High Out-of-Pocket Costs Burden Privately Insured Cancer Patients, Study Finds

A JAMA Network Open study reveals that patients with private insurance can face monthly costs nearing $600 after a cancer diagnosis, highlighting the disparities based on cancer stage and calling for stronger financial support policies.

It is no secret that the out-of-pocket costs (OOPCs) associated with cancer care in the United States can be a tough pill to swallow. Among patients with Medicare insurance—which has been linked to a boost in quality outcomes in some instances1—they often find themselves paying thousands of dollars yearly after receiving a cancer diagnosis; many of those who don’t have supplemental insurance for Medicare find themselves spending over half of their annual income on OOPCs alone.

The Affordable Care Act—which provided updates to Medicare Part D—did help with that, but patients were still faced with charges pertaining to inpatient admissions and drug spending.2

New JAMA study analyzes OOPCs for breast, colorectal, and lung cancer

With there being challenges in analyzing OOPCs that were related to certain cancer diagnoses in patients that privately insured, a retrospective cohort study published in JAMA Network Open2 sought to investigate this further.

The study utilized the OptumLabs-Surveillance, Epidemiology, and End Results [SEER] registry to classify privately insured patients with new cancer diagnoses. This was done by connecting population-level clinical data from the SEER program with medical claims records from individuals covered by Optum health insurance plans.

Key Takeaways

  • Privately insured patients with new cancer diagnoses faced an average of $592.53 in monthly out-of-pocket costs (OOPCs) in the six months following diagnosis.
  • OOPCs increased with disease severity, from about $462/month for stage 0 to nearly $720/month for stage 4 cancer.
  • Researchers emphasize the need for policies like paid sick leave and insurance continuity to reduce financial strain, especially for patients with advanced-stage cancer.

Methodology highlights real-world burden of cancer care expenses

Using difference-in-differences methods, the data of patients diagnosed with breast, colorectal, and lung cancer at different stages with OOPCs was compared tothose without cancer. In data that was evaluated from June 2024 through February 2025, the analysis featured individuals under 65 years old who resided in the United States between 2008 and 2022, were insured by a large national private health insurer, and had at least six months of continuous enrollment.

Patients who were enrolled but had no medical claims in a given month were given OOPCs of $0 for that particular month. For this particular study, high-deductible health plans were defined as having an individual deductible greater than or equal to $1,400 per year, or a family deductible for all members of $2,800 per year (or more).

Cancer stage strongly influences monthly OOP spending

Overall, the cohort included a total of 46,158 privately insured patients (mean [SD] age at diagnosis, 46 [12] years; 30,733 female [66.6%]; 2,543 Asian [5.5%], 4,114 Black [8.9%], 3,590 Hispanic [7.8%], and 31, 099 White [67.4%]). There were also 19,656 cancer patients, while the control group contained 26,502 patients without cancer in the control group.

Concerning the cancer patients, the breakdown was as follows:

  • 14, 581 patients had breast cancer
  • 2842 patients had colorectal cancer
  • 2233 patients had lung cancer

These resulted in OOPCs of $592.53 per month (95% confidence interval, or CI, $528.01-$627.04 per month) for the six months following the diagnosis. There was a direct correlation between a rise in cost with stage at diagnosis (mean OOPC increase range, $462.01 per month [95% CI, $417.92-$506.11 per month] for stage 0, to $719.97 per month [95% CI, $626.11-$813.83 per month] for stage 4).

There were several limitations to this study, including the fact that a difference-in-differences technique was to separate baseline medical spending from OOPCs linked to a cancer diagnosis, with there being evidence that supported the method's main assumption that trends between cancer and noncancer groups were similar pre-diagnosis. Although this was the case, the analysis could be impacted by differential attrition, as it’s possible that cancer patients could discontinue insurance coverage at different rates than those without cancer.

Keeping all of this in mind, the study investigators concluded that, “in this cohort study, patients with private insurance were found to have high OOPCs after an incident diagnosis of cancer, and those with the most advanced cancer had the highest OOPCs. The variability in OOPCs based on cancer stage underscores the need for policies such as paid sick leave, that address both insurance continuity and financial assistance, especially for patients with more advanced cancer.”

References

1. Saraceno N. Does Risk-Based Payment Drive Better Care in Medicare Advantage? Pharmaceutical Commerce. June 26, 2025. Accessed July 30, 2025. https://www.pharmaceuticalcommerce.com/view/does-risk-based-payment-drive-better-care--medicare-advantage-

2. Rose L, Rajasekar G, Nambiar A, et al. Estimated Out-of-Pocket Costs for Patients With Common Cancers and Private Insurance. JAMA Netw Open. 2025;8(7):e2521575. doi:10.1001/jamanetworkopen.2025.21575

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