National Breast Cancer Coalition

Finding Affordable Care

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:

If you have health insurance, learn how it works.

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.

Find out who pays for your health plan.

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?

Find out what is covered.

Health insurance plans vary a lot in what they cover and cost. You need to learn what your health plan covers:

  • Do you get your insurance through your job? Ask your benefits manager for a copy of your plan's benefits.
  • Do you buy your own insurance? You should have a booklet that explains what is covered by your plan.
  • Are you age 65 or older? You can probably get Medicare. The government office that manages the Medicare program is called the Centers for Medicare and Medicaid Services (CMS). Contact CMS for information on the Medicare program.
  • Are you disabled? Will your disability last six months or more? If so, you may be able to get disability benefits from the federal government through the Social Security Disability Insurance (SSDI) program.
    The government usually agrees that you are "disabled" if you have metastatic breast cancer (breast cancer that has spread to another organ in your body).
    Are you under age 65? And have you gotten SSDI benefits for at least 24 months? Then you can also enroll in Medicare. Contact the Social Security Administration (SSA) and Medicare program for more information.
  • Do you earn very little money? You may be able to get Medicaid. Contact your state's health department. The phone number should be in the government pages of your phone book. Someone there can tell you if you can get Medicaid. He or she can also tell you which benefits your state offers.

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.

If you don't have health insurance, look for free or low-cost services.

Contact breast cancer activists in your state.

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.

Find out if you can get screened at a CDC site.

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:

  1. get your mammogram through the CDC NBCCEDP and need treatment for breast cancer (You qualify if your mammogram shows a preinvasive condition, too),
  2. not have health insurance that covers breast cancer care,
  3. not qualify for the Medicaid program in any other way,
  4. be under age 65 (so that you can't get Medicare), and
  5. be a U. S. citizen or a "qualified alien."

Contact the CDC to find out:

  • if you can get a mammogram through this program, and
  • where you can get a mammogram through this program.

Check if your state offers its own cancer screening and treatment program.

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.

Learn about the Hill-Burton free care program.

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:

  1. provide a reasonable volume of services to people who can't pay and
  2. make their services available to all people living in the center's area.

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:

  1. Contact the Hill-Burton Program. Ask for a list of Hill- Burton care centers in your area.
  2. After you find a Hill-Burton care center, go there and ask for a copy of its "Individual Notice." This notice will tell you which types of free or low-cost services the care center provides through the Hill-Burton program. It will also tell you where in the care center to apply to the program.
  3. Apply to the program. Usually, you must go to the Admissions Office or Business Office to apply. The care center may ask you to fill out an application.
  4. If you are asked for proof of your income, give this information to the care center. A pay stub may be requested.
  5. If you are asked to apply for Medicaid, Medicare, or some other financial assistance program, you must do so.
  6. When you return the completed application, ask for a "Determination of Eligibility." This will tell you whether you can get free care through the program.

Contact a local or state health services group.

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.

Find other ways to get help paying for care.

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 for free medicine.

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.

Ask for help getting to and from your treatment center.

  • Your NBCC field coordinator may know about ride services in your area. Contact NBCC to see if there is a field coordinator near you.
  • You can ask doctors, nurses, and social workers about services that can help you.
  • Local groups may also have information. Try cancer organizations, community centers, churches, temples, and women's groups. Sometimes they can give you free or low-cost rides to your doctors' offices or to hospitals.
  • The Patient Travel organization has free information and referrals. The group helps people who must move far away for care after an illness or accident. Contact Patient Travel for more information.

Ask everyone for help.

  • Ask people to hold fund-raisers for you. Or talk with leaders of your religious group. See if they can help you cover the costs of your care.
  • Contact your local, state, and national elected public officials. (Some examples are mayors, state representatives and senators, and U. S. representatives and senators.) They may be able to help you.
  • Go to your local hospital. Explain your problem to a doctor, nurse, or social worker. They know the system. They may be able to direct you to the right place for help.

Get time off work.

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:

  • care for a newborn or newly adopted child,
  • care for very ill family members, or
  • recover from your own health problems.

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.