Cancer can have significant financial impacts on patients and their loved ones. These impacts can include medical costs related to cancer treatment, as well loss of income and non-medical costs for things like transportation. Below we summarize some of the most common financial impacts reported by people with cancer.

Medical Expenses – Cancer diagnosis and treatment can be expensive. Common medical costs related to cancer include:

• Doctor’s visits
• Testing related to diagnosis and staging (e.g., MRIs, PET scans, biopsies)
• Treatment costs, including surgery, radiation, and chemotherapy
• Hospital stays
• Medication costs

Even with insurance, many people with cancer face out-of-pocket costs, including copayments, deductibles, costs for treatments or drugs that their insurance may not fully cover.

Loss of income – Many people with cancer experience a loss of income if they need to take time off work or reduce their working hours during treatment and recovery.

• Some income may be able to be replaced through disability insurance coverage.

Transportation costs – Traveling to and from medical appointments can lead to expenses related to gas, parking, or public transportation. Some people may also need to pay for lodging if they live a long way from a treatment facility.

Non-medical costs – Many people with cancer may make changes to their lifestyles, such as adopting different diets, purchasing medical equipment or assistive devices, and making home modifications to get around more easily.

Caregiver expenses – Loved ones who act as caregivers for people with cancer may also experience financial burdens related to taking time off or work, travel costs, or additional household expenses.

Health insurance – insurance premiums, copays, and deductibles represent important, ongoing expenses for people with cancer.

Although cancer can be expensive, there are important resources available to help people with cancer and their loved ones meet their financial needs. Health insurance, employer assistance programs, government programs, and non-profit organizations can provide financial assistance and resources to help mitigate some of these costs.

Cancer care can be expensive, and many people with cancer and their loved ones experience medical and other costs related to cancer. Fortunately, resources are available to help people with cancer cover treatment and other costs. Some of the main resources that can help cover cancer-related costs are listed below:

Health insurance – Many individuals rely on health insurance to cover a significant portion of their cancer treatment costs.

• This may include coverage for hospital stays, surgeries, chemotherapy, and other necessary treatments.
• The level of coverage can vary widely, and some treatments or medications may not be fully covered. High deductibles, copays, and out-of-pocket expenses can also contribute to the financial burden.

Public insurance programs – In the United States, Medicaid provides health insurance coverage to individuals with limited financial resources and those who meet other eligibility criteria.

Clinical trials – Some individuals may participate in clinical trials, where experimental treatments are provided at no or reduced cost; however, not everyone is eligible for or interested in participating in clinical trials.

Charitable organizations – Nonprofit organizations and charities may offer financial assistance, support services, or grants to help individuals with cancer cover the costs of treatment.

• Visit the MI-COST Resource Connect page to search for organizations providing support to people with cancer in Michigan.

Fundraising and community support – Many individuals and families facing cancer organize fundraising events or turn to crowdfunding platforms to seek financial support from friends, family, and the community.

Employer benefits – Some individuals may have employer-sponsored health insurance plans that provide coverage for cancer treatment. In addition, some employers may offer assistance programs or disability benefits.

Personal savings and assets – Some people use personal savings or sell assets to help cover the costs of cancer treatment.

The availability and effectiveness of these options can vary widely depending on an individual’s specific circumstances, the care they need, and the nature of their insurance coverage. The financial impact of cancer can extend beyond medical expenses to include costs associated with travel, lodging, and other related expenses. Social workers at hospitals or cancer centers often help patients navigate these financial challenges and connect them with available resources. If you have financial concerns related to cancer or cancer treatment, you can discuss them with your healthcare providers.

Pharmaceutical assistance programs  – Many pharmaceutical companies that manufacture cancer drugs offer financial assistance programs to help make their medications more affordable. These programs help patients access their prescriptions at reduced costs or for free.

Common pharmaceutical assistance programs Include:

• Merck Patient Assistance Program
• Novartis Patient Assistance Foundation
• Bristol Myers Squibb (BMS) Access Support
• AstraZeneca AZ&Me Prescription Savings Program

Who can apply?

