You may have health insurance or a health plan that pays for all the care you need. Or it may pay for some of what you need, but not all. Or you may have no health insurance or plan.
Sadly, we are not guaranteed a right to health care in the United States. Someone has to buy it. It could be your employer, the government, or you. It is important to understand your health plan so you can be sure your plan is paying for everything it should.
What if you have no insurance? There are ways to get free and low-cost services.
What You Can Do:
Many of us feel that our health plan should pay all the costs of our health problems, but health care is like car insurance or home insurance. There are different packages and types of coverage. Your plan may not pay for all the health care you need or want. You need to learn about your health plan package.
Most American adults under age 65 get their health insurance through their jobs. Employers may pay for all, some, or no health insurance costs. There is no law that says employers must provide health insurance to their employees.
Other adults buy health insurance for themselves. For example, self-employed people usually buy their own insurance.
Most Americans age 65 or over can get health insurance through the federal Medicare program. The federal-state Medicaid program covers mostly lower-income families and people with disabilities. The rules for getting Medicaid vary by state.
Your health insurance "carrier" is the company that carries out your health plan's rules. It is also the company that pays for your care. Blue Cross and Blue Shield is an example of a health insurance carrier. When your insurance carrier pays for something, it is called a "benefit."
What is Medicare?
What is Medicaid?
Health insurance plans vary a lot in what they cover and cost. You need to learn what your health plan covers:
Some health insurance plans require you to pay a portion of the health care costs. This is called a copayment. There are several nonprofit groups that have copayment assistance programs for individuals with certain diagnoses. The Patient Advocate Foundation has a Co-Pay Relief Program for individuals with breast cancer, and a group called CancerCare is able to provide some copayment assistance for breast cancer oral drugs.
Several nonprofit groups provide copayment assistance for chemotherapy-related diagnoses including abnormally low levels of white blood cells (neutropenia), abnormally low levels of red blood cells (anemia), and nausea and vomiting. Among these groups are the Patient Access Network Foundation, Patient Services, Inc., and the HealthWell Foundation. Contact these groups to see if you are eligible for financial assistance with your copayment.
NBCCF's field coordinators work closely with NBCCF's national office. They know about the services you can get in their areas. And they can connect you with others who have been down the same road. Contact NBCC to see if there's a field coordinator near you.
The U.S. Centers for Disease Control and Prevention (CDC) runs the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The program has a long name, but a simple and important task. It gives breast and cervical cancer screenings and treatment to low-income women. All 50 states offer screening and diagnostic services through the NBCCEDP.
NBCCF worked hard to pass the Breast and Cervical Cancer Treatment Act in 2000. The Act expands the NBCCEDP. It allows states to give treatment through the Medicaid program. Now, if a woman gets a mammogram through this program, and it turns out she has breast cancer, the NBCCEDP can pay for her treatment, too. And as of May 2004, all 50 states and the District of Columbia have passed legislation to provide free treatment through the program, too.
To get breast cancer care through the program, you must:
Contact the CDC to find out:
A few states have health care programs for people without insurance. Contact your state health department to see what services your state offers. The phone number should be in the government pages of your phone book.
In 1946, Congress passed a law called the "Hill-Burton Act." It gave hospitals and other care centers money for building and updating. In return, the centers that received these funds agreed to:
This means that many care centers must give health care to some people who can't afford to pay. To qualify for free care, your income must be below a certain level and you must not be covered by Medicare or Medicaid, or some other health insurance program. You can apply to the program at any time. You can apply before or after you receive care. You can even apply if a bill has been sent to a collection agency. If you qualify, Hill-Burton funds will cover the care center's charges. It doesn't cover your private doctor's bills. Still, this can be a huge help.
Hill-Burton care centers must post a sign that says, "NOTICE - Medical Care for Those Who Cannot Afford to Pay." This sign must be posted in the care center's Admissions Office, Business Office, and Emergency Room.
Here's how to find out if you can get free care through the Hill-Burton program:
Many local and state groups give free or low-cost mammograms and other health services. For example, the Avon Breast Care Fund gives money to many community groups. These groups give free or low-cost mammograms to women without health insurance. Contact the Avon Breast Care Fund to find out what is in your area.
Look for groups that can help pay for care. The nonprofit group CancerCare has a booklet called, "A Helping Hand Resource Guide." It lists cancer-related assistance programs available across the country. Ask the group to send you a copy.
The Georgetown University Health Policy Institute has Consumer Guides for Getting and Keeping Health Insurance, available for all 50 states and the District of Columbia through its Healthinsuranceinfo.net Project. These Consumer Guides describe your health insurance rights and protections,and provide a listing of state and federal resources for financial assistance.
Ask your doctor or nurse about "drug assistance programs." Some drug companies give free medicine to patients who can't pay for it. Every drug company has different rules. These programs don't include all drugs. But they're worth looking into. Your doctor or clinic may have access to these programs. The drug companies have a group called Pharmaceutical Researchers and Manufacturers of America (PhRMA). PhRMA has information on all the drug assistance programs their members offer. Contact PhRMA to see if a drug company can help you.
The Family and Medical Leave Act (FMLA) lets people take time off from work. People use the time to care for their families or themselves without losing their jobs. Do you work for a company with more than 50 workers? If so, you can take up to 12 weeks of unpaid leave a year. The leave can be used to:
Some states have even better laws. The National Partnership for Women and Families is a nonprofit group. They work on health, work, and family issues. Call and ask them for their guide to the FMLA.
There are also programs that may help women with metastatic breast cancer if they want to retire from work. Women with metastatic breast cancer may be able to get Social Security Disability Insurance (SSDI). SSDI gives money to women who qualify. Contact the Social Security Administration for more information.