Managing Finances and Covering the Mortgage During Cancer Treatment

When Rhonda Broussard got an invoice for part of her breast cancer treatment, she freaked out. "I didn't plan for this!" the New Orleans-based nonprofit founder and CEO recalled thinking. She had grown accustomed to proactive calls from her hospital offering financial help and information before treatment began. This invoice appeared with no warning. "I had planned for what I'm doing with my money this year," she explained. Unexpected medical bills had not been in her plan.

Though Broussard could absorb the bill, many cancer patients face financial challenges due to medical expenses, lost wages and other expenses such as child care, transportation and parking during treatment.

As medical debts pile up, housing insecurity grows. No one should have to face this kind of financial anxiety to keep their household afloat during cancer treatment, but many do.

This guide helps people with cancer and their advocates find financial support when costs feel impossible to manage.

Health insurers increasingly recognize the importance of housing to overall health. Several health insurers have invested in housing support programs, and some have social workers on staff who can connect people facing financial hardship to local resources.

Health insurance won’t cover all your medical costs or your non-medical bills. But knowing the details of your insurance plan can help you budget and manage your other expenses so you can continue to afford your home. Your out-of-pocket maximum, deductible, copayments and coinsurance can add up; planning for these costs can help limit the financial damage cancer can cause.

Disability insurance can help bridge some gaps by covering living expenses, including housing.

• What Is Disability Insurance?

Disability insurance provides you with some or all of your income if you can’t work because of an illness or disability. Short-term disability insurance covers you for three to six months. Long-term disability insurance applies when you're unable to work for more than six months.

• How Does It Work?

Different types of disability insurance have different rules and prices and are offered by a wide range of insurers. Disability insurance requires a waiting period, called the elimination period, before benefits kick in. How long that period lasts, how long benefits last and what qualifies as a disability all affect the price.

• Where Can You Get It?

You can buy disability insurance on your own, get it through your employer or get it from your state or the Social Security Administration if you meet strict eligibility requirements.

• When Should You Get It?

You can't get disability insurance after a cancer diagnosis, so don't wait until you're sick to apply. If you're offered disability coverage at work, take it. Some employers provide it automatically. If you already have cancer, check with your employer. You may already have a basic level of coverage.

Lay out your likely costs so you can create a budget and determine if you'll have trouble paying for housing. Start by understanding what your insurance covers and what you'll owe for covered services and treatments.

1. To get a handle on your likely costs, learn insurance terms such as copayment, co-insurance, deductible, network and out-of-pocket maximum.
2. Next, get comfortable asking questions, not just about treatment options but also about cost. Your doctor, hospital, pharmacy and health plan can all be sources of information about, possibly help with, your medical costs.
3. Get creative. Health savings accounts (HSAs) let you use pre-tax contributions for medical bills. Rhonda Broussard fully funded her HSA before treatment. When her balance ran out, she worked with the hospital to set up an interest-free payment plan with minimum monthly payments until she could replenish it.

Out-of-pocket costs are health care expenses that insurance does not pay. These costs can add up. If you know what to expect, you can better assess whether you can cover medical bills alongside housing and other expenses.

Ask what something will cost before you get care. Your costs depend on many factors that are hard to predict. Still, if you don’t get clear answers, persist.

Surprise medical bills often arise from costs people don’t think to ask about. List every potential charge you can think of and ask about each one. Then ask what else you might be billed for that didn't occur to you. Common costs include:

• Doctor or other provider visits
• Lab tests
• Clinic visits for treatments
• Procedures
• Imaging tests
• Radiation treatments
• Drugs that you get in the hospital
• Drugs that you take at home
• Hospital stays
• Surgery
• Home health care visits

If it looks like you might have a problem paying your medical costs along with your rent or mortgage, ask for help to manage the medical expenses. Try to negotiate or at least ask the provider what your options are. It can be awkward to discuss money or admit you're worried, but you're not alone. You may also be able to set up a monthly payment plan.