Eligibility criteria vary by program, but requirements often include:

• Financial need: Many programs require you to meet specific income thresholds.
• Residency: You may need to be a U.S. resident or receive treatment in the U.S.
• Insurance status: Some programs are available to uninsured or underinsured patients, while others may help those with insurance but facing high out-of-pocket costs.

How to access pharmaceutical assistance programs:

• Ask Your Doctor or Oncology Team: Your healthcare provider may be aware of specific programs for the medications you are using. They may also help you navigate the application process.
• Visit Pharmaceutical Company Websites: Many drug manufacturers offer application forms directly on their websites. Look for a “Patient Assistance” or “Help with Costs” section.
• Visit the MI-COST Resource Connect page and search for “Medications” or “Copays.”

ADDITIONAL INFORMATION ABOUT PHARMACEUTICAL ASSISTANCE PROGRAMS IS AVAILABLE FROM:

• Triage Cancer – Find additional information and resources related to pharmaceutical assistance programs at the following links:
  • Pharmaceutical Assistance Programs – Prescription Drugs
  • Quick Guide to Getting & Paying for Prescription Drugs
  • Paying for Prescription Drugs – Resources

Many people with cancer reduce the amount they work during and after cancer treatment, and this can lead to lost income. Disability insurance programs and benefits (disability benefits) provide individuals with disabilities, including many cancer survivors, with a source of income when they are not able to work, or their earnings are limited because of their disability.

There are three main ways of obtaining disability benefits:

• Through an employer
• Through a private insurance plan
• Through a government program

Employer-sponsored disability benefits

Many employers offer disability coverage as a benefit of employment. The Family and Medical Leave Act (FMLA) provides unpaid job protection for up to 12 weeks per year for covered employees who need to leave work for certain health- or family-related concerns. To replace lost income, many employees rely on short-term and long-term disability programs.

When disability insurance benefits are obtained through an employer, it is classified as group coverage. This is because the benefits are based on the group of employees instead of an individual.

• Coverage eligibility is based on employment status – employees within the same level or classification have the same benefits.
• The premiums for coverage are usually based on general factors such as age.
• Disability benefits offered or purchased through an employer are offered at a percentage of an individual’s regular salary.
  • Most disability benefits replace about 60% of an individual’s regular salary.
  • That percentage may be higher or lower based on the specific employer-sponsored policy.
• Employer-sponsored plans are usually not portable, meaning that when an employee leaves their job, they will no longer have disability benefits provided by that employer.

Both short-term and long-term disability benefits require an individual to be deemed disabled by the terms of the specific policy offered. What qualifies as a disability is determined by individual disability insurance policies.

• A policy may define a disability as a specific diagnosis or a specific diagnosis with limitations.
• To identify whether you have a qualifying disability you should refer to your disability insurance policy.

Typically, before filing a claim for short-term or long-term disability an individual will use their accrued vacation time or sick leave. A discussion with personnel in the Human Resource (HR) Department or a supervisor will allow you to better understand your benefits.

Short-term disability usually provides 13-36 weeks of income replacement, and usually replaces about 60-70% of the employee’s wages before their disability began.

• The amount of coverage is policy specific, but short-term disability tends to cover a larger percentage of wages than long-term disability since the coverage lasts for a shorter period of time.
• An individual must file a claim for short-term disability.
• Once the claim is filed, there is often a waiting period for short-term disability benefits also known as the “elimination period.”
  • The elimination period starts after the onset date of the employee’s disability usually caps out at 30 days for most policies, but it can be as short as 7 days or none if the employee meets other criteria/exceptions. For example, there may not be an elimination period if the employee has already used up all banked sick days.
• Short-term disability coverage will end at some point in time, typically within a year, but often within several months.

Long-term disability usually begins at 26 weeks from the onset of the claimed disability and can last for several years, potentially until an individual’s retirement age as long as they remain eligible for the benefit. Long-term disability typically replaces approximately 40-70% of wages, depending on the specific policy.

• Long-term disability tends to cover a lower percentage of wages since the coverage lasts for an extended period.
• An individual already receiving short-term disability must file a separate claim for long-term disability benefits.
• Long-term disability can also have an elimination period, which prevents an individual from receiving long-term disability until a certain amount of time has passed since their disability began.
  • An elimination period may be as short as 90 days (three months) or as long as 180 days (six months).
  • The length of the elimination period is determined by an individual’s policy.

