Covering the Cost of Breast Cancer Care

    Covering the Cost of Breast Cancer Care

    By Shelly Gigante

    For patients battling breast cancer, the costs associated with treatment can be a significant source of stress, regardless of income or insurance.  

    According to the National Cancer Institute, the average cost of treating breast cancer during the first year following diagnosis will reach a projected $6,851 by 2020, up from $6,038 in 2010. Follow-up care will cost a projected $13,646 by 2020, up from nearly $10,500 in 2010.1

    Even for those with health insurance, out-of-pocket fees in the form of co-pays and deductibles can quickly become a financial burden, especially under a high deductible plan. Add to that any childcare or transportation expenses required to obtain medical care, plus lost income if patients are unable to work for a period of time, and the cost gets greater still.

    Susan Brown, senior director of health and program education for the nonprofit Susan G. Komen organization, notes that budgeting for breast cancer treatment based on averages is particularly tough, since the price varies dramatically depending on tumor location and stage of disease. Those in early stages of the disease, for example, may require a simple surgery and a few months of radiation therapy, while later stage patients and those with more aggressive tumors may require pricey procedures or medications for years — in some cases, for life.

    “The costs are also vastly different for people who are insured versus those who are uninsured because providers often enter into negotiated contracts with insurance companies to provide care at lower costs,” said Brown.

    Indeed, a 2015 study on the price of all types of cancer drugs from the University of North Carolina at Chapel Hill found uninsured cancer patients pay anywhere from two to 43 times what Medicare would pay for chemotherapy drugs.2 

    Regardless of the financial implications, however, Brown said patients diagnosed with breast cancer should never let money concerns stand in the way of their care.  Help is abundant, if they know where to look.

    “Delaying treatment to save a few dollars in the long run just does not serve that patient well,” she said. “We would really encourage people to reach out to providers, social workers, their insurance company and charitable organizations to try to work something out so they can get care when they need it, because we know that being able to complete treatment as it was originally prescribed really does offer the best chance for survival.”

    Work with Your Provider

    Breast cancer affects roughly one in 8 women (12 percent) over the course of her lifetime, according to Breastcancer.org.3 But thanks to continued research, the five-year survival rate for patients who undergo treatment now stands at roughly 90 percent, the National Cancer Institute reports.4

    To manage the cost of that care most effectively, Brown suggests patients express their concerns to their doctor, nurse, or hospital. Most treatment centers have financial counselors or social workers on hand to help set up payment plans as needed, process insurance paperwork required, and provide an estimate of the costs you will likely bear. Some may also negotiate a reduced rate to offset costs not covered by insurance, or waive their fee altogether for the uninsured.

    Indeed, providers are the first line of defense in the hunt for financial aid. They may have free medication samples to help defray the cost of drugs, be able to suggest lower cost generic medicines, or be able to negotiate a reduced rate to offset costs not covered by insurance.

    Finally, they may also be able to refer you to local government agencies and nonprofit groups that offer grants for medical care.

    Maximize your Benefits

    Patients with health insurance who are newly diagnosed should contact their plan to get an estimate of their treatment costs, and a list of in-network providers who can help keep out-of-pocket costs to a minimum, said Brown.

    Ask what is covered — and what is not — and inquire specifically about any limits, restrictions or co-pays.

    It will also help you take advantage of all the benefits to which you are entitled. 

    Breastcancer.org said patients who buy their own health insurance (rather than receiving it as a benefit of their spouse or their spouse’s employment) should be sure they pay their premiums on time, to ensure their policy remains in effect.  Patients should also request a case manager so they talk to the same person each time they call.

    The group further recommends patients double check with each specialist to which they are referred to ensure they are in their provider network, and that they maintain a detailed record of all the claims they submit with dates, noting whether they are still pending or already paid.

    Keep Careful Records

    A more detailed personal health record,  that includes documents of all paperwork related to their treatment, diagnosis, and insurance claims is also vital to ensure patients stay on top of their treatment plan, avoid unnecessary late fees, appeal claim denials, and budget for pending expenses, said Brown.

    “Keep careful records of your bills and make a note of the people you talked to, what they said and what you agreed upon,” said Brown. “Mistakes do occur on hospital bills.”

     (Related: A Personal Health Record…Cost Control)

    The Patient Advocate Foundation offers advocacy help for patients disputing insurance claim denials and provides arbitration, mediation and negotiation to settle issues with access to care, medical debt and job retention related to their illness.

    Good Samaritans        

    For low-income individuals who can demonstrate financial need, a number of additional resources exist from drug companies and nonprofits.

     “There are many treatment assistance programs available,” said Brown.

    Most pharmaceutical firms, for example, offer free or discounted medication to needy patients, while the Patient Advocate Foundation Co-pay Relief Program offers financial assistance to insured patients who need help with out-of-pocket medication or treatment expenses. 

