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Uninsured patients are asked to pay much more for cancer treatments than Medicare and private insurers pay, according to research published in Health Affairs.
Researchers reviewed newly available Medicare data on what physicians charged for intravenous chemotherapy drugs in 2012.
And the results showed that uninsured cancer patients were asked to pay anywhere from 2 to 43 times what Medicare would pay and 2 to 5 times as
much as private insurance would pay.
For example, uninsured patients who did not negotiate the billed amounts could expect to pay $6711 for an infusion of the colorectal cancer drug oxaliplatin. But Medicare and private health plans only pay $3090 and $3616, respectively.
“Patients with Medicare and private insurance don’t pay the sticker price of healthcare,” said study author Stacie Dusetzina, PhD, of the University of North Carolina at Chapel Hill.
“They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price.”
In addition to estimating costs for infused chemotherapy drugs, Dr Dusetzina and her colleagues looked at what cancer patients were asked to pay for a doctor visit.
Uninsured patients were billed between $129 and $391, depending on the complexity of the visit. Medicare paid between $65 and $188, and private insurance paid $78 to $246 for the same visits.
“This is unreasonable,” Dr Dusetzina said. “There needs to be more transparency and less variability in healthcare pricing.”
Under the Affordable Care Act, everyone in the US must be insured or face a tax penalty. However, many Americans remain without insurance. So differences in what the uninsured are charged really matter, Dr Dusetzina said.
“In states like North Carolina that didn’t expand Medicaid, there is a large group of people who can get insurance on the federal exchange but cannot get subsidies because the law assumed they would be covered by Medicaid,” she noted.
This population earns at or near the federal poverty level. Without subsidies to help pay for private insurance, many are likely to remain uninsured.
These drug pricing discrepancies could become even more important depending on the outcome of the pending Supreme Court case King vs Burwell, which challenges the legitimacy of federal healthcare subsidies and could leave as many as 8 million Americans without subsidies and uninsured in 2016. 
Photo by Rhoda Baer
Uninsured patients are asked to pay much more for cancer treatments than Medicare and private insurers pay, according to research published in Health Affairs.
Researchers reviewed newly available Medicare data on what physicians charged for intravenous chemotherapy drugs in 2012.
And the results showed that uninsured cancer patients were asked to pay anywhere from 2 to 43 times what Medicare would pay and 2 to 5 times as
much as private insurance would pay.
For example, uninsured patients who did not negotiate the billed amounts could expect to pay $6711 for an infusion of the colorectal cancer drug oxaliplatin. But Medicare and private health plans only pay $3090 and $3616, respectively.
“Patients with Medicare and private insurance don’t pay the sticker price of healthcare,” said study author Stacie Dusetzina, PhD, of the University of North Carolina at Chapel Hill.
“They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price.”
In addition to estimating costs for infused chemotherapy drugs, Dr Dusetzina and her colleagues looked at what cancer patients were asked to pay for a doctor visit.
Uninsured patients were billed between $129 and $391, depending on the complexity of the visit. Medicare paid between $65 and $188, and private insurance paid $78 to $246 for the same visits.
“This is unreasonable,” Dr Dusetzina said. “There needs to be more transparency and less variability in healthcare pricing.”
Under the Affordable Care Act, everyone in the US must be insured or face a tax penalty. However, many Americans remain without insurance. So differences in what the uninsured are charged really matter, Dr Dusetzina said.
“In states like North Carolina that didn’t expand Medicaid, there is a large group of people who can get insurance on the federal exchange but cannot get subsidies because the law assumed they would be covered by Medicaid,” she noted.
This population earns at or near the federal poverty level. Without subsidies to help pay for private insurance, many are likely to remain uninsured.
These drug pricing discrepancies could become even more important depending on the outcome of the pending Supreme Court case King vs Burwell, which challenges the legitimacy of federal healthcare subsidies and could leave as many as 8 million Americans without subsidies and uninsured in 2016.
Photo by Rhoda Baer
Uninsured patients are asked to pay much more for cancer treatments than Medicare and private insurers pay, according to research published in Health Affairs.
Researchers reviewed newly available Medicare data on what physicians charged for intravenous chemotherapy drugs in 2012.
And the results showed that uninsured cancer patients were asked to pay anywhere from 2 to 43 times what Medicare would pay and 2 to 5 times as
much as private insurance would pay.
For example, uninsured patients who did not negotiate the billed amounts could expect to pay $6711 for an infusion of the colorectal cancer drug oxaliplatin. But Medicare and private health plans only pay $3090 and $3616, respectively.
“Patients with Medicare and private insurance don’t pay the sticker price of healthcare,” said study author Stacie Dusetzina, PhD, of the University of North Carolina at Chapel Hill.
“They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price.”
In addition to estimating costs for infused chemotherapy drugs, Dr Dusetzina and her colleagues looked at what cancer patients were asked to pay for a doctor visit.
Uninsured patients were billed between $129 and $391, depending on the complexity of the visit. Medicare paid between $65 and $188, and private insurance paid $78 to $246 for the same visits.
“This is unreasonable,” Dr Dusetzina said. “There needs to be more transparency and less variability in healthcare pricing.”
Under the Affordable Care Act, everyone in the US must be insured or face a tax penalty. However, many Americans remain without insurance. So differences in what the uninsured are charged really matter, Dr Dusetzina said.
“In states like North Carolina that didn’t expand Medicaid, there is a large group of people who can get insurance on the federal exchange but cannot get subsidies because the law assumed they would be covered by Medicaid,” she noted.
This population earns at or near the federal poverty level. Without subsidies to help pay for private insurance, many are likely to remain uninsured.
These drug pricing discrepancies could become even more important depending on the outcome of the pending Supreme Court case King vs Burwell, which challenges the legitimacy of federal healthcare subsidies and could leave as many as 8 million Americans without subsidies and uninsured in 2016.