Typical Out-of-Pocket Expenses That Come With Cancer



August 11, 2020

When a loved one, family member or yourself becomes diagnosed with cancer, an important factor to consider is the cost.  Cancer is one of the most expensive diseases to treat, and according to a 2019 survey conducted by the Mesothelioma Center, 63% of cancer patients reported having financial struggles following a cancer diagnosis. One of the largest contributors to  these financial struggles are the out of pocket costs associated with cancer.  

What Are Out of Pocket Expenses? 

An out of pocket expense is the money you pay directly to cover the costs of treatment and care. These expenses are not reimbursed by your insurance. 

Out of pocket expenses are expected when covering the cost of cancer care and treatments. Although insurance can take care of a portion of those costs, your out of pocket expenses associated with cancer can still be overwhelming. In fact, they could put you in a position where you may not be able to afford the care and treatment you need.  

Understanding where these expenses come from and how they can add up overtime is necessary when trying to manage the financial burden associated with a cancer diagnosis. Luckily, tips and strategies can be used to help reduce these costs and alleviate the financial stress of a cancer diagnosis. 

How Out of Pocket Expenses Add Up

Cancer is expensive. Many of the expenses are associated with prescriptions, clinic visits, lab tests, procedures, surgery, rehabilitation, among many other things. Although insurance can take care of some of these costs, you can still expect to pay at least some portion of the expenses. Unfortunately, the costs that your insurance does not cover can end up being in the thousands.  

Even with good insurance coverage, cancer patients often face high expenses, including:

  • high co-insurance 

  • high deductibles

  • seek out-of-network specialists

  • needing a treatment that is not covered by their plan

Consider having a plan in place when it comes to paying for your cancer costs. This should include taking the time to learn as much as you can about your specific situation and asking the right questions in regards to the costs of your cancer treatment. 

List of Typical Out-of-Pocket Expenses 

When first being diagnosed with cancer, you should expect to have your highest out of pocket expenses in the first two to three months. These costs can continue up until they meet your applicable deductible and out-of-pocket maximums.

Some of the medical expenses that can contribute to your out-of-pocket cancer costs include:

  • Clinic visits for treatments

  • Lab tests 

  • Procedures for diagnosis or treatment

  • Imaging tests 

  • Radiation treatment

  • Drug costs 

  • Hospital stays 

  • Rehabilitation expenses

  • Surgery 

  • Home care 

  • Specialist referrals

  • Transportation costs 

  • Hotels or lodging during treatment

  • Out of network treatment 

There are more common out-of-pocket expenses that are specific for those going through cancer care.

Does insurance cover cancer treatment?

Whether it be employer sponsored or a private insurance plan, having insurance is critical for those with cancer.

Understanding your insurance plan will help you avoid unexpected costs and make the best health care decision for yourself or a loved one. There are important factors to understand and consider when considering out-of-pocket expenses and choosing the right treatment plan for you:

Deductible, Copay and  Coinsurance 

  • A Deductible is set amount of money you pay before your health insurance starts to cover a  portion of your bills

  • A Copay is the predetermined rate you pay for healthcare services, such as prescriptions, doctor visits, etc 

  • Co Insurance, which applies after you’ve met your deductible, is the percentage of a medical charge that you pay, while the rest paid by your health insurance plan. It 

These are all considered out-of-pocket costs and can fluctuate based on what type of treatments you receive and whether your treatment is covered under a specific type of benefit.

Out-of-Network Charges 

Some plans do not cover any out-of-network treatment. Paying for these on your own will significantly increase your costs for cancer care

High Deductible Health Plans (HDHP)

Among the many types of health insurance plans, an HDHP is a plan that requires  high upfront costs for health care by having a large deductible which will contribute to high out of pocket expenses. 

Non-Covered Treatments Health insurance plans 

These health insurance plans do not always cover every health care service or drug which can cause your out-of-pocket expenses to increase drastically.

Strategies to Manage your Out-of-pocket Expenses 

Out-of-pocket costs can be tough to predict and manage. They can vary greatly from month to month, making it difficult to determine the actual costs at the time of your diagnosis. 

To help manage the financial burden of cancer cost, consider the following tips and strategies to help manage your out-of-pocket expenses: 

  1. Consider utilizing a budget tool to keep track of your out-of-pocket expenses on a month to month basis. Get started with our Budget Tracking tool here 

  2. Be aware of your deductibles, copay and coinsurance  in your health insurance plan  

  3. Consider palliative care as it can help to reduce costs for patients and health care payers. 

  4. Maximize your insurance benefits by reading and understanding the benefits and limitations of your plan. This will allow you to be able to make better healthcare decisions for yourself.

  5. If you are considering out-of-network treatment care, try to find that same service within your network to avoid the extra costs 

  6. Hire a Healthcare Advisor to help sort out your costs and identify areas to save on expenses.

Benefits of a Healthcare Advisor 

Facing high out of pocket expenses associated with cancer care can be difficult to navigate on your own. But hiring a Healthcare Advisor can provide you with that extra support. Among other things, a Healthcare Advisor can 

  • guide you through understanding the limitations of your insurance plan

  • determine a strategy to maximize your insurance benefits

  • help reduce the burden and stress of a cancer diagnosis, allowing you to focus on your health and well being.

Caribou connects you to a vetted Healthcare Advisor that can assist you with financial related inquiries, including out-of-pocket expenses.