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Ask Sid

The Cancer Survivor's New Battle

After "beating" their disease, millions skip follow-up care because of cost—even with insurance

Health medicare-insurance

— Todd Heisler/The New York Times/Redux

  • Insurance for you—or everyone else? In small businesses especially, some cancer survivors face a tough choice: "My employer said my treatment was raising rates for everyone else, so I was asked to find private insurance to not impact my coworkers," says Anne Creech, 64, who battled colon and breast cancer. She complied, but could only afford a policy with riders to exclude coverage for screenings or other cancer-related care—only to recently learn her cancer had returned. Weeks before the diagnosis, her big concern was coming up with $3,700 for a recommended colonoscopy. Now, she learns that her insurer won't pay for any treatment.

Help from the new health care law

But help is on the way for many like Creech. In July, the first major benefit of the new health care law took effect, a federal "high-risk pool" intended to provide coverage for people who can't buy affordable insurance because of preexisting medical conditions. The $5 billion program is a stop-gap measure until 2014, when the law fully kicks in and nobody can be denied coverage on the basis of health. At healthcare.gov, uninsured people interested in "preexisting condition insurance plans" can determine whether they qualify for coverage. Even cancer survivors with employer insurance often face a devastating issue: getting cut off by insurers after reaching their annual or lifetime coverage limits. Roughly 100 million Americans have these coverage limits built into their policies.

But that will change starting next month, with provisions of the new health care law that prohibit insurance companies from setting lifetime limits. And over the next few years, annual limits will be phased out as well.

Starting with health insurance plans that begin or renew after Sept. 23, insurance companies are banned from placing lifetime limits on their coverage.

Also beginning Sept. 23, insurers must cover annual medical expenses up to at least $750,000. The minimum annual threshold rises to $1.25 million in September 2011 and increases to $2 million beginning in September 2012.

Limits will be completely prohibited starting Jan. 1, 2014.

For insured patients who are financially struggling, are uninsured or have inadequate insurance, help is also available from other organizations. See "Cancer Resources."

Sid Kirchheimer writes about health and consumer issues.

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