Private disability insurance

Individuals can also purchase private disability insurance policies through an insurance company. These private policies may be purchased by people who do not have disability coverage through an employer or can be used to provide extra coverage in addition to an employer’s policy.

• Eligibility requirements and premiums for private policies are based on the individual’s personal health history.
• Since private policies are purchased directly from an insurance company the policy stays with the individual even if they change jobs.
• Private policies can offer both short-term and long-term disability coverage.
• The cost of a private policy depends on several factors:
  • Type of policy
  • Risk involved in the individual’s occupation
  • Individual’s medical history
  • Elimination period
  • Length of time that the benefits will be paid out

Just as with employer-sponsored disability insurance, it is important to understand the terms of private disability insurance policies to know what to expect of your coverage.

Government-sponsored disability benefits

Disability benefits are offered through both the state and federal government. As with employer-sponsored and individual disability policies, government-sponsored programs include definitions of what qualifies as a disability.

Government-sponsored programs also usually include non-medical requirements, such as income and asset limits or contribution through payroll taxes, that an individual must meet to qualify for benefits.

State government benefits

State Disability Assistance (SDA) is a disability benefit program offered through the State of Michigan. Michigan SDA provides cash assistance to eligible adults with disabilities, and to some caretakers of disabled persons.

To be eligible individuals must be disabled and meet income and asset limits and residency requirements.

• Disability is defined under the SDA program as having one or more physical or mental impairments that lead to being unable to work for at least 90 days.
• SDA eligibility is also limited to individuals with less than $15,000 in qualifying assets, including cash, bank accounts, investments, and retirement savings, and less than $200,000 in real property.
• Income is also considered when determining the amount of SDA an individual is eligible to receive.

To apply for SDA, individuals can visit their local Michigan Department of Health and Human Services (MDHHS) office. Alternatively, individuals can apply online through the MI Bridges website and apply for “Cash Assistance.”

If approved for SDA, individuals will typically receive no more than $200 each month. To be eligible for SDA, Michigan also requires that SDA benefit recipients apply for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) through the Social Security Administration.

Federal government disability benefits

Social Security Disability Insurance (SSDI) is an entitlement program that individuals pay into through FICA taxes withheld from their paychecks.

• An individual earns up to four work credits per year through the collection of FICA taxes.
• The number of credits an individual needs to be eligible for SSDI depends on their age when their disability began.
  • Individuals 31 years of age or older need to have earned 20 work credits in the 10 years before their disability began to be eligible.
• In addition to earning enough work credits, in 2024 a non-blind individual cannot work and earn more than $1,550 each month after the date on which they claim their disability began.

The Social Security Administration (SSA) defines a disability in the same manner for both SSDI and SSI. For both, a disability is the “inability to do any substantial gainful activity [because] of any severe medically determinable physical or mental impairment which:”

1. Can be expected to result in death;
2. Has lasted continuously for 12 months; or
3. Can be expected to last continuously for 12 months.

With SSDI, individuals receive a cash benefit in an amount that depends on their earning history. If their disability began a year or more before their application for benefits, then they can receive up to one year of benefits from the date of their application. There is a five-month waiting period between the onset of a disability and the first benefit check. Individuals can also receive auxiliary benefits for their dependents. After being entitled to receive SSDI benefits for 24 months, an individual will be eligible for Medicare coverage, even if they are younger than 65.

Supplemental Security Income (SSI) is a need-based program for individuals who are 65 or older, blind, or disabled.

• SSI does not require that the individual has a work history or paid FICA taxes like individuals applying for SSDI, therefore it is beneficial for individuals who have been sick for a long period of time and who are not eligible for SSDI because either they have not worked long enough or recently enough. It is also available to children with a disability.
• Since SSI is a need-based program there are income and asset limits that impact eligibility.
  • The countable asset, or resource, limit for SSI is $2,000 for an individual and $3,000 for a couple.
  • Common assets or resources that are typically not counted include the individual’s primary residence, one motor vehicle, and a life insurance policy with a cash value up to $1,500.
  • Earned income through work is limited to $1,550 each month in 2024, and any earned income below that limit will lower the monthly SSI benefit amounts.

