The Affordable Care Act and Cancer

Aprobado por la Junta Editorial de Cancer.Net, 05/2023

The Patient Protection and Affordable Care Act (ACA) is a U.S. federal health care law. It was passed in March 2010 and changed many rules about health insurance in the United States.

This article explains some important ways the ACA affects health insurance and cancer care. You can learn more about at the U.S. government website of Learn more about the basics of health insurance in another article on Cancer.Net.

Can the ACA help me get health insurance?

The Affordable Care Act expanded the ways people in the United States can get health insurance. There are three main ways to get health insurance in this country:

  • A government-sponsored health insurance plan.

    • Medicare is a federal health insurance plan that covers people age 65 and older and some people with disabilities.

    • Medicaid is funded by both the federal and state governments. Each state has its own program, which means eligibility and services are different for each state. Medicaid covers low-income people who are older or have a disability. It may also cover other people with disabilities. Some states expanded Medicaid under the ACA. These states may provide coverage for other low-income adults.

    • The Children's Health Insurance Program (CHIP) provides health insurance to children eligible through Medicaid and/or a separate CHIP program administered by their state government.

  • A group plan subsidized by your employer, your spouse's employer, or your parent's employer for people under age 26. Subsidized means that it is partially paid for by the employer who provides the plan.

  • An individual plan or non-group plan that is purchased through the Health Insurance Marketplace, also known as Exchanges. The Health Insurance Marketplace was set up under the ACA to offer a choice of plans for people who do not have health insurance through an employer, Medicare, or Medicaid.

Most people can apply for health insurance coverage through Some states have their own insurance exchanges. Use this list on to find where you can purchase health insurance.

When can I enroll in a plan through the Health Insurance Marketplace?

Enrollment in a health care plan through the Health Insurance Marketplace is open during a period called Open Enrollment. For most people, plans cannot be purchased outside of this time, but there are some exceptions.

  • American Indians and Alaska natives can enroll in a plan through the Health Insurance Marketplace at any time.

  • People with income up to 150% of the federal poverty level who are not eligible for Medicaid can use the Health Insurance Marketplace at any time. You can find the current federal poverty level amounts at To calculate 150% of the current rate, multiply the amount by 1.5. For example, the federal poverty level for a single person in 2023 is $14,580, so that calculation would be $14,580 x 1.5 = $21,870.

  • If you go through a qualifying life event, you can sign up for a health insurance plan through the Marketplace. Qualifying events include a loss of health coverage, changes in household, changes in residence, and more. Learn more about Open Enrollment's dates to know and qualifying life events at

Can the ACA help me pay for health insurance?

If you earn less than a certain amount, you can get help paying for insurance through premium tax credits. This amount varies, depending on the size of your household. You can determine the amount of subsidies you qualify for using the KFF subsidy calculator on a separate website.

What other ways does the ACA regulate health insurance?

There are several parts of the ACA that impact health insurance coverage in the United States. These include:

  • You cannot be denied insurance because of a condition you had before you applied for insurance. Companies call this a pre-existing condition. Your insurance company also cannot refuse to pay for a condition you had before you got insurance. They must pay unless a special rule says they do not have to.

  • Your health insurance company cannot charge more because of your sex or because you have a specific health condition.

  • If you join a group insurance plan through your employer, you will get benefits in 90 days or less. This means the company starts paying within this time. This rule started on January 1, 2014.

  • Private insurance companies cannot limit how much they pay for care in your lifetime. In the past, they could stop paying after a certain amount, called a cap. But most cancer care is expensive. Some people had to pay for all their care after the coverage stopped. Now, your insurance company must keep paying for care. This is true even if you need a lot of care, such as for cancer.

  • Your insurance company cannot stop paying its part of your bills. This is true unless you or someone else on your plan commits fraud, or cheating.

  • A company cannot cancel your insurance if they find a mistake in your application.

  • If the plan covers your children, they can use it until they turn 26.

What will I pay for prevention tests and services under the ACA?

Some tests and services can lower your cancer risk. The ACA requires that health insurance pay for some standard health services to lower cancer risk and catch cancer in earlier stages, for certain groups of people. They include:

  • Regular screenings for colorectal cancer.

  • Regular screenings for breast cancer. Companies may also be required to cover some other services to prevent breast cancer. For example, women with a higher risk of breast cancer can:

    • See a genetic counselor to talk about breast cancer risk

    • Talk to a doctor about medication to prevent breast cancer

  • Regular screening for cervical cancer and the HPV vaccine to prevent cervical cancer

  • Help to stop smoking, such as counseling and medication

Note: A recent U.S. District Court ruling may impact what prevention tests and services are covered under the ACA, especially for younger people. This article on KFF's website has information about this ruling and how it can impact what is covered.

What can I do if my insurance will not pay?

If your insurance company refuses to pay for something or ends your coverage, you can appeal that decision. That means that you or your doctor ask them again to cover it. An appeal can be reviewed by a third party.

First, you can ask your insurance company to reconsider. They are required to explain why they did not pay or ended your coverage. They also need to tell you how to file an appeal. There are two ways you can appeal:

Internal appeal: An internal appeal is done by the insurance company. You can ask them to review their decision. If coverage is still denied after internal review, an external review can be done.

External review: An external review determines if your insurer can deny your claim or not. Insurers are required by law to accept the decision of external review.

For people with urgent situations, internal and external review can be completed at the same time. Learn more about appealing a health plan decision at

What will insurance cover if I am in a clinical trial?

Clinical trials are research studies involving volunteers. Most health insurance companies cannot limit what they pay if you're in a clinical trial, meaning they must pay for all of the health care services related to the clinical trial. This is true for insurance starting January 1, 2014 or later. Also, your company cannot stop your insurance if you are in a clinical trial.

If your health insurance started before January 1, 2014, the company can limit what it pays if you join a clinical trial. It can also stop paying for your health care.

If you have questions about your insurance coverage, talk with your health care team and/or an insurance company representative before treatment begins. Learn more about coverage during a cancer clinical trial in a different article on this website.

Related Resources

Health Insurance

Understanding the Costs Related to Cancer Care

Health Insurance and Cancer Treatment: How to Get and Stay Organized

More Information

CancerCare: Understanding the Affordable Care Act

KFF: Health Reform