ClinicalTrials.gov
Web site: www.clinicaltrials.gov
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Assistance for women
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The Centers for Disease Control (CDC) provides screening and diagnostic services in every state through the National Breast and Cervical Cancer Early Detection Program. This program offers an early breast and cervical cancer detection program for women who have low-incomes or are uninsured and underserved. Services include clinical breast exams, mammograms, pap tests, surgical consultations and referrals to treatment and diagnostic testing if a screening outcome is abnormal.
Contact your state Department of Health or the National Breast and Cervical Cancer Early Detection Program for specific information about the programs in your area.
National Breast and Cervical Cancer Early Detection Program
Phone: 1-800-232-4636
TTY: 1-888-232-6348
Web site: www.cdc.gov/cancer/nbccedp
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Community health centers and free clinics
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Community health clinics provide general health care services. If you cannot pay or have no insurance, the cost is usually based on a sliding-fee scale according to your income.
Free clinics generally provide health care services at little or no cost to individuals with limited income and resources. Typically there is no charge for a visit with a doctor or nurse and all lab work and medications are free.
The federally-sponsored Bureau of Primary Health Care Web site will help you locate these types of health care services in your area.
Bureau of Primary Health Care
Web site: www.ask.hrsa.gov
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Federally Qualified Health Center
(FQHC)
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FQHCs are federally supported community-based health clinics that provide health care services, including prevention, in areas that are underserved. These programs include Community Health Centers, Public Housing Primary Care plans, Migrant Health Centers, Homeless Health Care programs and Urban Indian and Tribal Health Centers<. Go online to the Bureau of Primary Health Care Web site for help finding free or low-cost health care.
Bureau of Primary Health Care
Web site: www.bphc.hrsa.gov
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Rural Health
Clinics (RHC)
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RHCs are located in rural, medically underserved communities. Coverage includes health care services provided by doctors, nurse practitioners, visiting nurses, clinical psychologists and social workers. Go to the Bureau of Primary Health Care Web site for help finding free or low-cost rural health care.
Bureau of Primary Health Care
Web site: www.bphc.hrsa.gov
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Department of Veterans Affairs (VA)
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Most military veterans are eligible for medical care and prescription coverage through a local VA facility. Those who have service-connected medical conditions may be able to receive priority access to care. In addition, the TRICARE managed care program may provide health care services for eligible dependents. If you believe you might qualify for benefits, contact the VA in your area through their Web site or call their toll free number.
Department of Veterans Affairs
Phone: 1-800-827-1000
Web site: www.va.gov
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Qualifying and Applying for Health Care Assistance Programs
Every health care assistance program has its own eligibility standards. When you contact a program, ask what the program requires to be eligible to obtain services. Some programs may have requirements concerning income, asset limits, health insurance coverage and immigration status. Other programs may only require a referral from your doctor.
When you apply for a health care assistance program, let your doctor's office know what is required from them in order for you to qualify for benefits. For example, the assistance program may require verification of your health condition or current medical need from the doctor's office.
After your doctor agrees to provide medical information to the assistance program, you may need to follow up with your doctor's office to make certain that this happens within the timeframe the benefit program requires for eligibility.
If there is a delay in obtaining the required paperwork from your doctor's office, try bringing the program forms to a meeting with the doctor. If appropriate, fill in the general information portions of the form, such as your name and address, to make things easier for your doctor. If you have concerns about getting the required medical information submitted to the benefit program on time, ask one of your health care team members, such as a nurse or social worker, to help with this process.
When you qualify for benefits through a health care assistance program, find out when the services will start or if there is a waiting period. You may need to identify other ways to temporarily meet your medical needs if there will be a delay before benefits begin.
Evaluating Health Care Services Found On the Internet
The Internet can be a good resource for obtaining information related to health care assistance programs. However, you may find that some sites do not clearly identify their sponsors and may be misleading about the sources of information used.
Take the following steps as you evaluate whether an online resource is reliable and up to date:
- Consider the source. Find out who sponsors the Web site and whether you might be looking at information presented by an individual, organization or retailer from another country. If the source is from outside the U.S., the products or services offered do not have to meet federal requirements or standards.
- Think about the purpose of the Web site. Consider why the Web site exists. The purpose of the Web site might be to educate, inform, sell a product or service, promote an idea, or to raise money. Each of these types of sites has a different motive, intention and way of presenting information.
- Find out where the information on the Web site came from. Good sources include sites sponsored by the government (.gov), those run by medical facilities or educational institutions (.edu), or sites sponsored by nonprofit groups intended to educate, provide service (.org), or share scientific writings (such as medical research). Commercial Web sites (.com) are often set up to sell a product or service and may have very different reasons for existing.
- Review Web site contact information. Contact information should be available for the sponsor of the Web site, including address, telephone numbers and names of people and/or departments within the organization.
Reporting Concerns about Online Services
If you have serious concerns or bad experiences with any health care products or services obtained online, take the following actions:
- If an online resource makes false claims about their services and/or products, notify the Federal Trade Commission (www.ftc.gov).
- If you lose money using the Internet to make purchases, contact your credit card company, the office of your state attorney general and the Better Business Bureau online (www.bbb.org).
- If the problem is serious, contact your doctor immediately. File complaints about adverse reactions or other serious matters with the Food and Drug Administration (www.fda.gov).
Many resources exist to ensure that health care assistance is available and affordable for those who need them. Contact members of your health care team, a hospital social worker or a nonprofit group, such as a cancer organization, for help finding health care assistance programs.
This document was produced in collaboration with:
David S. Landay, Esq., author of Be Prepared: The Complete Financial, Legal and Practical Guide for Living with Cancer, HIV and Other Life-Challenging Conditions.
Works Cited
Weston, Liz Pulham. "A survival guide for the uninsured." MSN Money. 31 January 2007.
http://articles.moneycentral.msn.com
"Guide to Finding Health Insurance Coverage." Prepared by Families USA for Cover the Uninsured Week: Let's Get America Covered. 2 February 2007. www.CoverTheUninsured.org
"Insurance Questions and Programs Offered to Cancer Survivors." Beyond the Cure. The National Cancer Society. 22 May 2006.
http://beyondthecure.org
Landay, David S. Be Prepared: The Complete Financial, Legal and Practical Guide to Living with Cancer, HIV and Other Life-Challenging Conditions. New York: St. Martin's Press, 1998.
"Medical Insurance and Financial Assistance for the Cancer Patient." Cancer.org. American Cancer Society. 22 May 2006.
www.cancer.org
"Use Caution Buying Medical Products Online." FDA Consumer Magazine. U.S. Food and Drug Administration. 8 February 2007.
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