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Featured Expert
  • Dr. Yousuf Zafar
    Dr. Yousuf Zafar

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 getting proactive calls from her hospital, offering financial help and information before receiving any treatment. 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 will help people with cancer and their advocates understand the financial support available to help ease seemingly insurmountable financial burdens.

Cancer and Finance In Focus

Does Insurance Help With Housing?

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 help identify resources to help people facing financial hardship.

Health Insurance

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 you mitigate the damage cancer can do to your personal finances.

Disability Insurance

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 short periods, typically three to six months. Long-term disability insurance applies when you’re unable to work for longer periods, usually 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 typically requires a waiting period — called the elimination period — before you can get benefits. How long that period lasts, how long benefits last and what qualifies as a disability are some of the variables that affect the price.
  • Where Can You Obtain 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 once you've been diagnosed, so it's essential to get it while you're healthy. If you're offered disability at work, consider taking it. Some employers automatically provide disability insurance. If you already have cancer, check with your employer; you may already have a basic level of coverage.

Will You Be Able to Afford Your Home During Treatment?

A family enjoys some time together at home

A cancer diagnosis can be physically, emotionally and financially overwhelming. Making ends meet during cancer treatment may be especially tricky. Understanding your costs can be challenging, too, as cancer treatment costs depend on whether and what type of insurance you have, where you get care and where you live.

Know What Your Insurance Will Cover

Lay out your likely costs so you can create a budget and determine if you'll have trouble paying for housing. An important first step is to understand what insurance covers and your share of the cost for covered services and treatments.

  1. To get your arms around your likely costs, learn important insurance terms. A health insurance glossary can help you understand insurance terms such as copayment, coinsurance, 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. For example, Rhonda Broussard fully funded her health savings account (HSA). HSA's enable you to use pre-tax contributions for medical bills. Once she had spent the amount she had put in her HSA, she worked with the hospital to set up an interest-free payment plan with minimum monthly payments until she could fund her HSA again.

Know What You’ll Be Expected to Pay Out-of-Pocket

Out-of-pocket costs are health care expenses that insurance does not pay. These costs can add up. If you know what they’re likely to be, you can more easily assess if you’ll be able to afford to pay them plus your other expenses, especially housing.

Always ask what something will cost before you get care. Your costs can depend on many factors that can be hard to predict ahead of time. Still, if you don’t get clear answers, persist.

Surprise medical bills often arise from costs people don’t think to ask about. Make a list of what you could get charged for and ask about them. Then, ask what else you could get charged for that you didn’t know to ask. Some costs you can expect 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 remember you are not alone. And, you might be able to set up a manageable monthly payment plan.

Know Your Monthly Output

Figure out what your expenses are. Scrutinize your credit card statement to see if there are any regular expenses such as subscriptions and other recurring monthly expenses that you can cancel or scale back. Make as much room in your ongoing budget as you can for upcoming medical bills.

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. Facing your financial worries is the first step in finding solutions. On the other hand, even if it seems like you'll make ends meet, you should still consider seeing if you can lower your housing expenses.

Ways to Lower Your Housing Expenses

A woman recovering from cancer applies some makeup

Housing is often the largest single household expense, typically about 30% of household income. Lowering mortgage expenses can have a significant impact on your budget. Here are several strategies to create some breathing room in your budget by reducing your housing expenses.

Refinance

You may be able to shave 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 you can save enough to make refinancing costs worthwhile, use current interest rates to calculate what your costs would be for a refinance.

When you refinance, you’ll probably start a new 30-year term to maximize monthly savings. Though clock resets, improving cash flow may be worth the time you’re adding to the mortgage.

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.

Reduce Escrow Account Payments

When you take out a mortgage, most lenders require you to have an escrow account, which is an account that your lender will use to pay your property taxes and homeowner’s insurance. Each month, part of your mortgage payment funds your escrow account.

You might be able to save hundreds of dollars a month by reducing your escrow payments. A few strategies to lower these payments include:

Remove PMI

If the value of your home or your equity has increased enough that the loan value is less than 80% of the home's value, you may be able to remove PMI through a reassessment or refinancing.


Find Cheaper Homeowner’s Insurance

You might be able to save money by shopping around for homeowners insurance. Get several quotes and see if you can do better.


Seek Property Tax Relief

You might be able to lower your tax bill by challenging the assessment on which it's based, or by seeking property tax relief from your state or local government.


Mortgage Lender or Servicer Hardship Programs

If your mortgage payments are a hardship during cancer treatment, contact your lender as soon as you can to avoid foreclosure. They may be willing to work with you. Relief may come in the form of more flexible payment terms – that you’ll have to agree and adhere to – or as actual relief from some of your obligations. Being proactive and discussing your situation may unlock options you didn’t realize you had. Government agencies and policies are designed to help people stay in their homes and avoid foreclosure if possible.

