How to Prepare for Changes to Your Health Insurance

Finding affordable health insurance that meets your needs after a breast cancer diagnosis has always been tricky, and with recent policy changes it’s about to get more difficult. 

With the passage of the “Big, Beautiful Bill,” Congress made huge cuts to Medicaid and ACA Marketplace health plans.

In addition, if Congress allows the enhanced tax credits for ACA Marketplace plans to expire at the end of this year, there will be an average 75% increase in the cost of premiums for those plans, according to the health information nonprofit KFF.  

Experts say that these and other policy changes will make it harder for people to afford and stay enrolled in many types of health insurance plans.  

"I’m deeply concerned that people with cancer will be caught off guard when these changes go into effect," says Dan Sherman, founder and president of The NaVectis Group, a consulting company in Grand Rapids, Michigan that trains healthcare providers to help patients with financial issues related to their care.  

It’s understandable if you’re confused about how and when all of this might impact you. Some of the changes to health plans have already gone into effect; others won’t be fully in effect until January 2026, or even 2027 or 2028.  

These eight tips can help you get ahead of the changes, stay covered, and manage costs. 

You could save money by getting more of your care before your current health insurance plan renews, especially if you’ve already met your deductible or out-of-pocket maximum. And if you think your coverage might be less affordable or comprehensive in the future, that’s another good reason to get more of your care now.

For some insurance plans, the dates of open enrollment (when you sign up), the process of how you sign up or stay enrolled, and/or the eligibility requirements are changing. Some insurance plans that used to automatically re-enroll people will soon stop doing so. Keep an eye on these changes so you don’t have a gap in coverage. 

You can get free, one-on-one assistance finding and comparing health insurance plans from the social workers or financial navigators at your cancer center (even if you’re not in active treatment anymore). Financial navigators provide free assistance with managing costs related to your care. Nonprofits such as Triage Cancer and the Patient Advocate Foundation can also help you. To learn about Medicare coverage options, contact the State Health Insurance Assistance Program (SHIP) or the Medicare Rights Center.  

Experts say that most people in treatment for breast cancer or with a history of cancer need more coverage than what’s offered in short-term health plans, limited-benefit plans, Medicare Advantage plans, and Healthcare Sharing Ministries. These types of plans may be advertised or promoted by brokers in misleading ways, which is another reason it’s worth getting unbiased help analyzing your options.   

If possible, choose a plan that will be accepted during the upcoming calendar year at the cancer center, hospital system, or oncology practice where you want to receive your care. It may be worth calling to confirm this before you decide on a plan. (Ask to speak with the patient services department, the billing department, a patient financial counselor, or an office manager/administrator). The plans accepted by a particular facility or doctor can change from year to year. And don’t rely on the information about in-network providers that you see in an insurance plan’s website or printed materials because this may be outdated.   

If you are denied Medicaid coverage, you can appeal that decision or reapply — if you do so within 90 days. A financial navigator may be able to help you figure out why the coverage was denied and if it’s worth appealing or reapplying. 

“Sometimes we see people getting denied Medicaid because their application didn’t have the correct information — for example, the patient moved but their mailing address wasn’t updated in the system. So it’s important to find out why the initial denial happened,” says Anthony Dulisse, a patient financial navigator at MD Anderson Cancer Center at Cooper in Camden, New Jersey.  

For Medicaid appeals, contact your state’s Medicaid agency. 

Denials of Medicare coverage also happen, but they’re less common. For Medicare appeals, contact your local SHIP office or use this Medicare appeals guide.

If you can’t afford health insurance or the costs of care with your insurance, reach out to the financial assistance department at the facility where you’re receiving cancer care (or did in the past). A social worker or financial navigator may be able to help guide you to resources. “At our cancer center, we don’t turn people away if they are uninsured. We try to help them get insurance, get free or reduced price care through our charity care program, or assistance from outside charitable programs,” says Dulisse. (He adds that it’s important to know that for most of these programs, you need to meet eligibility requirements and fill out an application). For low-cost or free mammograms or other imaging or screening tests, you can contact local Federally Qualified Health Centers, safety net hospitals, and programs affiliated with the National Breast and Cervical Cancer Early Detection program. There are also nonprofits that provide assistance with medical and non-medical expenses.  

Sherman recommends to everyone — but especially those enrolled in Marketplace plans that may get more expensive in 2026 — to start preparing as soon as possible. 

“That could mean looking at all your other possible insurance options, finding out about charitable and financial assistance resources that might be available, or trying to find ways to set money aside or increase your income to help deal with the higher costs,” he says.

 

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