When you get diagnosed with metastatic breast cancer, you may find that there’s a lot to worry about. Not only are you concerned about your health, but you care about your family and your other responsibilities. You want to do everything you can to treat your cancer so you can continue living your life and spending time with your family and friends.

One concern that may come up is how to cover the costs of treating metastatic breast cancer. As one MyBCTeam member explained, “How do you recover financially? I had to get loans, and the credit card debt, and then there’s what I owe the hospital. The stress is horrible. I am grateful for my life, truly I am, but the financial burden is too much.”

Fortunately, there are various ways to get the financial aid you need so your treatment costs aren’t a burden later on.

The Cost of Treating Metastatic Breast Cancer

According to 2020 data, breast cancer is the most expensive type of cancer to treat in the United States. Several aspects of metastatic breast cancer care can get expensive. These include:

• Medication costs
• Surgery costs
• Other associated costs (like child care, wigs, caregivers, and nipple tattooing)

A 2017 study in Cancer of around 364,000 Americans diagnosed with one of the four leading types of cancer (breast, lung, prostate, and colorectal) found that around 84 percent had insurance, 12 percent had Medicaid, and 4.6 percent had no medical insurance whatsoever. For the latter group, this means that they need to pay for their treatment with their own money (out of pocket) or find financial programs to help ease the burden.

There are several options and resources available when it comes to covering costs associated with breast cancer. Don’t be shy about asking for help or to get connected with resources. As one cancer survivor on MyBCTeam put it, “I did pay off my cancer bills and it was a lot but it’s all over now. I should have asked for help at the time.”

Health Insurance Options for People With Metastatic Breast Cancer

Your out-of-pocket costs associated with treating metastatic breast cancer will be lower if you have health insurance. Many people in the U.S. have health insurance through their employers, and some people qualify for government programs like Medicare or Medicaid.

Medicare

The federal government sponsors a health cost-coverage program called Medicare that may take care of some of the costs associated with treating metastatic breast cancer. It’s available for people in the United States who are over age 65 or who have disabilities. Medicare coverage comes in four parts, called A, B, C, and D.

Medicare Part A covers:

• Care anytime you’re in the hospital
• Care in a skilled nursing facility
• Laboratory tests
• Home health care
• Surgery
• Hospice care

Part B takes care of:

• Care from doctors or other medical providers
• Outpatient care
• Some home health care
• Preventive medical services, such as vaccinations and annual wellness visits

Medicare Part C is an alternative to Original Medicare and includes private Medicare Advantage plans that you can choose to enroll in. Medicare Part C plans sometimes also cover prescription drugs.

Part D provides limited prescription drug coverage.

You will automatically be enrolled in Medicare Parts A and B if:

• You’re over 65 years old and receive benefits from Social Security or the Railroad Retirement Board (RRB).
• You’re under 65, have a disability, and have received Social Security disability benefits or RRB benefits for at least 24 months.

If you’re over 65 but do not get benefits from Social Security or RRB, you will need to sign up with Medicare to get Medicare Parts A and B at the Social Security website.

If you’re diagnosed with metastatic breast cancer and qualify for Medicare, you’ll likely want to enroll in a prescription drug coverage plan through Medicare Part D. You can shop for and compare drug plans through Medicare.gov.

If this all seems confusing to you, talk to your hospital or cancer treatment center. As one MyBCTeam member told another, “Most of these places have advocates that can get you squared away with Medicare so there are no problems with getting what you need.”

Medicaid

Medicaid is a state-operated health insurance program for people in low-income families, children, pregnant people, the elderly, and people with disabilities. Programs vary by state, so benefits and out-of-pocket costs will be different. Most Medicaid programs cover services including:

• Hospital services
• Nursing facility services
• Home health services
• Physician services
• Copays
• Prescription drugs

You may enroll in Medicaid at any time of the year through your state’s Medicaid website or phone number.

MyBCTeam members who have Medicaid seem satisfied with the way the program handles breast cancer treatment. One said, “I have Medicaid right now. It covers everything.”

Health Care Coverage for Veterans

If you are a U.S. veteran living with metastatic breast cancer, the Department of Veterans Affairs (VA) will provide you health care services for your entire lifetime, starting from the time of diagnosis. VA health care benefits cover a range of services and medical treatments to treat metastatic breast cancer. VA health care covers:

• Preventive services
• Inpatient hospitalizations
• Urgent and emergency care services at VA facilities
• Prescriptions written or approved by a VA health care provider
• Therapy and rehabilitation services
• Additional health care benefits

Independent Health Insurance Plans

Individual insurance plans are available for people through the U.S. Health Insurance Marketplace. People who are eligible include those who are:

• U.S. citizens, nationals, or noncitizens lawfully present in the U.S.
• Not imprisoned
• Ineligible for Medicare or Medicaid

You may enroll in an individual health insurance plan through HealthCare.gov. The site may direct you to your state’s health insurance exchange.

Therapies, treatments, and medications for metastatic breast cancer may be covered differently under different individual insurance plans. Most plans cover:

• Basic emergency services
• Hospital services
• Copays
• Prescription medications
• Preventive services

Before selecting a plan, make sure it covers your physicians and necessary services and drugs. After all, dealing with getting coverage for something not specifically listed can be hard. “Insurance said they would pay for chemo but not radiation,” one MyBCTeam member shared. “My doctor said I didn’t need chemo. It makes no sense …”

Employer-Based Health Insurance

Job-based health insurance — also known as employer-based insurance or group coverage — comes from your employer or your union. If you work at least 30 hours per week at a company with 50 or more full-time employees, your employer likely offers some form of health insurance coverage. If you have metastatic breast cancer and don’t have a job, job-based health insurance may still be available to you through your spouse or parent (usually up to age 26). Different plans will cover costs differently and some may cover costs that others don’t.

Your health insurance company may cover more than just medical costs. “Some health insurance plans also provide free rides via Uber or Lyft. … Check with your insurance plan,” one MyBCTeam member suggested.

Other Resources

If insurance doesn’t cover enough of your costs, you have other options, too.

Hospital Resources

Many hospitals and cancer centers have resources to help you figure out how to get the treatment you need and pay for it without causing undue stress. When someone on MyBCTeam said that they had lost their health insurance, others encouraged them saying, “Let the financial person at the hospital and oncology center know about your loss of insurance. They may have resources.”

Someone else added, “Ask for an appointment with either the social worker or financial officer and bring a list of everything you might need help with.”

Prescription Resources

Even if you have coverage for medications, you may have eligibility for other discounts and financial support, too. Look for pharmacy discount programs and coupons and patient-assistance programs from drug manufacturers.

For one MyBCTeam member, a pharmacy discount program helped a lot. “I’ve been on medication since March,” they said. “I didn’t go through my insurance. I buy it using a discount program at my pharmacy at my grocery store. It is the lowest price I could find.”

Another found help from a drug manufacturer. “I had insurance,” they explained, “but I still qualified for copay assistance with two of my chemo drugs.”

Other Financial Assistance Programs

There are also nonprofit organizations and programs designed to help people with metastatic breast cancer cover their costs. You can find lists of resources at the following sites:

• Facing Our Risk of Cancer Empowered
• Living Beyond Breast Cancer
• Susan G. Komen

Note that you may need to cover your costs and then apply for reimbursement from these groups.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 68,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Are you figuring out how to cover treatment costs for metastatic breast cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.