More than 80,000 young adults ages 20 to 39 are diagnosed with cancer each year in the United States, according to the American Cancer Society.1 Thanks to medical advances, more and more are surviving through the first year and going into remission.
But that means, besides the health struggle, tens of thousands of young adult and millennial cancer survivors out there are facing financial challenges. If you or someone you love is in this position, where do you start? How do you create a plan? How do you execute that plan?
The financial challenges
Young adult cancer patients are two to five times more likely to declare bankruptcy than patients 65 and older, according to an analysis by the Family Reach Foundation, a nonprofit cancer advisory group. Why? Older patients potentially have a lifetime of assets to fall back on and can claim Social Security retirement income based on their lifetime earnings.
Young adult cancer survivors also face unique hurdles in their financial recovery compared with other age groups.
- They may not have the same parental support that childhood cancer patients do.
- Young adult patients often have larger debt loads from student loans, buying homes, or starting businesses than older patients.
- Younger adults sometimes go without health insurance or opt for high-deductible health insurance.
- Some younger adults may have relied on a parent’s plan, and opted for bare-bones coverage after age 26.
In addition, there’s the loss of income and loss of employer-provided health insurance and other benefits that can accompany not working during treatment. Young adult cancer patients might receive Social Security Disability Income and Medicaid insurance, but these safety nets sometimes don’t provide enough financial support or many provider options.
Financial recovery for young adult cancer survivors is also difficult because, while there’s no end to the information available on how to get help paying for treatment, there’s little information available about getting finances in order once someone’s in remission. Few grants and scholarships for cancer patients acknowledge that being in remission doesn’t mean an end to cancer-related medical bills and cancer-related financial consequences. There are ongoing doctor visits, blood tests, prescriptions, MRIs or CT scans, and maybe physical, occupational, and other rehabilitation services. Young adult survivors sometimes are reported to skip medications, meals, and other necessities because they can’t afford them, which only makes survivorship more difficult.
As with most financial challenges, it often pays to consult a financial advisor about strategies and plans. And while all cancer patients face a myriad of financial challenges, young adults typically need to address two key problem areas: medical bills and student loans.
Getting medical bills under control
Cancer treatment entails bills from numerous providers: primary care doctors, hospitals, imaging centers, oncologists, surgeons, labs, radiologists, and more. Patients must pay for certain charges, such as pharmacy expenses and insurance copayments, at the time of treatment. Others get billed to the patient later, after the insurance company processes the provider’s claims.
Few people are skilled at deciphering medical bills or insurance explanation of benefits (EOB). The first step in making sure your cancer treatment bills are accurate is to request a detailed, itemized statement from each provider, which by law they must provide. Compare these statements with the EOBs from your insurer. Ask the provider to adjust any mistakes or overcharges you find.
Also look for charges that your insurer denied or covered at an out-of-network rate instead of an in-network rate, and appeal any mistakes with your insurer. Further, look for inaccurate provider charges for services or medications you didn’t receive, incorrect quantities of medication, and incorrect dates and times of service (which can result in being charged for more days in the hospital than you should have been). Also look for incorrect medical billing codes and duplicate charges.
If these tasks are too overwhelming or you don’t have time for them, consider hiring a health care advocate, also called a patient advocate, medical negotiator, or medical billing advocate. These professionals are experts in finding mistakes on medical bills and negotiating lower fees on behalf of their clients. The fee for their help is often a percentage of the amount the patient advocate saves you.
If you have the time and energy, you can try negotiating your bills yourself. Hospitals can sometimes put patients on a payment plan, or they may give discounts if patients are able to pay in full, says two-time young adult cancer survivor Samantha Watson, founder and CEO of the Samfund, a nonprofit organization that offers help to young adults who are struggling financially because of cancer.
“Hospitals also have financial assistance programs in place that will reduce or cover a patient's bill depending on the specific program's parameters,” Watson explained. “Most patients don't know about these programs but should definitely either ask their provider or spend time on the hospital's website. All of the info is there, but it's not always easy to find.”
When the Samfund helps patients, it generally starts by asking for at least one-third off the total bill, and it sometimes requires asking for a manager or supervisor, she added.
If you aren’t working, “call the billing department, explain that you're struggling and unemployed, and ask for their help. They may be able to defer the payments for a little bit,” Watson elaborated. Your hospital’s financial assistance program may also be able to reduce or write off your bill depending on your income status and their requirements.
Bankruptcy is an option for survivors with overwhelming bills. While it can provide a fresh start, it’s not a decision to make lightly, and it should be evaluated with the help of a bankruptcy attorney. You’ll want to learn about the different types of bankruptcy that individuals can file, which of your debts you may be able to discharge (medical bills, credit cards, personal loans) and which you may not (student loans), and which of your assets you may have to give up to repay your creditors.
