A study of national wage loss from cancer showed that 91 per cent of households suffer a loss of income or rise in expenses as a direct result of a cancer diagnosis (via Current Oncology). The major costs of a cancer diagnosis and treatment are for things like lack or loss of income, medicines and home health services. Families face many indirect costs and other expenses because of cancer and its treatment, along with their usual bills. For some people, the financial impact of cancer is financially and emotionally devastating. The costs for a person who has cancer can include things like:
- Travel (gas and parking) to doctor visits, clinics, hospitals, and treatment appointments
- Drugs are not covered by provincial/territorial formularies
- Lodging (a place for the patient and/or family to stay) during treatment away from home
- Meals during travel or clinic visits
- Extra child care costs
- Lack of or loss of income
- Communication (phone calls, faxes, copies of medical records, etc.) with doctors, friends, and relatives
- Special foods and nutritional supplements
- Special equipment or clothing
Source: Canadian Cancer Society
Other Financial Factors to Consider (taken from Financial Hardship of cancer in Canada)
- Barriers to maintaining or returning to work. Canadians that have no contractual or legal right to job security may be at risk of losing their jobs while being treated for cancer or taking a leave to provide care. Medical appointments may be so time-consuming and uncoordinated that holding on to a job becomes impossible. Survivors may be left with conditions that rule out their previous occupations. For example, lack of mobility in the arm and/or shoulder from breast cancer can affect work a person can do.
- Gaps in federal programs. The federal Employment Insurance program will pay sickness benefits of up to 55 per cent of an individual’s salary, up to a maximum of $485 per week. However, there are limitations: *http://www.servicecanada.gc.ca/eng/sc/ei/index.shtml
- The benefit is only paid for 15 weeks, which is far shorter than the average treatment period for many cancers. A study by the Canadian Breast Cancer Network showed that two-thirds of respondents were away from work for 16 weeks or more during treatment, and the average gap without EI coverage was 23 weeks.
- Not everyone qualifies for the benefit. A person must work at least 600 hours in the last 52 weeks before making a claim – a requirement that may be difficult to meet for part-time or seasonal workers, or for those who recently found work after a period of unemployment and were then diagnosed with cancer. Most self-employed Canadians are also ineligible for this benefit. Although the federal government opened up the EI program to self-employed workers in January 2010, most have not opted in.
- If your illness recurs or a second round of treatment is required, you will not qualify unless you have worked at least 600 hours (approximately 16 weeks or four months for a typical full-time job) since your last claim.
- Absence of private insurance. Through an employee benefits package, many people are able to draw on sick leave or private health insurance while dealing with cancer. However, some workers have no private coverage of this kind. While the number is difficult to pinpoint, recent studies have estimated that 20 to 30 per cent of Canadians rely solely on government benefit programs or have no coverage at all. Studies also show that Métis and non-status Aboriginals are more likely than non-Aboriginals to be underinsured or have no insurance at all (via “Out-of-pocket spending on prescription drugs”)*. Several barriers can stand in the way of obtaining adequate private insurance:
- A person’s employer may not offer a benefit package or the employee may not have worked enough hours to qualify for benefits.
- A previous diagnosis may make a cancer survivor ineligible for coverage as an individual if she or he becomes unemployed or self-employed.
- Premiums may be considered too costly by self-employed people and others who could opt into group coverage, particularly if they are dealing with other financial challenges at the time.
- Caregivers are usually unable to recover their lost wages when they must miss work to provide care to a family member.
The cost of medical travel. Travel appears to be one of the biggest indirect costs of cancer, particularly for rural Canadians who must travel to larger centres for highly specialized treatment and services. Studies across Canada show that these costs can quickly surpass all other out-of-pocket expenses (via Financial and Family Burden Associated with Cancer Treatment in Ontario, Canada). While some of these expenses can be recovered later, they are nevertheless up-front costs for the patient. The money must be found and paid immediately, sometimes long before reimbursement is received.
These travel expenses take many forms, and hit rural people the hardest:
- Lost wages are an additional challenge for people who must take travel long distances for medical treatment.
- Fuel is a significant and growing expense for rural people.
- A more reliable vehicle may need to be purchased for the many hours of highway travel.
- Accommodation may be difficult to find at an affordable price. Some patients need to be away from their home community for several months – for example, if they are undergoing a bone marrow or stem cell transplant.
- A companion may need to travel with a person who is weakened by illness and treatment, leading to additional expenses and lost wages for a spouse, friend or family member.
- Childcare may be needed, sometimes with little advance notice. If parents have no family support nearby, paid child care will be required.
- Parking can be a significant expense around major treatment centres, where people may spend several hours waiting to see a specialist.
- Child care and housekeeping. Parents with cancer may need additional help with child care and household responsibilities while they attend medical appointments or when they aren’t well enough to handle these tasks. This is more of a problem for single parents, but it can also be an issue for two-parent families if both parents are unable to work because one is sick and the other must take care of the children. If a friend or family member can’t step in, it may be difficult to find immediate, affordable help. In extreme cases, the only option may be temporary foster home, or the patient with cancer may die, which burdens the family with a new set of challenges.
