Battling cancer is hard enough on its own. But when you’re forced to find an insurance plan that will stand by you during this battle, the task seems much heavier. In 2017, MD Anderson and their providers broke the news that they made the decision to not be participating providers for any individual insurance plan on or off the marketplace in Texas. Specific individual plans outside of Texas and some plans that offer out-of-network benefits could be accepted, however.
MD Anderson used to be much more accessible to patients when it came to health insurance they would accept. They are one of the more prominent treatment facilities for cancer care nationwide and the news that they were not accepting individual marketplace plans came as a major blow to many patients.
Why not accept these plans?
This was strictly a business decision. MD Anderson will only take plans that pay them the most and, unfortunately, carriers are not willing to pay for what hospitals and providers bill. The victim in this fight between insurance carriers and doctors is always the patient. The cancer fighter.
Cancer stats
Every year, more than 20 million Americans are affected by cancer. While devoting their lives to simply surviving, they are also asked to pay large amounts of money in the process. Whether it be because their chosen provider doesn’t accept their insurance plan, or their health insurance only covers a small portion of the bill, the patient is forced to pay dearly for their survival. Patients spend most of this money on surgeries, expensive medications, and radiation treatments. In 2014, a study found that the average cost of surgery for cancer treatment is $35,000. In addition, 12 months of chemotherapy can cost as much as $100,000 while only three months of radiation therapy could be $35,000. To summarize all of this, in just the first year alone, a patient could end up paying $170,000. This is not including the other financial factors, such as medication, clinic fees, time off work, etc…
How to obtain care at MD Anderson without going bankrupt
Here at Take Command Health, we know you want the best care for you or any loved one who is fighting this battle. We want to help you find the least expensive ways to get your treatment at MD Anderson if you are looking at health insurance through the marketplace. Your best option would be to look for a plan that provides out-of-network benefits. Here’s what we found specifically for Texas:
*Premiums vary, this data is based upon a 40 year old non-smoking male.
Dallas, Texas
Baylor Scott and White PPO Bronze Plan
Preferred Provider Organization (PPO): you don’t need a referral to see a specialist.
Premium: $430/month
Deductible: Out of network for individual $14,300 and $28,000 for a family.
Out of Network Max: The most you will pay out of pocket per calendar year when you receive treatment at MD Anderson is $14,300 per individual and $28,000 for a family. Once you reach this price point, all services will be covered at 100%.
What does this mean for your $170, 000 bill? You pay $14,300 deductible plus $5,100 per year for your premium. Your savings: 88%.
Houston, Texas
Memorial Hermann Elect Silver Plan PPO
Preferred Provider Organization (PPO): you don’t need a referral to see a specialist.
Premium: $520/month
Deductible Out of Network: $8,000/individual, $16,000/family. Once you fulfill your out of network deductible, you are responsible for 50% of specialist’s visits.
Out of Network Out of Pocket Max: The most you will have to pay out of pocket for out of network providers: $15,000 as an individual and $30,000 for a family.
What does this mean for your $170,000 bill? You pay $8,000, then 50% of all visits until you’ve paid $15,000. You also pay $6,200 premium. Total savings: 87%.
Memorial Hermann Elect Silver HSA
Preferred Provider Organization (PPO): you don’t need a referral to see a specialist.
Premium: $520/month
HSA Benefit: Contribute money to your health savings account tax-free. This saves you the tax on all money you contribute to your HSA. Under 55 years old: max of $3,350 and $6,750 for family. Over 55: can add $1,000 more.
Deductible: Out of network provider (MD Anderson): $5,000/individual $10,000/family. Once you reach deductible, specialist’s visits are covered at 50%.
Out of Network Max: The most you have to pay out of pocket for an out of network provider is $15,000 per individual and $30,000 per family.
Medications: From out of network providers, mediations are covered at 50%. Because many cancer medications are specialty drugs, your doctor is often required to make a call or fill out extra paper work in the form of a prior authorization.
What does this mean for your $170,000 bill? You pay $5,000 up front, then 50% of your bills until you reach $15,000. Add in $6,200 for your premium. Subtract your HSA savings, roughly $1,000. You save: 88%.