Forbearance

Your lender might agree to lower or suspend your payments for a certain period, such as while you can't work because of treatment. You might have to pay back a lump sum when your payments resume, so make sure you agree to a plan you can manage when your income resumes.


Loan Modification

Unlike forbearance, which provides temporary relief, a loan modification makes structural revisions to your mortgage terms. You might be able to get a lower interest rate or add time to the term, or even lower the total loan amount.


Reinstatement

Your lender might agree to a plan that lets you avoid foreclosure by paying off the past due amount by a specific date, which could help if you're facing temporary challenges paying the mortgage.


Repayment

A repayment plan is an arrangement with your lender that gives you time to repay past-due amounts.

Where to Go for Housing Help

A man does some serious research on his computer about where cancer patients can go for housing help

The last thing you should have to worry about when battling cancer is your housing. There are many resources and organizations dedicated to helping ease housing worries for people with cancer.

State Assistance

State programs may be available to provide mortgage assistance or other affordable housing support. Some of those programs include:

Hardest Hit Fund
This fund is financed by the federal government and serviced by the state government. It helps homeowners avoid foreclosure.

Homeowner’s Hope Hotline
Call 888-995-HOPE (4673) for HUD-approved housing counseling to explore options.

State Housing Financing Agencies (HFA)
These organizations are state-chartered authorities that help individuals and families access affordable housing.

U.S. Department of Housing and Urban Development (HUD)
HUD offers a list of HUD-approved local counseling resources.

HUD Programs

Consumer Financial Protection Bureau

Amidst economic devastation from the COVID-19 pandemic, new mortgage relief measures have been instituted by the coronavirus relief bill, including a temporary moratorium on foreclosures and evictions and an explicit right to request forbearance for up to a total of 360 days.

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

In the wake of the Great Recession of 2008, HUD created several programs to help homeowners avoid foreclosure. Several of these programs ended in 2016.

Fundraising

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. Relying on fundraising may not be the safest best. Estimates suggest most campaigns do not reach their goals. Still, it can’t hurt to try this approach.

Using photos, sharing your story and amplifying your message on social media are strategies that improve your chances of success.

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

Beyond direct crowdfunding campaigns, there are creative ways to raise funds to pay for cancer treatment and related costs. Selling t-shirts, making and selling a cookbook, or hosting events can raise money and rally friends, family members and acquaintances behind the cause.

Home Modifications for People With Disabilities and Cancer

When you're battling cancer or living with disabilities due to cancer, there may be modifications that will make your living situation more comfortable, like adding a ramp or safety features like a shower seat and grab bars.

There are many organizations that can help you make your home safe and accessible.

National Resource Center on Supportive Housing and Home Modification
This organization offers a directory of home modification resources across the country.

Rebuilding Together
Rebuilding Together is a national network of volunteers who repair homes for people with disabilities. You can find your local organization at the website.

Rehabilitation Engineering Society of North America (RESNA) Catalyst Project
RESNA provides a directory of state financial assistance programs for home modification.

Rural Housing Repair Loans and Grants Program
This organization offers low-interest loans to low-income, rural homeowners for repairs and updates. State-specific housing loans are also available for individuals living in rural areas.

U.S. Department of Veterans Affairs (VA)
The VA provides specially adapted housing grants, special housing adaptation grants and temporary residence adaptations for veterans who need financial assistance to modify their homes.

Insight From a Leading Expert on Cancer-Related Financial Toxicity

Dr. Yousuf Zafar

Dr. Yousuf Zafar
Associate Professor of Medicine, Public Policy and Population Health Science at Duke Cancer Institute and Duke-Margolis Center for Health Policy

Dr. Zafar is a gastrointestinal medical oncologist and healthcare delivery researcher. Dr. Zafar answers pressing questions and provides additional insight into how treatment costs impact cancer patients and their families.

Q. What is financial toxicity?

Dr. Zafar:

Financial toxicity is akin to physical toxicity, wherein the patient experiences any sort of financial harm related to their cancer treatment. It can be direct financial harm in terms of out-of-pocket costs or cost-sharing or deductibles or parking. Or it could be indirect financial harm, like lost wages or travel or other indirect expenses as well.

The costs can be overwhelming even for patients who have a good income and some savings.

Patients can experience both objective and subjective financial harm. Objective financial harm or toxicity is when they have a bill that has to be paid, or they're missing income. But people can feel financial toxicity as well. Even if the bill itself is relatively small, it can cause fear in terms of being able to pay their other bills.