SSI benefits are cash benefits which are paid around the first of the month. In 2024, an eligible individual can receive a maximum of $943 and an eligible couple can receive a maximum of $1,415 each month. SSI benefits become payable no earlier than the month after an individual applies.

In Michigan, SSI beneficiaries are automatically eligible for Medicaid health insurance benefits through the Michigan Department of Health and Human Services. This is true so long as the SSI beneficiary is eligible for at least $1 in SSI benefits.

Guidance for applying for SSDI can be found at www.ssa.gov/disability or by calling 1 (800) 772-1213. Additional information related to SSI can be found at www.ssa.gov/ssi.

Continuing Disability Review (CDR) – After approval for SSDI or SSI benefits, the Social Security Administration will review an individual’s case every so often to determine if they are still disabled. This is known as a Continuing Disability Review (CDR).

• The frequency of the CDR varies from every 18 months to 7 years depending on the likelihood of medical improvement.
• It is important to update the SSA on changes that could affect SSDI or SSI eligibility, such as returning to or stopping work, or changes in household composition, income, or resources for SSI benefits.

Additional information related to disability benefits can be found at the following sources:

• MI Bridges – Create your account to apply for State Disability Assistance
• Social Security Administration – Create your “my Social Security” account to review your work history and apply for benefits and find additional information including:
  • SSDI application information
  • SSI application information
• Triage Cancer – Find additional information and resources related to disability insurance at the following links:
  • Cancer & Disability Insurance
  • Quick Guide to Disability Insurance
  • Quick Guide to Supplemental Security Income (SSI)
  • Quick Guide to the Timing of Social Security Disability Insurance & Medicare Benefits

It can be difficult to know what to expect after receiving a cancer diagnosis and starting treatment. Below is a list of topics and questions related to the financial impact of cancer that people with cancer have identified as important. These questions are designed to make it easier for you and your loved ones to talk about specific concerns and needs during an appointment.

Not all topics apply to all people, but it can be helpful to think about what concerns you may have and to bring a list of questions to discuss with your oncologist or other health care provider when you meet with them.

General questions about cancer and treatment

• What is my diagnosis and stage?
• Is it possible to cure my cancer?
• What is my treatment plan?
• Are there clinical trials I can participate in? If so, will this cost more or less than standard treatment?

Cost of appointments and treatment

• How much will I have to pay for my treatment?
• Is there a less expensive drug, like a generic, that will be equally effective?
• How many visits will I have? Will I have to pay each time I come to the cancer center (copay, parking, etc.)?
• What happens if I can’t pay for some of my treatment costs?

Help with understanding my treatment costs and what my insurance covers

• Do I need additional or supplemental insurance coverage?
• Do I have a copay every time I come to the cancer center?
• Is there someone I can talk to about my questions about my insurance and treatment costs?

Transportation to and parking at the cancer center

• Does someone need to drive me to treatment appointments?
• Are services available if I can’t find someone to drive me?
• How much does parking cost?

Living far from the cancer center

• Is it possible for me to receive my treatment closer to where I live?
• Are there free or reduced-cost hotels nearby for me and my family?

Working during treatment

• Can I keep working during treatment? If not, when can I go back to work?
• Can I schedule my treatment around my job?
• Do I need to file Family and Medical Leave Act (FMLA) paperwork? If so, how?

Assistance programs

• Are assistance programs available to help me with treatment costs or other expenses or needs?
• If I need a wig or other supplies, is there somewhere I can get them for free or at a reduced cost?

Family and living responsibilities

• Can I schedule my treatment around my family’s schedule?

Your oncologist or healthcare provider may not be able to answer all of your questions in a regular medical visit. If that is the case, you can ask if there is someone else in their clinic or hospital who you can follow up with to address your concerns.

These questions are based on work by Lauren M. Hamel, PhD, Associate Professor in the Department of Oncology at the Wayne State University School of Medicine and the Population Studies and Disparities Research at the Karmanos Cancer Institute.

Many people with cancer have family members, friends, or other individuals who act as caregivers during and after cancer treatment. These caregivers can provide important logistical, physical, emotional, and financial support to people with cancer. While cancer caregiving can be very rewarding, it can also involve both financial and emotional costs to caregivers.

