Six Months of the Affordable Care Act: Rights and Protections for Cancer Patients

By Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight

Jay Angoff (image courtesy of the U.S. Department of Health & Human Services)

If you or a loved one has lived with cancer – you probably know more about the American health insurance system than you ever wanted. While most Americans have health insurance, few really know much about how their insurance works until the worst possible moment, when they are sick and need potentially life-saving care.

During the health reform debate, President Obama talked about the devastation of watching his mother battle both ovarian cancer and her insurance company. Unfortunately, such stories are all too common.

Thanks to the Affordable Care Act, fewer cancer patients are going to have to fight that two-front war. And many of the new patient rights and protections that will help cancer patients are beginning to take effect NOW, starting September 23rd. For example:

• Ending limits on care and benefits. Insurance companies can’t impose lifetime limits. And in most health plans, annual limits will be restricted. This means that your health insurance will be there right with you, covering your treatments, as long as you need it.
• Ending rescissions. If you get sick, your insurance company can’t drop you from coverage just because you made a mistake on your paperwork. If you keep paying your premiums and act in good faith, you won’t face losing your health insurance the moment you need it most.
• Appealing denied claims. If you are in a new plan, and your insurance company denies a claim, you have new rights to a fast and fair appeals process so you can ask them to reconsider that denial. This holds insurance companies accountable for delivering the benefits patients are entitled to.
• Covering kids. Cancer can strike at any age. Now, plans that offer coverage to your kids will have to continue covering them up to age 26, as long as they can’t get coverage through their own job. And most insurance companies can’t deny coverage to kids under age 19 because of a pre-existing condition, so you know you can buy your kids coverage if your employer doesn’t cover them.
• Choosing your own doctors. Now, new health plans have to let patients choose their own doctor from the plan’s network. And if you are in an emergency medical situation, you can’t be charged more to get treatment at a hospital out of your network.
• Keeping you healthy. As the saying goes, an ounce of prevention is worth a pound of cure. Now, new plans have to provide a number of preventive services without cost sharing. These include numerous cancer screenings, so more cancer cases will be detected early, as well as counseling and screenings to help prevent chronic conditions that contribute to poor health like heart disease, diabetes, and obesity.

Fighting cancer is a fight for your life – Americans shouldn’t have to fight their insurance companies at the same time. Now, thanks to the Affordable Care Act, patients have new tools and resources to get the care they need and take back control from insurance companies.