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    Making Treatment Decisions
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    Learning about insurance can be tough, especially during times of stress. However, a step-by-step plan may help you understand your options and decide what is best for you.

    Step 1: Understanding the basic types of insurance

    The first step is to understand the three types of insurance that are most important for people with breast cancer: health insurance, disability insurance and long-term care insurance.

    • Health insurance pays either some or all of the costs related to medical treatment. It can be bought by a person or an employer. It can also be provided by the federal or state government, such as Medicare (for people over age 65) or Medicaid (for people with a low-income). 
       
    • Disability insurance provides part of a person's income if she or he cannot continue working due to illness or injury. It can be short-term or long-term, depending on the length of time a person is unable to work. Short-term disability is usually less than six months. 
       
    • Long-term care insurance covers the cost of residential care (in a nursing home or at home) for people who are unable to care for themselves. Private health insurance plans often cover some of these costs. Medicare covers some costs, though there are limits and specific guidelines. Medicaid covers this care, but each state has its own benefits. For more coverage, you can buy a separate long-term care policy.

    Step 2: Reviewing your current insurance policies

    The next step is to review your current policies to see what coverage you have for each type of insurance.  

    If you work, start by reviewing the coverage given by your employer. It is a good idea to meet with someone from the human resources department to go over your questions.  

    If you do not work, you may want to talk about your insurance options with a hospital social worker or another person recommended by your health care provider or treatment center. The hospital may have a financial information office that can offer guidance. You can also talk to a staff member of your state or local health department.  

    When reviewing your policies, be sure to read the policies themselves and not just the marketing brochures that describe them. An insurance policy is a legal contract that describes your rights and responsibilities, as well as those of the insurer. It deserves the same level of attention as any other legal document.

    Step 3: Finding gaps in coverage

    The final step in making insurance decisions is to find out whether there are any gaps in your coverage. If there are gaps, you may want to consider buying supplemental (extra) insurance or getting help to obtain the coverage you need.

    Things to keep in mind when working with insurance providers

    When buying insurance:

    • Work with an insurance agent or agency that is licensed by the state insurance department.
    • Never cancel an old policy until a new one is in effect.
    • Make sure you know the limits of your new policy in terms of pre-existing conditions and waiting periods.
    • Check the application to make sure the information is correct. False or incorrect information may cause denial of some benefits or even cancellation of a policy.

    When dealing with an insurance company or agent:

    • Understand and follow the policies and procedures to the best of your ability.
    • Ask questions about any policies and procedures that are unclear.

    Make a folder for each insurance policy:

    • Keep copies of the policies themselves, claim forms, invoices and letters.
    • Keep a log of phone calls, including:
      • The date and time of the call
      • A brief summary of the subject
      • The name of the person you spoke to
      • Any actions that were to result from the call

     Komen Advocacy Alliance and the Affordable Care Act (health care reform)

    The Komen Advocacy Alliance continues to focus on patient protections included in the Affordable Care Act (ACA). These are the aspects of the health care system that directly affect women with breast cancer and women who may develop breast cancer.

    The Komen Advocacy Alliance seeks to ensure:

    1. All women have access to breast health care services that may save their lives
    2. Breast cancer survivors have access to affordable health insurance
    3. People are empowered with information, so they know what to look for, when to see their doctors, and what to ask them

    The Komen Advocacy Alliance is committed to advancing our mission by:

    1. Making sure that throughout the transition to new coverage options, such as the Health Insurance Exchanges and the Expansion of Medicaid, breast cancer survivors have access to insurance coverage as good as the current programs available to them.
    2. Reducing barriers to getting quality care by advocating for an essential health benefits package that covers the entire continuum of evidence-based breast health care services including breast cancer screening, treatment and survivorship care recommended by patients’ health care providers.
    3. Ensuring that preventive services required to be covered by the ACA include mammograms and all other evidence-based screening, counseling and early detection services needed for early diagnosis and treatment.
    4. Reducing health care disparities and promoting education and outreach to ensure breast cancer survivors understand and get all the benefits of ACA that apply to them.

    Learn more about the Komen Advocacy Alliance.

    Updated 04/28/13

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