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Choosing an Employer-Sponsored Health Insurance Plan

If you or a family member has cancer, a history of cancer, or a high risk of developing cancer, choose the most comprehensive insurance plan you can afford.

In addition, make sure that the hospitals in the plan’s network includes at least one large, well-regarded cancer center. Rare or complex cancers are often treated at these centers.

If you have a choice and can afford it, choose a plan that includes as many of the following as possible:

  • Annual coverage of $1 million or more
  • Lifetime coverage of $2 million or more
  • Coverage for cancer screening tests (mammogram, colonoscopy, Pap smear, etc.) and other preventive services at 100% coverage, or for a copayment or coinsurance no higher than what you would pay for other services
  • A low deductible (or no deductible) when using in-network physicians and hospitals
  • Coinsurance of no more than 20% of the eligible charges when using in-network physicians and hospitals
  • Copayments for physician visits of $40 per visit or less
  • Coinsurance of no more than 30% of the eligible charges when using out-of-network physicians
  • An annual out-of-pocket maximum for in-network physicians and hospitals that you can afford. Note: You may want to opt for a higher-priced plan with a broader network, rather than seeing out-of-network physicians as part of a less expensive plan. This is because the out-of-pocket maximum you will owe is usually much higher when you use out-of-network physicians and hospitals. In addition, you may be responsible for paying the difference between the physician's charge and the insurance company's definition of the "usual and customary" charge.
  • Coverage for second opinions
  • Coverage of clinical trials for the treatment of life-threatening conditions such as cancer
  • A pharmacy benefit plan for prescription drugs where you pay a fixed amount (copayment) instead of a percentage of the drug's cost (coinsurance). Note: Drugs for cancer and other serious health conditions can be expensive. You may be responsible for paying hundreds or thousands of dollars out-of-pocket if your plan requires you to pay a percentage of the cost of these drugs.
  • Coverage for care at large cancer center(s) in your area or elsewhere
  • Hospice care for 6 months or longer
  • Transplant coverage (for bone marrow and organ transplants) with access to transplant centers of excellence in your area and nationally, if needed. At least $1 million in coverage per transplant