The Open Enrollment season for health insurance plans can feel overwhelming even in the best of times.

But when you're undergoing cancer treatment, it can be an emotional rollercoaster filled with an extra bit of uncertainty and mystery. 

And yet, this is one of the most critical times of year to take the time to review your options and choose a plan that aligns not only with what you need right now, but also with what you may need in the next 12–24 months. This matters whether you're newly diagnosed, actively receiving treatment, in surveillance, or transitioning into survivorship.

It can be the difference between thousands of dollars saved… and thousands lost. 💸

So here are some tips on the essential things to take into consideration when considering your health insurance plan options: 

💡 Tip # 1 - Look Beyond Just the Monthly Premium 

A lower premium doesn’t always mean lower costs. Cancer is a high-utilization condition. This means that you will be utilizing services that will far exceed the annual premiums you are likely to pay.

Here are some better questions to ask:

• What is the annual deductible?

• What is the out-of-pocket max?

• How are infusions, chemo drugs, imaging, and radiation covered?

• Is there a separate deductible for specialty drugs?

Sometimes a higher premium plan saves you more because when you are undergoing cancer care, you'll likely reach the out-of-pocket maximum quickly.

 🩺 Tip # 2- Confirm Your Care Team Stays In-Network 

Your care team may include some or all of the following specialties

• Primary care physician

• Medical oncologist

• Radiation oncologist

• Surgeon

• Plastic surgeon 

• Psychiatrist

• Imaging centers

• Infusion center

• Hospital

Please do not assume that being in-network this year guarantees in-network status next year. Networks change quietly. I shared in this article how I ended up with a $670 bill for being out of network at a local institution despite having done my due diligence to verify my insurance eligibility before scheduling an appointment with a new primary care provider. 

💊 Tip # 3- Look Closely at Drug Formularies 

Cancer treatment commonly involves:

• targeted therapies

• biologics

• hormone therapy

• anti-nausea meds

• bone-strengthening agents

• immunotherapy

Each insurance plan has its own formulary (the medications that are covered) as well as tiers.

When your insurance plan lists medications, it organizes them into tiers.

A tier is simply a category that determines the cost of a prescription.

The higher the tier ➜ the higher your cost.

Most insurance plans use a structure like this:

💊Tier 1 — Lowest Cost

Generic medications
These have the lowest copays and are the most affordable.

💊💊Tier 2 — Moderate Cost

Preferred brand-name medications: These are brand-name drugs for which the insurance company has negotiated better pricing.

💊💊💊Tier 3 — Higher Cost

Non-preferred brand-name medications. These often cost more because the insurance company pays a higher cost for them.

💊💊💊💊  Tier 4 (and sometimes Tier 5 or 6) — Highest Cost

Specialty medications. These include high-cost drugs used in cancer treatment, autoimmune conditions, biologics, targeted therapies, and immunotherapy.
Instead of a fixed copay, many of these plans have coinsurance (such as 20%–40% of the medication cost), which can be expensive.

— and some cancer meds fall under costly “specialty tiers.”

Here's what you need to verify:

• Is your medication covered?

• Which tier is it on?

• What is the coinsurance percentage?

💡 Why Tiers Matter for Cancer Patients

Cancer care often includes drugs in the highest tiers, which means:

Higher out-of-pocket costs

Separate specialty pharmacy rules

Prior authorizations

Step therapy requirements

Limited dispensing pharmacies

Understanding tiers helps you compare plans during Open Enrollment and avoid surprise expenses.

🤔 Tip #4 - PPO vs HMO. Choose the Flexibility You Need 

Cancer care often requires:

• second opinions

• subspecialty consults

• sometimes out-of-state NCI-designated centers

• possible clinical trials

A PPO may cost more but offers more flexibility, mobility, and fewer referral barriers.

🤦🏾‍♀️Tip #5- Don’t Forget Supportive Services

Look for coverage or allowances for:

• Lymphedema compression care

• physical therapy & occupational therapy

• pelvic PT

• mental health services

• acupuncture

• nutrition & survivorship rehab services

These are essential for healing, recovery, and quality of life — not “extras.”

💵 Tip #6- Be Careful of HSA Plans 

HSAs are excellent long-term savings tools, but they are often paired with high-deductible plans. They are best suited for individuals who do not frequently need to utilize the healthcare system. 

Because the costs in HSA plans are front-loaded in exchange for a lower premium, this may not be the time for a high-deductible plan unless you have strong financial flexibility.

📝 Tip #7- Review Disability & Supplemental Options 

If you're employed, your employer usually offers additional plans, such as 

• short-term disability

• long-term disability

• critical illness riders

• supplemental cancer plans

Open enrollment is a good time to review these. Some of these may be unavailable once cancer is diagnosed, but some may still be allowed in survivorship. 

Final Thoughts ✨

Open Enrollment is not just paperwork — it’s a safeguard for your continuity of care.

Your top priority this season is straightforward: ensure that your oncology team, treatment center, and essential medications remain in-network.  This protects the care you already rely on and ensures no surprise disruptions as you move into the next year.

Choose the plan that keeps your treatment steady, your care team intact, and your focus where it belongs — on your healing. 💛

Finally, if you’d like help reviewing plan options, comparing formularies, or ensuring your oncology team stays covered, you can schedule a complimentary Discovery Session to learn more about how I can assist you as your independent patient advocate.

You do not need to navigate this alone.

[Click here] to Schedule a Discovery Session