If you have cancer, the Affordable Care Act safeguards your healthcare benefits and protects you from losing your insurance coverage.
Cancer and Insurance Coverage

Health insurance* must contribute to the cost of your cancer treatment.
Under the Affordable Care Act, you have the following rights as a cancer patient:
- Because you have cancer, your insurance cannot be canceled.
- If you have cancer, you cannot be denied insurance.
- Children with cancer cannot be denied coverage.
If you qualify and want to participate in a clinical trial, your health plan must help cover the normal costs of approved research studies. A clinical study could help you access breakthrough cancer therapies.
Limits on How Much You Must Pay for Cancer Treatment
The Affordable Treatment Act limits how much you must spend out of pocket for medical care from your doctors and hospitals participating in your plan. These safeguards are available even if you have cancer:
There is no monetary restriction on how much an insurance company can spend on covered healthcare expenses. The annual and lifetime limits have been removed.
If you are sick, you cannot be charged more for health insurance.
Your out-of-pocket expenses will be restricted. There is a limit to how much you can spend on copays, coinsurance, and deductibles.
If you enroll in a health plan through your state’s Marketplace or have an employer-provided health plan that includes medical and pharmaceutical costs in 2020, the following are your spending caps or maximums:
• If you are single, your out-of-pocket expenditures for in-network treatment are limited to $8,150 per year. • For a family, the annual ceiling is $16,300.
If you purchase insurance through your state’s Marketplace, you may be eligible for financial assistance to cover some costs. Tax credits and cost-sharing subsidies are offered to those with qualifying incomes. Find out more at healthcare.gov. You may be eligible for Medicaid even if you have not previously qualified. Some states have expanded Medicaid to cover more people. Check with your state’s Marketplace to see if your state is one of those.
Mental Health Care During Cancer Treatment
Many patients experience despair and anxiety while undergoing cancer therapy. You can obtain a free depression screening. Health plans marketed through state Marketplaces, the individual market, and small businesses must cover mental health care.
While firms with more than 50 employees are not required to provide mental health services, most do.
Furthermore, mental health services must be offered under the same terms and circumstances as conventional health care services. Health plans can no longer provide more limited mental health benefits than they can other health care benefits.
Your chosen plan will determine the amount you pay for your care. You can also access these services through Medicare and Medicaid.
Savings on Cancer Drugs for Seniors
If you have Medicare Part D, the Affordable Care Act will close the so-called “donut hole.” That is a gap in your prescription drug coverage. Before the Affordable Care Act, you had to pay the total cost of medications once you hit the yearly drug-spending cap. While in the donut hole, you pay only 25% of the expenses of both covered brand name and generic medicines.
Essential Health Advantages
If you get health insurance through your state’s Marketplace, the individual market, or an employer with fewer than 50 employees, your plan must provide certain primary health benefits.
As a cancer patient, you may require the following services:
• Chronic illness care
• Emergency care
• Hospital care
• Lab services
• Mental health services
• Outpatient therapy
• Prescription drug coverage
• Rehabilitation services.
Remember that each state defines precisely what must be covered under these categories. Individual health plans may exceed the essential standards. Before enrolling, read the summary of benefits to determine your costs. While major firms are not obligated to provide fundamental health insurance, nearly all do.