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Understanding Health Insurance Benefits

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Most patients with mantle-cell lymphoma (MCL) require several periods of treatment. Although initial treatment is usually successful in putting MCL into remission, most patients eventually relapse and need more treatment.1

Treatment for MCL can be expensive.2 Therefore, it is important for patients and their families to understand health insurance coverage. If they have no coverage, they should be aware of the assistance options that may be available to them.

Health insurance is an arrangement with an insurance company that can help protect patients from the high costs of healthcare. The term benefits refers to the services that are covered by health insurance. Private companies that offer health insurance are often called health plans.

Types of health insurance include:

  • Group health insurance – coverage offered by one’s employer or union
  • Individual health insurance – purchased directly from the insurance company or health plan
  • Government-sponsored health insurance – obtained through a government agency or program, such as Medicare or Medicaid.

Different healthcare services are covered under different benefits. For example:

  • Medical benefits usually pay for doctor’s office visits and medications that are administered in the office
  • Pharmacy benefits usually pay for medications taken by mouth (oral medications)
  • Hospital benefits pay for inpatient stays in the hospital.

Although most health insurance covers these 3 types of benefits, there may be differences in the details of the coverage. For example, a medication that is covered by one health plan may not be covered by another.

Patient out-of-pocket costs may vary from one health plan to another. Several types of out-of-pocket expenses may be the patient’s responsibility, including:

  • The premium – the amount of money charged by an insurance company for coverage; for patients who have group health insurance, the employer or union decides how much of the premium employees must pay for coverage
  • The deductible – the amount patients owe for healthcare services each year before the insurance company begins to pay
  • The copayment, or copay – a fixed amount patients owe for each covered healthcare service; for example, a patient may have a $50 copay for each doctor visit
  • Coinsurance – the patient’s share of the costs of a covered healthcare service, calculated as a percentage of the allowed amount for the service; for example, the patient may be responsible for 20% of the cost of the medication, whereas the insurance company pays for the remaining 80%.

Nearly all patients are expected to share in the cost of their treatment, but some will be responsible for a greater share than others. Understanding their health insurance benefits may help patients to plan ahead for costs related to their treatment.

References

  1. Lymphoma Action. Mantle cell lymphoma. https://lymphoma-action.org.uk/types-lymphoma-non-hodgkin-lymphoma/mantle-cell-lymphoma. Accessed April 9, 2019.
  2. Mantle cell lymphoma costs vary by treatment type, adverse events. Journal of Clinical Pathways. www.journalofclinicalpathways.com/news/mantle-cell-lymphoma-costs-vary-treatment-type-adverse-events. December 14, 2017. Accessed April 9, 2019.

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