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Does Health Insurance Cover Chemotherapy?

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From radiation from the sun to the cigarettes you smoke during office breaks, all can lead to cancer. We may believe we are safe, but it can come unannounced and turn our world upside down. One of the best-known treatments for cancer is chemotherapy. Cancer cells grow and multiply faster than most normal cells, and chemotherapy uses drugs to kill those fast-growing cells. But chemo, as it’s referred to in common parlance, is expensive. So, is chemotherapy covered by insurance? Well, let’s figure out.  

What is Chemotherapy?

Chemotherapy is a type of cancer treatment to kill cancer cells. The treatment involves the use of drugs which target the rapidly growing cells in the body and destroy them. Chemo can also stop or slow cancer growth, shrink tumours, and prevent the cancerous cells from multiplying. Chemotherapy is often used in combination with other treatments, such as radiation, hormone therapy, immunotherapy, or surgery.

Chemo can be administered in many ways – intravenously (IV), orally, topically, or by injection. However, it can cause severe side effects, such as nausea, vomiting, hair loss, fatigue, diarrhoea, constipation, loss of appetite, weakened immunity, etc. Most of these side effects usually subside after the treatment is over.

Understanding Health Insurance Coverage

When you get hospitalised due to an emergency or planned treatment, paying the bills from your pocket can pinch you and, in some cases, drain your finances. This is when health insurance provides a safety net against the hefty medical bills. To simplify it, health insurance is an agreement between an insurance company and the policyholder in which the insurer agrees to cover the medical costs, and in return, the policyholder has to pay a premium. With a comprehensive health plan, you are financially prepared for any medical emergency.

Does Health Insurance Cover Chemotherapy?

The question — Is chemotherapy covered by insurance — comes to anyone’s mind on being diagnosed with cancer. Yes, chemotherapy is covered, but a traditional health insurance policy may not be sufficient to cover the exorbitant costs because a patient has to undergo multiple sessions of chemotherapy. So, it is advisable to buy critical illness insurance or a cancer-specific healthcare plan which will cover all the costs associated with cancer treatment, including chemotherapy. A traditional health plan will cover only hospitalisation expenses.

Types of Health Insurance Plans and Chemotherapy Coverage

The types of health insurance plans which cover chemotherapy are individual health insurance plans, family health insurance, and critical illness insurance. Although individual and family health plans provide financial protection against a wide range of medical treatments, including chemotherapy, these plans may not have sufficient coverage for critical illnesses like cancer because of long-term treatment.

Hence, purchasing critical illness insurance is advisable for several reasons. First, while undergoing chemotherapy, you may incur unexpected expenses, which a traditional health plan may not fully cover, leading to financial strains. Critical illness plans cover the exorbitant costs of cancer treatment and recovery.

Second, the number of chemotherapy sittings depends on the type, stage, and severity of cancer, and the cost can add up based on the number of chemo sessions. A basic health insurance plan will not be able to meet the high costs.

Third, when diagnosed with a critical illness, the insurer pays lump sum compensation, irrespective of the hospital expenses incurred. You can use the payout for medical as well as non-medical expenses, such as paying off debts, children’s education, etc. The payout also helps compensate for lost income, as the insured cannot earn during the treatment period. In contrast, a health insurance plan will only reimburse the actual expenses incurred.

FAQs

1. Does health insurance cover chemotherapy?

Yes, health insurance policies cover chemotherapy. However, a standard health plan may not provide sufficient coverage, considering the prolonged treatment and high costs. It is best to buy critical illness insurance if you or any family member has a risk of being diagnosed with a critical illness like cancer or want to remain covered under a healthcare plan designed specifically for such illnesses.

2. What is the average cost of chemotherapy in India?

In India, the average cost of chemotherapy can range between INR 50,000 to INR 2,00,000 based on the type, stage, and severity of cancer.

3. I have a comprehensive health insurance policy. Do I need to buy critical illness insurance if I get diagnosed with cancer?

Yes. The reason is that critical illness insurance will help cover the exorbitant costs of treatment and recovery. The standard healthcare plan will not be adequate. Secondly, you can also use the lump sum payout of critical illness plans for miscellaneous expenses, as it is not restricted to medical expenses. However, a health insurance plan will only cover your actual hospitalisation expenses.

Conclusion

With the ever-increasing rise in healthcare costs, health insurance has become a necessity today. However, it is important to pick a plan that offers you sufficient coverage in times of need. If any of your family members have a history of being diagnosed with cancer, buying critical illness insurance or cancer insurance is extremely vital. Before buying the plan, ask your insurer about the policy, including questions like does health insurance cover chemotherapy or does health insurance cover chemo because your base plan will not be adequate to pay for cancer-related treatments. The critical insurance plan will not only cover the cost of treatment but will also take care of non-medical expenses.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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