Common costs associated with cancer caregiving include:

• Medical expenses – Even if their loved one is insured, cancer caregivers may be responsible for additional out-of-pocket costs for their loved one (e.g., insurance premiums, copays, medications, and medical supplies not covered by insurance).
• Lost income – Cancer caregivers may need to change their work schedule, including reducing their working hours, to provide care to their loved one. This may result in lost income or depletion of vacation or other paid leave banks.
  • Caregivers who are covered by the Family and Medical Leave Act (FMLA) may qualify for job protected leave to care for their loved one, although this leave is unpaid.
  • Some employers may offer flexible work arrangements or other employee benefits to support caregivers. Caregivers should contact their human resources department to understand what resources or options may be available to them.
• Travel and lodging – Cancer care often requires repeated medical appointments over a long period of time. Caregiver transportation costs, such as those for gas, rideshares, and public transit, can add up. Additionally, caregivers may temporarily or permanently relocate to be closer to their care recipient or may need to pay for travel and lodging if their care recipient is hospitalized far from home.
• Home modifications and other non-medical expenses – Cancer caregivers may find themselves spending money on modifications to their own or their care recipient’s home environment (e.g., installing shower guard rails) for health and safety. They also may purchase other things, like special foods, clothing, or devices for their care recipient.
• Costs related to caregiver well-being – In addition to financial costs, caregiving can be emotionally and physically difficult and caregivers may incur costs related to supporting their own health or health care.

Oncology social workers are trained to talk with both cancer patients and caregivers about their concerns and needs and can often direct caregivers to potential financial and other supportive resources. Seeking support as early as possible and finding ways to manage these costs helps to avoid unnecessary expenses.

Resources and information for caregivers – Several resources exist to support the financial and emotional needs of cancer caregivers:

• CancerCare has social workers on staff that can offer initial support and work to create a financial plan (Phone: 1-800-813-HOPE).
  • Their Helping Hand database includes information for regional and national resources providing financial and practical assistance to people with cancer and their caregivers.
  • They offer support groups for both people with cancer and their caregivers.
  • Their My Cancer Circle site provides online resources and tools to help coordinate practical support, such as providing meals or transportation, from family, friends, and community members to help relieve some of the caregiving burden.
• Triage Cancer provides practical information and resources for people with cancer and their caregivers, including A Practical Guide to Cancer Rights for Caregivers
• Caregiver Action Network provides information and resources to improve quality of life for people who provide care to loved ones with cancer and other chronic conditions.
• Family Caregiver Alliance provides information, support, and resources for family caregivers of individuals with debilitating conditions.
  • Resources are available in several languages, including Spanish, Chinese, Vietnamese, and Tagalog.
  • They also provide a state-specific guide to resources, including those available in Michigan
• The Administration for Community Living provides an Eldercare Locator, connecting older adults and their families with local services. They can also be contacted by phone at 1-800-677-116
• Additional caregiver support may be available through the hospital or health system where the person with cancer is being treated. Oncologists, social workers, or other providers may be able to direct you to available resources.

Respite care

Cancer caregivers may sometimes need help with or a temporary break from caregiving. In addition to coordinating with other members of the caregiver’s or care recipients’ support communities to provide help, caregivers can also sign up for a professional respite service, either finding and training a provider on their own or going through an agency.

• Local respite services can take place in-home (e.g., a professional or family-selected caregiver provides services to the cancer patient at home) or at a location outside the home.
• Respite services are usually offered on a sliding fee schedule or financial assistance may be available through a combination of family contributions, state, and federal funding (e.g., Michigan Medicaid vouchers), and/or private insurance.
• If insurance is used to cover respite care, there may be limits on the duration of respite care provided, per month or per calendar year.

Not all caregivers will need or want respite care services, but respite care may be especially helpful if it is planned early in the caregiving process, allowing the caregiver to take breaks before caregiving demands become overwhelming. The financial costs of respite services may also be lower when considered earlier in the caregiving process.

Additional information and resources related to respite care are available from the Access to Respite Care and Help (ARCH) National Respite Network:

• Time for Living and Caring: Making Respite Services Work for You! (English and Spanish versions available).
• The ABCs of Respite
• National Respite Locator Service