Q. What is the impact on either physical health or psychological well-being?

Dr. Zafar:

The greater the cancer-related financial harm that patients experience, the worse their overall quality of life [and] the worse their physical symptoms. It can absolutely impact their quality of care. We know that as a patient's out-of-pocket costs increase, the adherence to their cancer treatment decreases.

Q. What are some of the barriers patients face?

Dr. Zafar:

A lot of this is happening in a void where clinicians aren't talking about it, and patients aren't talking about it. Part of it has to do with not necessarily knowing what the answer is. If I ask a patient, "Are you able to afford your care?" And they say, "No," I might not have a good solution for them. Maybe I can refer them to a financial counselor [or] get pharmaceutical financial assistance for their drug. But there may not be a great solution aside from saying, "Maybe we have to try something different." It is uncommon that I have to try something different. Usually, we can put something together for a patient.

Q. Why don't patients feel comfortable raising cost concerns?

Dr. Zafar:

They don't think it's the doctor's job. They don't think doctors know the answer. They're concerned about getting lesser-quality care if they say that they can't afford treatment. Sometimes they're embarrassed, but actually that's less common.

We found when patients have a cost discussion with their oncologist, more than half of patients saw their out-of-pocket costs go down without having to change treatments. So while that is a fear, I think that treatment changes happen infrequently.

Q. What should patients do?

Dr. Zafar:

I think the first question is, "What should clinicians do?" We shouldn't place that responsibility fully on patients. I think first clinicians have to learn how to have a cost discussion and realize that based on the evidence, most of the time, you can help the patient with their costs.

Second, patients should speak up. I think patients often feel that there's just no solution to the problem, so why bother bringing it up. But there may be a way to get help, and the only way to know is to ask.

Our financial counselors and social workers have told me that it is much easier to prevent medical debt than to dig someone out of it. So, preventing it is the greatest priority whenever possible.

Financial Resources for People With Cancer

Even if you can manage out-of-pocket health care costs during cancer treatment, your other living expenses can feel overwhelming. There are many resources to help cancer patients with non-medical expenses.

Additional Housing Resources

Hope Lodge
The American Cancer Society offers cancer patients and caregivers free places to stay near their treatment site through Hope Lodge.

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 comprehensive program connects people to resources for housing as well as other expenses.

Help With Household Expenses

Citizens Energy
This is a nonprofit organization 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
This organization provides self-sufficiency grants, which are designed to help people facing emergency financial needs pay for those emergencies or monthly expenses. These grants are for people who live just above the poverty line and do not qualify for low-income support.

TANF
TANF provides help to low-income people pay for food, clothing, utilities, transportation, household expenses and housing.

U.S. Department of Health and Human Services
HHS’s Office of Community Services offers a Low Income Home Energy Assistance Program and other social service support systems.

Help With Medical Bills

When you’re sick, burdensome medical bills are the last thing you want to worry about. There are many resources to help.

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 benefits can protect you from more of your medical costs. Certain cancers qualify for compassionate allowances, which means the Social Security Administration can make eligibility determinations more quickly.

Medication Assistance

There are many ways to get help paying for medications, through nonprofit organizations, retail pharmacy discount programs or pharmaceutical assistance programs, provided you do not have government health insurance. If you’re eligible for Medicaid, covered prescriptions will be very low cost, and if you’re eligible for Medicare, Medicare Part D can help you pay for medications.

Nutrition Resources

Proper nutrition is especially important during cancer treatment. The disease and the treatments may affect how and what you eat and what your body needs to stay strong.

Cost should not get in the way of getting the nutrition you need to fight cancer. Resources are available.

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

Meals on Wheels
This program delivers meals to older people’s homes. You can find local programs and see if you qualify online or call them at 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 nutritional food.

Supplemental Nutrition Assistance Program (SNAP)
SNAP, formerly the Food Stamp Program, helps people pay for food at grocery stores. SNAP benefits are administered locally, so research your state or local programs or call 800-221-5689 to locate the right program in your area.

General Financial Resources

American Cancer Society
This large organization offers information and resources to help people manage the cost of cancer care.

American Red Cross
Most people are familiar with the Red Cross. It 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 is a program that provides some direct financial assistance and helps cancer patients understand and navigate 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 help for medication, other health services and travel for their treatment.

Patient Advocate Foundation
This foundation helps people navigate health care and health insurance and offers limited financial assistance programs for specific conditions.

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


About the Author

Deb Gordon is author of “The Health Care Consumer’s Manifesto” (Praeger 2020), a book about shopping for health care based on consumer research she conducted as a senior fellow in the Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government between 2017 and 2019. Her research and writing have been published in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics and The Hill. A profile of two cancer patients who participated in Deb’s research appeared in Managed Care Magazine.


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