How Much You Can Really Expect to Pay for Treatment if You Get Cancer
Researchers are learning more about cancer every day — and hopefully, in the near future, a viable cure will be in the works. Until then, however, we’re facing some harsh truths. The National Cancer Institute notes nearly 2 million new cancer cases will be diagnosed in the U.S. in just 2018 alone. On top of that, it’s estimated that 609,640 people will die, with mortality rates higher among men than women.
There’s also something else to consider with any serious illness — and that’s the cost.
Cancer is the most expensive disease to treat to date
Drugwatch reports research from the American Institute of Cancer Research finds cancer costs $895 billion annually to treat. You can compare that to heart disease, which costs $753 billion. Diabetes and traffic accidents come in at just $204 billion, which looks incredibly small compared to the other huge costs.
As far as where these costs come from, 50% are from hospital or outpatient doctor visits, 35% are from inpatient hospital stays, and 11% are from prescription drugs. And costs are only on the rise.
You can expect to pay at least some portion of these medical expenses
Those who are treating their cancer often end up with sky-high medical bills that are extremely difficult to pay off. And while private insurance will take care of many of the costs associated with the condition, the American Cancer Society notes patient out-of-pocket costs still total around $3.9 billion per year. And most of the expense is involved in the hospital outpatient or office-based provider visits.
The American Cancer Society notes it’s also likely you’ll pay portions of the following expenses:
- Visits to your doctor and clinics
- Lab tests, which can include blood, urine, and more
- Any procedures involved in diagnosing or treating you, such as room charges, equipment charges, and seeing different doctors
- Imaging tests
- Radiation treatments and drug costs
- Hospital stays
- Equipment involved in home care
How much the individual will pay
A report from the American Cancer Society Action Network looked at the costs for three extremely common cancers — breast, lung, and colorectal. According to their findings, the average patient can expect to pay anywhere between $6,000 and $10,000 per year out of pocket when premiums, deductibles, co-pays, and co-insurance were factored in. On an employer-sponsored plan, the cost was closer to $6,000. On an exchange plan, the cost is close to $10,000. For patients who need out-of-network care at any point or treatment that’s not covered by their insurance plan, these costs only get worse.
You might think your excellent insurance will save you from astronomical out-of-pocket costs, but that might not be the case. The report found high co-insurance, deductibles, occasional out-of-network care, and uncovered treatments really add up, even for those with a good plan.
Those costs seem high, but possibly manageable. However, U.S. News & World Report found different statistics that are way more severe. Newly approved drugs can cost up to $10,000 per month, and patients are expected to pay 20-30% of these costs. That means a year’s worth of these new drugs could take $24,000 to $36,000 out of your pocket — and that’s before health insurance premiums.
Plan for unexpected prescription drug costs
Your health insurance plan may pay for chemotherapy administered through an IV — but the American Cancer Society notes oral chemotherapy can cost you serious money out of pocket. Oral chemo prescriptions are typically treated like regular prescription drugs, and they often come with a very high co-pay. Some insurance companies hike up the co-pay to be 25% of the original drug cost, which can result in thousands of dollars you need to pay up front just to attain the drug from the pharmacy.
If you need help paying for your prescription drugs, all hope isn’t lost. Drug manufacturers offer payment assistance plans and drug discount cards. You can also check GoodRx.com or WeRx.org to see which stores in your area offer the best price on the prescription drugs you’re looking for.
Questions for your healthcare provider
Everyone’s needs are different, and of course, your healthcare will be tailored to fit your diagnosis specifically. But there are some general questions you should keep in mind to ask your doctor.
Questions regarding treatment to ask:
- Does each treatment require a co-pay?
- How much will a hospital visit cost and how much will insurance cover?
- How can I check if the doctors taking care of me in the hospital are in my network?
- How much will surgery cost me and how much will insurance cover?
- Do you expect there to be many home care costs?
Questions regarding prescriptions to ask:
- How much will the chemo drug by mouth cost?
- How much will other drugs used to manage the side effects cost?
- How much will each prescription individually cost me after insurance?
- What programs are out there to assist me with these costs?
- Are there generic forms of this drug?
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