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Our highly trained specialists are available 24/7 via phone and on weekdays can assist through video calls and online chat. We connect patients, caregivers, and family members with essential services and resources at every step of their cancer journey. Ask us how you can get involved and support the fight against cancer. Some of the topics we can assist with include:
For medical questions, we encourage you to review our information with your doctor.
Financial and Insurance Matters
Health insurance plans are private (also called commercial) or public (government-funded). Most people in the US have health insurance through their employer.
If you don’t have insurance through your employer, you can also see if you’re eligible for government-funded insurance. Your state’s Marketplace decides if you qualify for financial help for insurance coverage.
A managed care plan is an agreement between health insurance companies and health care systems and providers. Providers and facilities that have these agreements are “in-network.” If you have a managed care plan, health services with in-network providers are usually less expensive. You might have to pay more or all your medical bill if you get care outside your network.
When you’re looking for insurance, you might notice one of the following in the plan name:
HMOs, PPOs, POS plans, and EPOs are all kinds of managed care plans.
Health maintenance organizations (HMOs) offer lower monthly premiums and out-of-pocket costs. However, they are less flexible with a smaller network of providers to choose from. They usually don’t cover out-of-network providers except for medical emergencies. You might also need a referral from your primary care provider before you can see a specialist.
Preferred provider organizations (PPOs) usually have higher premiums and out-of-pocket costs. But they’re typically more flexible with a larger network of providers to choose from. They may partially cover out-of-network visits but with higher copayment and coinsurance compared to in-network visits. And with a PPO, you might not need a referral from your primary care provider to see a specialist.
Point-of-Service (POS) plans are a hybrid of HMO and PPOs. Premiums are usually more than an HMO but less than a PPO. There is some flexibility with a larger network of providers (like PPOs), but usually require a referral from your primary care provider to see a specialist (like HMOs).
Exclusive Providers Organizations (EPOs) have some flexibility and cost less than most PPOs. You don’t need a referral from your primary care provider to see a specialist, but you can go out-of-network, except for emergencies.
High-deductible health plans (HDHPs) have lower monthly payments but higher deductibles. Some HDHPs come with the choice to sign up for a Health Savings Account (HSA). HSA funds come from your salary and are tax-free. But you can only use this money for certain qualified medical expenses.
Whether you’re starting to look at your insurance options or you already have health insurance, it’s important to know what your plan does and does not cover.
Here are some things to think about:
If you have cancer, it’s important to understand your health insurance’s Summary of Plan Benefits (SPB) to understand covered and excluded services.
Many insurance companies require pre-authorization for cancer services. Here are some things you might want to check your insurance coverage for:
Along with the American Cancer Society, other sources of information and support are:
US Department of Health and Human Services, State Health Marketplaces & more
Toll-free number: 1-800-318-2596 (also in Spanish)
TTY: 1-855-889-4325
Website: www.healthcare.gov
Provides information on the new insurance law, takes you through the steps of finding insurance, and much more. If you don’t have Internet access, the phone number will help you connect with your state’s Marketplace to sign up for a plan
You can learn about hardship exemptions (which allow some people to avoid the penalty for not having health insurance)
US Department of Health and Human Services
Medicaid
Toll-free number: 1-877-696-6775
Website: www.medicaid.gov/index.html
Medicare
Toll-free number: 1-800-633-4227
TTY: 1-877-486-2048
Website: www.medicare.gov
Your state social service or human service agency can give you the best answers to questions about your benefits, eligibility, and fraud.
Answers questions, provides literature, and gives referrals to state Medicare offices and local HMO’s with Medicare contracts.
Department of Veterans Affairs
Toll-free number: 1-800-827-1000
Website: www.va.gov
For information on Veteran’s medical benefits and whether you qualify for them
Toll-free number: 1-877-222-8387
Website: www.va.gov/healthbenefits/apply/veterans.asp
*Inclusion on these lists does not imply endorsement by the American Cancer Society.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
Along with the American Cancer Society, other sources of information and support are listed below.
US Department of Health and Human Services, State Health Marketplaces & more
Toll-free number: 1-800-318-2596 (also in Spanish)
TTY: 1-855-889-4325
Website: www.healthcare.gov
Provides information on the new insurance law, takes you through the steps of finding insurance, and much more. If you don’t have Internet access, the phone number will help you connect with your state’s Marketplace to sign up for a plan
You can learn about hardship exemptions (which allow some people to avoid the penalty for not having health insurance) at https://www.healthcare.gov/fees-exemptions/exemptions-from-the-fee/#hardshipexemptions
US Department of Health and Human Services
Medicaid
Toll-free number: 1-877-696-6775
Website: www.medicaid.gov/index.html
Medicare
Toll-free number: 1-800-633-4227
TTY: 1-877-486-2048
Website: www.medicare.gov
Your state social service or human service agency can give you the best answers to questions about your benefits, eligibility, and fraud.
Answers questions, provides literature, and gives referrals to state Medicare offices and local HMO’s with Medicare contracts.
Department of Veterans Affairs
Toll-free number: 1-800-827-1000
Website: www.va.gov
For information on Veteran’s medical benefits and whether you qualify for them
Toll-free number: 1-877-222-8387
Website: www.va.gov/healthbenefits/apply/veterans.asp
*Inclusion on these lists does not imply endorsement by the American Cancer Society.
American Hospital Association. Health insurance primer. American Hospital Association. Published January 2022. Accessed August 4, 2023. https://www.aha.org/guidesreports/2022-03-21-commercial-health-insurance-primer.
LongTermCare.gov. Basic needs. US Department of Health & Human Services. Accessed August 4, 2023. https://www.acl.gov/ltc/basic-needs.
HealthCare.gov. Health care options, using a flexible spending account FSA. Published 2019. Accessed August 3, 2023. https://www.healthcare.gov/have-job-based-coverage/flexible-spending-accounts.
Healthcare.gov. Type of plan and provider network. HealthCare.gov. Published 2018. Accessed August 3, 2023. https://www.healthcare.gov/choose-a-plan/plan-types/
Healthcare.gov. How to buy a Catastrophic health insurance plan. HealthCare.gov. Accessed August 3, 2023. https://www.healthcare.gov/choose-a-plan/catastrophic-health-plans/
Healthcare.gov. How to set up an HSA (Health Savings Account). HealthCare.gov. Accessed August 3, 2023. https://www.healthcare.gov/high-deductible-health-plan/setting-up-hsa/
Healthcare.gov. Official Health Insurance Guide. HealthCare.gov. Accessed August 3, 2023. https://www.healthcare.gov/quick-guide
Program Details | FLTCIP. www.ltcfeds.com. Accessed August 4, 2023. https://www.ltcfeds.com/program-details
Last Revised: September 30, 2023
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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