The Financial Costs Of A Breast Cancer Diagnosis

Breast cancer doesn’t just impact your health. It affects your finances, too. The average cost¹ of breast cancer treatment in 2020 was between $20,000 and $100,000. 

Insurance helps, but costs can still mount up for medications, radiation and chemotherapies, hospital stays, and potential surgeries.

That said, it’s important you don’t let your finances get in the way of seeking treatment.  

The cost of treatment

Breast cancer treatment can be expensive. Typical treatments include surgery, radiation, hormone therapy, immunotherapy, and chemotherapy. 

In one study², 28% of women with stage 0-III breast cancer said the cost of their treatments influenced their decision whether to undergo surgery.  

For women with yearly incomes of $45,000, the same study reported that they prioritized costs over treatments that could preserve the appearance of their breasts. 65% of these women felt financially unprepared, and 35% reported experiencing financial stress due to their cancer treatment. 

Late-stage cancer

Treatment costs for breast cancer are generally higher³ if your cancer is diagnosed in more advanced stages.  

A 2016 study found treating stage III breast cancer was nearly twice as expensive⁴ as stage 0. 

Check-ups, testing, and screening

After a breast cancer diagnosis, you may require regular testing in the form of mammograms and other imaging (ultrasounds, breast MRIs and staging CT scans), pelvic exams, and bone density tests. You may also have to factor in prescribed medications and trips to see your treating team, often involving an oncologist, radiation oncologist and breast surgeon.

The cost of breast cancer screening alone ranges between $151 and $751, depending on where you live. For example, California, Michigan, Wisconsin, Alaska, and New York have higher-than-average screening costs.  

Chemotherapy

The average monthly cost of chemotherapy in the United States ranges between $1,000 and $12,000. 

Radiation and immunotherapy

For radiation therapy, the average monthly cost is $9,000, and for immunotherapy, it can be between $10,000 and $12,500. 

Medication

According to the National Cancer Institute⁵, some cancer patients face out-of-pocket medication costs of up to $12,000 per year. 

Direct versus indirect expenses

To understand the financial impact of being diagnosed with breast cancer, you should consider both direct and indirect costs. 

Direct medical costs include:

• Medical testing

• Therapeutic treatments

• Surgeries

• Prescription medications 

• Doctors fees

Indirect costs include:

• Physical therapy

• Psychological therapy

• Income lost due to time off work

• Gas, parking, and accommodation if you need to travel for treatment 

Health insurance coverage versus out-of-pocket expenses 

When it comes to minimizing breast cancer treatment costs, health insurance can go a long way - especially since it can reduce your out-of-pocket expenses. 

However, even with insurance, you may end up with costs you find unmanageable. Examples include high coinsurance and deductibles. 

You will likely feel the most financial pressure in the months after you are diagnosed. 

Your out-of-pocket expenses may include: 

• Monthly premiums

• Deductibles

• Co-payments

• Co-insurance

• Out-of-pocket caps

• Network status

• Unexpected or indirect costs 

Choosing the right health insurance

It’s important to remember that not all health insurance policies are made equal. And, even with insurance, you may have to pay some out-of-pocket expenses. 

A general rule of thumb is that the more coverage your insurance provider offers, the less you’ll have to pay upfront. 

In the US, catastrophic plans offer the lowest coverage, and platinum plans offer the highest. The average monthly premium for a low coverage plan is $313. For high coverage plans, this increases to $709.

Keep the following in mind when selecting health insurance:

Premiums 

In general, more comprehensive insurance policies will have higher monthly premiums. The average monthly cost⁶ of health insurance in the United States is $495, but prices vary depending on the level of coverage you require.

Deductibles 

This is the amount you must pay out-of-pocket for treatment before your insurance starts covering costs.

Co-payments 

This is a flat fee you pay for each healthcare-related treatment, service, prescription, procedure, etc. Co-payment fees⁷ range from $15-$25 for a routine check-up to $200-$300 for urgent treatment (e.g., a trip to the emergency room).

Co-insurance

This is the percentage you pay of the total cost of a healthcare-related service or procedure. In most cases, you will not be able to confirm the total cost of treatment until you receive the final bill. 

Out-of-pocket maximum 

Your out-of-pocket maximum is the most you will have to pay in a year for services covered by your health insurance plan. After you reach this cap, your insurance will cover any further costs.

In/out-of-network 

Some insurance policies have a set network of doctors and medical facilities that you can use. You must go to an in-network hospital or consultant to get the full benefit of your insurance.

Unexpected costs

Sometimes you will receive a treatment that your insurance does not cover. In these cases, your insurance will not reimburse you for the total amount. 

Many health insurers in the US will cover some but not all of the costs associated with cancer care. For example, most private insurance and Medicare insurance plans only offer limited long-term care coverage. You may choose to take out additional long-term care insurance in order to offset these costs.  

How to keep costs down 

As well as choosing the right insurance, there are other ways you can reduce the cost of your cancer treatment.

Medical assistance programs

Medical assistance programs are authorized under Title XIX of the US Social Security Act (Medicaid). Medicaid is funded by the State and Federal Governments to provide health coverage to low-income individuals and those with disabilities. 

Clinical trials 

Clinical trials are an affordable way to access the latest breast cancer treatments. Clinical trials study new medications to see if they are effective. 

If you meet the criteria for a clinical trial, you can access potentially life-changing treatments before they become widely available. 

Advocacy 

If you are struggling with the financial implications of your breast cancer diagnosis, there are advocacy groups and organizations in the US to help advocate on your behalf. Some groups may even be able to provide some type of financial assistance. 

In most cases, to access the services of these groups, you will be required to prove eligibility. 

Advocacy groups include:

• Breast Cancer Action 

• Georgia Breast Cancer Coalition Fund 

• National Breast Cancer Coalition

• Massachusetts Breast Cancer Coalition 

• Young Survival Coalition

The lowdown 

The price of medical care in the United States can be a source of anxiety if you are diagnosed with breast cancer.

The best way to manage your finances is to ensure that you have a suitable health insurance plan that covers most of your medical expenses and leaves you with minimal out-of-pocket payments. 

There are other ways to manage the costs of treatment if you do not have access to insurance. These include Medicaid, advocacy groups, and clinical trials.