Figure out what your expenses are. Scrutinize your credit card statement for subscriptions and recurring charges you can cancel or scale back. Free up as much of your monthly budget as possible to absorb medical costs as they come.

Once you’ve trimmed what you can, create a tentative budget based on what you know so far about your likely income and expenses.

If your initial budget looks bleak, try not to despair. Take stock of your finances now. That clarity makes solutions easier to find. Even if it seems like you'll make ends meet, it's worth checking whether you can lower your housing expenses.

You may be able to cut costs by refinancing your mortgage. Refinancing involves getting a new loan with better terms and using it to pay off the original mortgage. To see if the savings outweigh the costs, use current interest rates to estimate your new monthly payment.

When you refinance, you’ll probably start a new 30-year term to maximize monthly savings. Though the clock resets, improving cash flow can be worth extending your loan term.

If you’ve built up a lot of equity in your home, you may be able to do a cash-out refinance, where you can get cash to help with bills and add that amount to your loan balance.

Private mortgage insurance (PMI) adds costs to a mortgage when the loan value is more than 80% of the home’s value. If you’ve built up equity or your home’s value has increased, you may be able to cancel PMI, but you may have to refinance your mortgage to get those savings.

When you take out a mortgage, most lenders require an escrow account to cover your property taxes and homeowner's insurance. Each month, part of your mortgage payment funds your escrow account.

Save hundreds of dollars a month by reducing your escrow payments. A few strategies to lower these payments include:

If cancer treatment makes it hard to keep up with mortgage payments, contact your lender as soon as possible to avoid foreclosure. They may be willing to work with you. Relief can take the form of more flexible payment terms you'll need to accept and stick to, or a reduction of some obligations. Reach out early. Lenders have more options available when you contact them before falling behind. Government agencies and policies exist to help people stay in their homes and avoid foreclosure.

State programs may provide mortgage assistance or other affordable housing support, including:

• Hardest Hit Fund

The federal government finances this program, which state agencies administer to help homeowners avoid foreclosure.

• Homeowner’s Hope Hotline

Call 888-995-HOPE (4673) for HUD-approved housing counseling.

• State Housing Financing Agencies (HFA)

These state-chartered authorities help residents find affordable housing options.

• U.S. Department of Housing and Urban Development (HUD)

HUD keeps a list of approved local counseling resources.

• Consumer Financial Protection Bureau

Amid economic devastation from the COVID-19 pandemic, the CARES Act enacted mortgage relief measures, including a temporary moratorium on foreclosures and evictions and the right to request forbearance for up to 360 days.

• U.S. Department of Housing and Urban Development (HUD)

After the 2008 financial crisis, HUD created programs to help homeowners avoid foreclosure. Several ended in 2016.

Platforms like GoFundMe and MightyCause can help patients raise money to support housing and other costs during treatment. As medical bills rise and consumers struggle to pay for care, even with insurance, people increasingly turn to crowdfunding platforms. On GoFundMe, more than $1.5 billion has been raised for health care costs across approximately 250,000 campaigns each year. Fundraising alone may not be the safest bet. Most campaigns don't reach their goals. It's still worth trying.

Photos, a personal story and social media promotion can improve your chances of reaching your goal.

If you start a crowdfunding campaign, several platforms are available, but their focus, fees and rules vary. Some that you may have heard of don’t allow individual fundraisers.

Crowdfunding isn't the only option. Selling T-shirts, putting together a cookbook or hosting events can raise money and bring your community together to help cover treatment costs.

Cancer and related disabilities can make your home harder to get around safely. Modifications like ramps, shower seats and grab bars can improve safety and comfort at home.

Several organizations offer assistance with home modifications.

