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Cancer Treatment Coverage in California

If you or a loved one is facing cancer, comprehensive coverage is essential. All Covered California plans cover cancer treatment as an Essential Health Benefit. Learn what's covered and how to minimize costs.

What's Covered for Cancer

All Covered California plans must cover cancer treatment, including:

  • Diagnostic services: Biopsies, imaging, lab work
  • Surgery: Tumor removal, reconstructive surgery
  • Chemotherapy: IV and oral chemotherapy drugs
  • Radiation therapy: External beam, brachytherapy
  • Immunotherapy: Newer targeted treatments
  • Hormone therapy: For hormone-sensitive cancers
  • Oncology visits: Specialists, second opinions
  • Hospital stays: Inpatient treatment when needed
  • Supportive care: Pain management, palliative care
  • Clinical trials: Routine costs of participation
Pre-existing Coverage: You cannot be denied coverage or charged more because of a cancer diagnosis or history.

Cancer Treatment Costs

Cancer treatment can be expensive, but your out-of-pocket maximum caps your annual costs:

Plan Tier Out-of-Pocket Max Chemo/Radiation Specialty Drugs
Bronze $9,200 30-40% after deductible 30-40% coinsurance
Silver $8,200 20-30% coinsurance 25-35% coinsurance
Gold $8,200 15-20% coinsurance 20-30% coinsurance
Platinum $4,500 10-15% coinsurance 15-25% coinsurance
Key Point: With cancer treatment, you'll likely hit your out-of-pocket maximum within the first few months. A Platinum plan with a $4,500 max may cost less overall than a Bronze plan with a $9,200 max, even with higher premiums.

Best Plans for Cancer Patients

Enhanced Silver (CSR)

Best for: Income under 250% FPL

  • Silver 94: $1,400 out-of-pocket max
  • Silver 87: $2,800 out-of-pocket max
  • Dramatically lower costs
  • Best value if you qualify
Platinum Plans

Best for: Higher income, known treatment ahead

  • $4,500 out-of-pocket max
  • Lowest coinsurance rates
  • Predictable maximum costs
  • Higher premiums but capped exposure
Consider These Factors:
  • Cancer center access: Make sure top cancer centers are in-network
  • Drug formulary: Check that your chemo drugs are covered
  • Out-of-pocket maximum: Lower is better for extensive treatment
  • PPO vs HMO: PPOs offer more flexibility for second opinions

Financial Assistance Programs

Help is available if you're struggling with cancer treatment costs:

Drug Manufacturer Programs

Many drug companies offer copay assistance or free medication programs for cancer drugs.

Hospital Financial Aid

Nonprofit hospitals must offer charity care programs. Ask about financial assistance.

Cancer Organizations

American Cancer Society, CancerCare, and others offer grants and assistance.

Social Workers

Cancer center social workers can help identify resources and navigate coverage.

Your Rights as a Cancer Patient

  • Guaranteed coverage: Cannot be denied or charged more for cancer
  • No lifetime limits: Plans cannot cap total benefits
  • External review: Right to appeal coverage denials to independent reviewer
  • Continuity of care: Can continue seeing doctors if plan changes mid-treatment
  • No prior authorization for emergencies: Emergency cancer care is always covered
  • Clinical trials: Plans must cover routine costs of approved trials

Need Help With Coverage?

Our agents can help you find plans with the best cancer coverage and lowest out-of-pocket costs.

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