- Researchers say 20 percent of cancer survivors have “job lock,” where they stay in jobs mainly to keep their health insurance.
- Experts say cancer survivors should take the time to fully understand their health coverage at work.
- There are alternatives for health insurance under the Affordable Care Act and other programs if cancer survivors decide to leave their jobs.
For many Americans, job and health insurance go hand in hand.
It’s a partnership that takes on greater meaning when faced with a major health problem.
It’s called “job lock.”
The research involved cancer survivors who answered the 2011, 2016, and 2017 Medical Expenditure Panel Survey: Experiences with Cancer Survivorship questionnaire.
Of 1,340 cancer survivors, nearly 20 percent reported job lock.
Of 1,593 spouses and partners surveyed, almost 11 percent reported job lock.
Younger survivors were more likely to be affected than older survivors.
Another factor associated with job lock is having an income near the poverty level but too high to qualify for Medicaid.
Changing jobs, moving from full-time to part-time work, or leaving the workplace entirely are all things that affect health insurance coverage.
“You could be in a robust plan that offers low copays or low deductibles. Depending on the new plan, all that could change and not be to your benefit,” Brown told Healthline.
“That’s part of the hesitation,” she explained. “It also depends on whether or not your current provider is in network. Someone going through a treatment plan for cancer, one thing they rely on is consistency with providers. Any interruption in that could impact their treatment and potentially their health.”
When leaving a job means losing your health insurance, you may be able to continue coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) for a limited time.
That’s provided you can afford the monthly premiums.
Since 2014, anyone lacking health insurance can purchase a plan through the ACA marketplace regardless of preexisting conditions. Depending on your income, you may qualify for a subsidy, which translates into lower premiums or no premium at all.
But there are a number of factors that can complicate matters, including:
- a family income too high to qualify for subsidy
- unaffordable premiums
- states with a limited number of plans
- networks that may not include preferred doctors
- lack of awareness of how the ACA works or how to sign up
George Kalogeropoulos is chief executive officer of HealthSherpa, an online portal for shopping and enrolling in ACA plans.
He told Healthline that it’s difficult for people to understand what’s available and how to enroll.
“People are used to their employers handling insurance and have no idea how to sign up or how any of that works,” Kalogeropoulos said. “Some people don’t understand they may be eligible for a subsidy or Medicaid. Even the basic vocabulary of managing healthcare is alien to some. But that’s the system we have.”
He explained that employer coverage in the United States costs about $7,000 for an individual and $20,000 for a family.
People who are used to their employer paying even part of that can end up with a case of sticker shock.
“There are no preexisting condition or lifetime payout restrictions, which is all good stuff,” said Kalogeropoulos.
“But when people with complex medical conditions have specialists they work with, then go to an ACA plan, they may find that all their doctors are not in network. That’s a huge barrier,” he added.
You may be able to break the job lock.
Brown said that the first thing cancer patients should do is get a better sense of what’s included in their health plan. Then you can map out how it impacts healthcare going forward.
“Work with your [human resources] department if you have one. I would encourage anyone with cancer to have that conversation. By and large what we’ve seen is that employers want to be supportive and care about employees. Of course, we see the other side, too,” she said.
Brown also suggests talking with your healthcare provider.
“Provider offices are often overloaded and inundated, but most have nurse navigators on staff to help patients understand their coverage,” said Brown.
“We have a program called Zero 360 where prostate cancer patients and family members can speak with a case manager. They can help people understand their insurance copays and deductibles, options that are available, or how to go through the appeals process,” she continued.
Brown noted there are other valuable resources, such as Triage Cancer. This nonprofit helps people with cancer navigate unemployment, career, and financial planning at no cost to them.
Brown suggested that cancer patients may also have some protection under the Family and Medical Leave Act.
Kalogeropoulos believes that it’s worth the time to at least assess what’s available.
“People can go to our site, HealthSherpa, or healthcare.gov, and screen what’s available in 5 minutes. You can search providers and find out if you qualify for a subsidy. Each state is different, but some states have exchange plans with networks similar to commercial plans,” he said.
Kalogeropoulos cautions against purchasing short-term plans that don’t cover preexisting conditions or healthcare-sharing ministries that aren’t actually health insurance.
The key, said Brown, is for people not to isolate themselves but to stay engaged with others.
“So many people are going through this also. They can share perspective and information that is helpful,” said Brown.
“COVID-19 has exposed that some changes have to happen in our healthcare system to a degree that wouldn’t have happened otherwise. We certainly have a lot of work to do,” she said.