• National Resource Center on Supportive Housing and Home Modification: Offers a directory of home modification resources across the country
• Rebuilding Together: A national network of volunteers who repair homes for people with disabilities. Use the website to find your local affiliate
• Rehabilitation Engineering Society of North America (RESNA) Catalyst Project: Provides a directory of state financial assistance programs for home modification
• Rural Housing Repair Loans and Grants Program: Offers low-interest loans to low-income rural homeowners for repairs and updates
• U.S. Department of Veterans Affairs (VA): Offers specially adapted housing grants, special housing adaptation grants and temporary residence adaptations for veterans who need help modifying their homes

Even when you can manage medical costs, everyday living expenses can pile up during cancer treatment. Many resources can help cancer patients cover nonmedical expenses.

• Hope Lodge

Through Hope Lodge, the American Cancer Society offers cancer patients and caregivers free lodging near their treatment center.

• Temporary Assistance for Needy Families (TANF)

TANF provides cash grants for low-income people to help with housing and other expenses.

• United Way 211 program

This program connects people to housing and other financial resources.

• Citizens Energy

Citizens Energy is a nonprofit that offers discounted energy services to low-income households.

• Federal Communications Commission (FCC)

The FCC administers the Lifeline program to help low-income households lower monthly phone and internet bills.

• ModestNeeds

ModestNeeds provides self-sufficiency grants that help people cover emergency and monthly expenses. These grants are for people who live just above the poverty line and don't qualify for low-income support.

• TANF

TANF helps low-income people pay for food, clothing, utilities, transportation and housing.

• <a href=""https://www.acf.hhs.gov/ocs/liheap-state-and-territory-contact-listing target="_blank">U.S. Department of Health and Human Services

HHS’s Office of Community Services offers the Low Income Home Energy Assistance Program and other support services.

SUBSIDIZED HEALTH INSURANCE

You might qualify for more generous health insurance coverage through Medicaid, Medicare, Social Security Disability Insurance or Supplemental Security Income. If you're eligible, these programs can cover more of your medical costs. Certain cancers qualify for compassionate allowances, so the Social Security Administration can process your application faster.

MEDICATION ASSISTANCE

Many programs help cover medication costs, including nonprofit organizations, retail pharmacy discount programs and pharmaceutical assistance programs. Most require that you don't have government health insurance. If you're eligible for Medicaid, covered prescriptions will be very low cost.

Good nutrition matters during cancer treatment. Cancer and its treatments can affect your appetite, diet and nutritional needs.

Don't let cost get in the way of eating well during treatment. Several programs can help.

• Feeding America

Feeding America is a national network of food banks that connects people to local programs.

• Meals on Wheels

This program delivers meals to older people’s homes. Find local programs and check eligibility at the website, or call 888-998-6325.

• National Hunger Hotline

If you have immediate food needs, call the National Hunger Hotline at 866-3-HUNGRY to find local programs and see if you’re eligible.

• Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

WIC helps low-income women who are pregnant or postpartum with supplemental food assistance.

• Supplemental Nutrition Assistance Program (SNAP)

SNAP, formerly the Food Stamp Program, helps people pay for food at grocery stores. SNAP benefits are administered locally. Research your state or local programs or call 800-221-5689 to find options near you.

• American Cancer Society

The American Cancer Society offers information and resources to help people manage cancer care costs.

• American Red Cross

The Red Cross provides financial assistance for active and retired military members and their families.

• Cancer Finances

This directory from Samfund catalogs organizations that provide financial support for people with cancer.

• Family Reach

Family Reach provides direct financial assistance and helps cancer patients understand their health insurance costs.

• Mercy Medical Angels

This group funds air and ground transportation costs for patients who travel for treatment.

• National Organization for Rare Disorders

This organization helps patients with certain cancers get financial assistance for medication, medical services and travel for treatment.

• Patient Advocate Foundation

This foundation helps people understand their health care and insurance options and offers limited financial assistance for specific conditions.

• Samfund

Samfund gives financial support to young adults who are fighting or are in remission from cancer.