Statewide in Texas
Blue Cross HMO plus and Multi-state plans
HMO plans require a referral to see a specialist.
Premium: $540/month
Deductible: No out of network deductible.
Out of Network Max: No maximum. You just keep paying.
What is covered? 50% of all services are covered.
What does this mean for your $170,000 bill? You will pay $85,000 plus $6,400 premium. Total savings: 46%.
You’ve got options.
*Premiums vary, this data is based upon a 40 year old non smoking male.
Preferred Provider Organization (PPO): you don’t need a referral to see a specialist.
Premium: $430/month
Deductible: Out of network for individual $14,300 and $28,000 for a family.
Out of Network Max: The most you will pay out of pocket per calendar year when you receive treatment at MD Anderson is $14,300 per individual and $28,000 for a family. Once you reach this price point, all services will be covered at 100%.
What does this mean for your $170, 000 bill? You pay $14,300 deductible plus $5,100 per year for your premium. Your savings: 88%.
Preferred Provider Organization (PPO): you don’t need a referral to see a specialist.
Premium: $520/month
Deductible Out of Network: $8,000/individual, $16,000/family. Once you fulfill your out of network deductible, you are responsible for 50% of specialist’s visits.
Out of Network Out of Pocket Max: The most you will have to pay out of pocket for out of network providers: $15,000 as an individual and $30,000 for a family.
What does this mean for your $170,000 bill? You pay $8,000, then 50% of all visits until you’ve paid $15,000. You also pay $6,200 premium. Total savings: 87%.
Preferred Provider Organization (PPO): you don’t need a referral to see a specialist.
Premium: $520/month
HSA Benefit: Contribute money to your health savings account tax-free. This saves you the tax on all money you contribute to your HSA. Under 55 years old: max of $3,350 and $6,750 for family. Over 55: can add $1,000 more.
Deductible: Out of network provider (MD Anderson): $5,000/individual $10,000/family. Once you reach deductible, specialist’s visits are covered at 50%.
Out of Network Max: The most you have to pay out of pocket for an out of network provider is $15,000 per individual and $30,000 per family.
Medications: From out of network providers, mediations are covered at 50%. Because many cancer medications are specialty drugs, your doctor is often required to make a call or fill out extra paper work in the form of a prior authorization.
What does this mean for your $170,000 bill? You pay $5,000 up front, then 50% of your bills until you reach $15,000. Add in $6,200 for your premium. Subtract your HSA savings, roughly $1,000. You save: 88%.
HMO plans require a referral to see a specialist.
Premium: $540/month
Deductible: No out of network deductible.
Out of Network Max: No maximum. You just keep paying.
What is covered? 50% of all services are covered.
What does this mean for your $170,000 bill? You will pay $85,000 plus $6,400 premium. Total savings: 46%.
Out of Network Benefits Summary
|
Insurance |
Deductible |
Out of Pocket Max |
Medications |
Savings |
|
Baylor Scott & White PPO |
$14,300 individual $28,600 family |
$14,300 individual $28,600 family |
50% after deductible | 88% |
|
Memorial Hermann PPO |
$8,000 individual $16,000 family |
$15,000 individual $30,000 family |
50% after deductible | 87% |
|
Memorial Hermann HSA |
$5,000 individual $10,000 family |
$15,000 individual $30,000 family |
50% after deductible | 88% |
|
BCBS HMO |
$15,000 individual $45,000 family |
Unlimited |
50% coinsurance | 46% |
What’s the Bottom Line?
If you are an MD Anderson patient and shopping the individual marketplace, your best bet is to enroll in a plan that can help keep your costs as low as possible. Currently there are no individual plans offered that provide in-network coverage with MD Anderson. Electing a plan that has an out of pocket maximum puts a limit on how much you will have to spend this year. Even if that out of pocket maximum is $15,000 that sure beats the $170,000 you would be charged without any coverage.
Take Command Health is here to help.
You have enough on your plate battling cancer. We want to help you find the best plan for your unique situation. Email us at support@takecommandhealth.com or sign up below to learn more about the best insurance options to help you continue treatment at MD Anderson.