The Leukemia & Lymphoma Society (LLS) recently released new research showing the significant financial costs facing consumers treated for five serious conditions while enrolled in short-term health plans: lymphoma, heart attack, lung cancer, diabetes and mental health hospitalizations.
According to the study, conducted by actuarial firm, Milliman, Inc., is the latest in LLS’s Cost of Cancer Care initiative, a comprehensive effort to address the extraordinary cost of treating cancer, specifically the direct costs to patients.
The findings from the report are timely, as some commercial insurance companies are accelerating promotion of short-term, limited duration (STLD) health plans since the Trump administration increased the length of time patients may be covered under them. The plans are not required to meet the same minimum standards of coverage as those regulated by the Affordable Care Act (ACA), and therefore, put more patients at risk of being exposed to increased costs and inadequate coverage.
Among the Study Findings:
- A patient newly diagnosed with lymphoma while covered by a STLD plan could pay $23,100 to $45,800 in out-of-pocket expenses (including premiums and cost sharing for medical expenses) during the six months following diagnosis.
- Patients who are newly diagnosed with lymphoma while enrolled in an ACA-compliant plan could pay $6,300, on average, in out-of-pocket expenses over the same time period.
- A newly diagnosed lung cancer patient risks facing out-of-pocket expenses of more than $100,000 in the six months following diagnosis if the patient is unable to renew the STLD coverage and becomes uninsured.
“The findings of this study confirm what we long suspected — that the design of these plans leaves patients vulnerable to expensive bills,” says Gwen Nichols, MD, LLS chief medical officer. “Short-term plans don’t offer typical health insurance benefits and provide very little protection when a patient faces a serious, unexpected diagnosis. LLS is working at the state and federal levels to protect patients from these dangerous plans. We urge cancer patients and their caregivers to ask questions about whether their treatments are covered by these plans, given their serious shortfalls.”
Addressing the Cancer Cost Burden
LLS initiated its Cost of Cancer Care initiative in 2017, recognizing that patients and families were taking on more out-of-pocket costs for their care and treatments, according to the study.
The society has engaged stakeholders across the healthcare system — drug makers, pharmacy benefit managers and insurers, healthcare providers, and other patient organizations — and called upon each to do their part to help make meaningful progress in lessening the cost burden for patients.
LLS engaged Milliman to develop a series of research reports examining insurance coverage issues. Previous research revealed the out-of-pocket cost burden associated with cancer treatment for Medicare patients with blood cancer diagnoses, and the financial burden faced by those enrolled in commercial plans. This research helps inform the policy initiatives LLS promotes as it works to protect patients’ access to quality treatment and care, the study says.