Right to lifetime coverage – So long as you choose to remain insured, you’re insured. According to the Affordable Care Act (ACA), your health insurance cannot place lifetime dollar limits on your coverage. Your health insurance also cannot drop you because you get cancer or any other sickness. According to the Women’s Health and Cancer Rights Act (WHCRA), your insurance likewise cannot remove you from a plan when you choose reconstruction surgery.
Right to new coverage – Under the ACA, if you apply for health insurance through your employer or the Marketplace, you cannot be denied coverage due to any pre-existing condition, such as cancer.
Right to equivalent payments – With the ACA, if you have a new or pre-existing diagnosis, your insurance cannot charge you any extra for it. With or without cancer, you will be paying the same monthly premiums.
Right to breast reconstruction – Under the WHCRA, any insurance that covers mastectomies must also cover a woman’s breast reconstruction. This includes:
- All stages of breast reconstruction on the breast, where the mastectomy was performed
- Any potential surgery or reconstruction desired to a remaining natural breast in order to increase symmetry
- External prostheses (breast-like fillings for your bra before or during your reconstruction process)
- Any physical complications that might arise from the reconstruction process
Unfortunately, at this time, neither the WHCRA nor the ACA requires insurances to cover mastectomies. Check with your insurance to understand under what conditions your insurance will cover a mastectomy (whether with a cancer diagnosis or as a preventative method). Rest assure, however, that if the mastectomy is covered, all reconstruction surgery will be likewise covered.
Right to know my rights – If you’re insurance covers mastectomies, it has the responsibility to annually inform you of your right to breast reconstruction, according to the WHCRA.
**NOTE: All health insurance plans purchased on or before March 23, 2010 are not required meet the ACA’s coverage requirements.