You’ll also want to understand the long-term implications of having a bankruptcy on your credit report and in the public record. It may be difficult or impossible to borrow money, especially at a reasonable interest rate, for several years. And getting a job could be more difficult because some employers check applicants’ credit reports and want to see decent scores. (Learn more: The importance of credit scores)
Most experts advise against taking on credit card debt to pay your medical bills. Credit card interest rates are typically much higher than rates for other types of consumer debt. Medical providers may charge no interest at all and may be willing to negotiate and renegotiate a payment plan as your situation evolves. Also, while credit card debt can drag down your credit score, medical debt generally will not, as long as you keep it out of collections.
Overcoming student loan challenges
Many young adults enter cancer treatment carrying student loan debt. They might be employed and in the repayment phase of their loans, or they might still be in school and have their loans in deferment. Either way, student loans can cause several problems for young adult cancer survivors that healthy young adults don’t struggle with.
For federal student loans, deferment and forbearance are the two options for temporarily not having to make payments. Interest does not accrue during deferment on subsidized federal student loans. Interest always accrues during forbearance, as well as during deferment, on unsubsidized federal loans. Any interest you don’t pay as it accrues gets added to your student loan balance as capitalized interest, meaning you end up paying interest on your interest — not unlike a credit card. So while you’ll remain in good standing with your lender when your loans are in deferment or forbearance, your loan balance will keep growing (with the exception of the loan type listed earlier). (Related: When student debt becomes unaffordable)
Does being in cancer treatment make you eligible for deferment or forbearance? The government’s federal student loan website says that borrowers may be eligible for deferment for up to three years while experiencing economic hardship.
However, this doesn’t usually apply to situations involving cancer treatment, explained Kate Houghton, president and CEO of Critical Mass, a coalition of advocacy organizations and institutions dedicated to improving the lives of young adults with cancer.
“Typically, an economic hardship means you are disabled or lose your job. … This should apply for cancer treatment, but unfortunately, in practice, it rarely does,” she said.
A young adult who has lost their job due to cancer will often not be able to look for work while undergoing cancer treatment, said Houghton, herself a young adult cancer survivor. Patients are generally dealing with stamina issues, side effects, baldness, and an uncertain prognosis.
Student loans can be discharged due to disability, but typically only a permanent one. Cancer and its treatment often cause disability, and while it can be serious, it’s usually temporary — though long-term, disabling side effects from treatment can occur, and those can certainly affect one’s ability to earn an income.
These problems are why young adult cancer survivors so often find themselves in default or owing much more on student loans than they started with.
Even forbearance — during which interest accrues — has its limits. For federal student loans, it’s a 36-month limit over the life of the loan.
The other option for managing federal student loans during periods of financial stress is getting on an income-driven repayment plan. These calculate the monthly payment as a percentage of the borrower’s discretionary income. If the borrower’s income is less than 150 percent of the poverty level, the monthly payment is zero, said Mark Kantrowitz, the publisher and vice president of research at SavingforCollege.com and a 15-year cancer survivor. Income-driven repayment can lead to negative amortization, causing the amount of debt to grow. However, after 20 or 25 years of repayment, depending on the plan, the remaining debt is cancelled. Cancelled debt may be taxable as income, though.
If you’re eligible, you can claim the student loan interest deduction on your taxes even if you don’t itemize — though the most interest you can deduct is $2,500, meaning you may be able to shave a few hundred dollars off your tax bill, depending on your tax bracket. Your tax bracket increases as your income increases, so the value of this deduction will likely be nil if you have little to no income.
Light at the end of the tunnel
Recovering from a major financial setback is a challenge for anyone, but for young adult cancer survivors, it’s extra difficult. Compared to their healthy peers, young adult cancer survivors often have weaker immune systems, less physical stamina, and ongoing medical bills. They may also have infertility-related expenses when they’re ready to start a family and ongoing side effects and disabilities as a result of their illness and treatment: numbness, paralysis, chronic pain, brain fog, and a lifetime of higher medical bills.
A study by the American Journal of Managed Care found the average net worth of young adult recipients of Samfund grants, all of whom are cancer survivors between the ages of 21 and 39, is a negative $35,000 compared with a positive $68,000 for their counterparts in the general population.2 That’s a huge disparity. Physical symptoms and employer biases can make it hard to get back to work, too.
If you’re a young adult cancer survivor, don’t try to fix all your financial problems at once. Write down short-, mid-, and long-term goals for your financial recovery, then flesh out those goals with small, achievable steps that you can take one day at a time. Also, don’t be afraid to lean on your support network of family, friends, and fellow survivors: They care about you and want to help.
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1 American Cancer Society, “Key Statistics for Cancers in Young Adults,” Jan. 8, 2020.
2 American Journal of Managed Care, “Young Adult Cancer Survivors Disproportionately Affected by Treatment Costs,” Aug. 19, 2016.