    Cleaning for a Reason provides free house cleaning for women undergoing treatment for any type of can cancer, so they can focus on their health, and the National Cancer Society’s Road to Recovery program provides transportation to patients who do not have a ride to treatment.  

    Corporate Angel Network also matches patients in need of travel with empty seats on private corporate jets.

    Many local churches, synagogues and other religious organizations also have volunteers who can help with day to day tasks, like transportation or grocery shopping, according to Breastcancer.org.

    Susan G. Komen also offers a hotline staffed by oncology social workers who can act as a resource and direct patients along to breast cancer financial assistance groups.

    Clinical trials, such as those funded by the National Cancer Institute, may also give patients, regardless of income, access to cutting edge therapies, at virtually no cost.  Susan G. Komen offers information on its web site about the benefits and drawbacks of participating, and how to enroll. Breastcancertrials.org offers a link to help patients identify trials that may be right for them.

    “We are big proponents of clinical trials because we will never learn more than we know today unless people agree to participate in trials,” said Brown, acknowledging not that trials are necessarily the right move for everyone. “It’s an opportunity to get at least the current standard of care or something that might be even better, but of course there are no guarantees.”

    Other Sources of Cash

    Remember, if money is tight, you may also be able to tap your retirement account or life insurance policy for funds to help cover your medical expenses.

    Generally, withdrawals from a traditional IRA before age 59-1/2 are taxed as ordinary income, plus assessed a 10 percent early withdrawal penalty, but the IRS makes an exception for health care costs.

    Traditional IRA owners who are under age 65 may withdraw funds from their account penalty-free to pay unreimbursed medical expenses if those bills exceed 10 percent of their income. That threshold is 7.5 percent if you are older than 65. (You will still owe income tax on the withdrawal.)

    In the case of a Roth IRA, which is funded with after-tax dollars, account holders can withdraw their contributions tax and penalty-free at any time regardless of age.  The 10 percent penalty is similarly waived for an early withdrawal of the earnings prior to age 59-1/2, if used to cover unreimbursed medical expenses.

    Retirement savers who qualify due to “immediate and heavy financial need, may also be able to take a hardship distribution, or loan, from their 401(k).

    While health and well-being always trumps tax concerns, however, James Guarino, a certified public accountant with Moody, Famiglietti & Andronico in Tewksbury, Massachusetts, said individuals are generally better off tapping other sources of cash for their medical expenses and leaving their retirement savings alone.

    “I believe most tax and financial planning professionals, me included, would instinctively suggest that individuals consider other payment options first before they tap their retirement plan assets,” he said.

    Apart from a personal loan from the bank, patients may also be able to borrow funds from a friend or family member who is in a position to help.

    Borrowing from a cash value life insurance policy can also provide emergency funds, said Guarino, noting the wisdom of such a move is determined on a case by case basis. “In general, life insurance policies offer loan borrowing capacity that may be more advantageous than typical bank or credit card loans,” he said, noting some of the bigger advantages of borrowing from cash value policies include more flexibility with repayment terms, better interest rates and elimination of the need to undergo a credit check.

    But, he warns, interest will accrue over the life of the loan and the loan will eventually need to be paid back, either during the policyholder’s lifetime or from the policy’s death benefit when they die. “Misjudgment and or mismanagement of the loan could lead to a reduction in the death benefit or, the possible loss of the policy altogether,” said Guarino. 

    To reiterate, using the cash value of a life insurance policy reduces its value and death benefit and increases the chance the policy will lapse. If a policy lapses with an outstanding loan that exceeds the cost basis, it becomes taxable. Many people talk with a financial professional about risks and alternatives before turning to an IRA or life insurance policy for funds.

    (Related: Treat the Cash Value with Care)

    In the fight against breast cancer, knowing what to expect, both medically and financially, can help you and your family plan ahead – a source of relief at a stressful time.

    By talking with your doctor, understanding your benefits, and exploring all available funding sources, patients can help to keep their costs under control and focus their energy into what matters most – getting well.


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    1 National Cancer Institute, “Cancer Prevalence and Cost of Care Projections,”  2011.

    2 University of North Carolina at Chapel Hill, “Price of cancer drugs varies widely based on who’s paying,” 2015.

    3 Breastcancer.org, “U.S. Breast Cancer Statistics,” Sept. 30, 2016.

    4 National Cancer Institute, “SEER Stat Fact Sheets: Female Breast Cancer,” Sept. 12, 2016.


    The information provided is not written or intended as specific tax or legal advice. MassMutual, its employees and representatives are not authorized to give tax or legal advice. You are encouraged to seek advice from your own tax or legal counsel.


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