- Home care expenses. The growing need for home care, particularly during the palliative stage of illness, can greatly add to the out-of-pocket costs of dealing with cancer. While most provinces provide a certain amount of “free” home care to qualifying families, there is no national standard for home care.
- Even if a family qualifies for provincial home care assistance, a shortage of home care staff may prevent them from taking full advantage of these services. If their need exceeds what the provincial service can provide, the family may need to pay for private home care. These shortages are often more acute in rural areas. People receiving care at home may also require supplies not covered by provincial health plans, including:
? Supplies for gastric feedings
? Digital thermometers (needed by all children with cancer and adults with low immune status)
? Electric razors (needed by adults predisposed to bleeding)
? Bath stools, walkers and canes
Challenges for Métis, First Nations and Inuit. Aboriginal people with cancer face huge financial challenges:
? The Métis and non-status Aboriginals are more likely than non-Aboriginals to be underinsured or have no insurance at all. At the same time, this population has higher mortality rates from cancer and a lower mean income (Profile of Métis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study).
? Jurisdictional issues present additional challenges for First Nations and Inuit people. They are covered by Health Canada’s Non-Insured Health Benefits program – however, if they live on reserve, they are often ineligible for provincial programs available to the rest of the population, such as home care and palliative care. As a result, health care providers and First Nations/Inuit people often struggle with jurisdictional problems on a regular basis.
Be sure to contact your healthcare provider(s), social worker, government representatives and financial advisor regarding financial information for cancer patients. These people have expert knowledge regarding these types of programs and which financial assistance programs would be most suitable for you.
Coping With Your Financial Concerns When You Have Breast Cancer (all provinces), created by Willow Breast and Hereditary Cancer Support, the only comprehensive resource, customized for each province, to help people navigate the financial difficulties associated with breast cancer.
Government income programs based on your contributions/premiums and amount paid through employer:
Canada Pension Plan – Disability Benefits The Canada Pension Plan (CPP) disability benefit is a taxable monthly payment that is available to people who have contributed to the CPP and who are not able to work regularly at any job because of a disability.
The CPP disability benefit is not designed to pay for such things as medications and assistive devices.
To qualify for a CPP disability benefit, you must:
- have a severe and prolonged disability
- be under the age of 65
- meet the CPP contribution requirements.
You should apply as soon as you develop a severe and prolonged or terminal medical condition that prevents you from working regularly at any job.
Do not delay in sending your completed application forms. You must apply for the CPP disability benefit in writing. The date your application is received affects the date your benefit begins.
For more information about Canada Pension Plan – Disability Benefits, click here.
Toll-free: 1-800-277-9914 (Service Canada)
Employment Insurance (EI) Benefits Employment Insurance (EI) provides Sickness Benefits to individuals who are unable to work because of sickness, injury, or quarantine.
You may be entitled to receive EI sickness benefits if:
- you are employed in insurable employment;
- you meet the specific criteria for receiving EI sickness benefits;
- your normal weekly earnings have been reduced by more than 40 per cent; and
- you have accumulated at least 600 hours of insurable employment during the qualifying period or, if you are a self-employed fisher, you have sufficient insurable earnings from self-employment in fishing during the qualifying period.
You have paid EI premiums
If you are employed in insurable employment, your employer will deduct EI premiums from your wages or salary. These premiums go into the EI Fund. There is no minimum or maximum age for paying EI premiums.
You pay EI premiums on all your earnings up to a maximum amount. In 2015, for every $100 you earn, your employer will deduct $1.88, until your annual earnings reach the maximum yearly insurable amount of $49,500. The maximum amount of premiums to be paid in 2015 is therefore $930.60.
For more information about Employment Insurance (EI) Benefits, click here.
Toll-free: 1 800-206-7218 (Service Canada)
Employment Insurance (EI) – Compassionate Care Benefits Compassionate care benefits are Employment Insurance (EI) benefits paid to people who have to be away from work temporarily to provide care or support to a family member who is gravely ill and who has a significant risk of death within 26 weeks (six months). A maximum of six weeks of compassionate care benefits may be paid to eligible people. To be eligible for compassionate care benefits, you must be able to show that:
- your regular weekly earnings from work have decreased by more than 40 per cent; and
- you have accumulated 600 insured hours of work in the last 52 weeks, or since the start of your last claim (this period is called the qualifying period).
For more information about EI – Compassionate Care Benefits, click here.
Toll-free: 1 800-206-7218 (Service Canada)
Employment Insurance Sickness Benefits EI Sickness Benefits to individuals who are unable to work because of sickness, injury or quarantine. Generally, you need to have worked 600 insured hours in the last 52 weeks and prove that your earnings have been reduced by at least 40 per cent to qualify for sickness benefits.
To see whether you meet the sickness benefits criteria, you will need to submit:
- a medical certificate,
- an application form
- records of employment from all employers you have worked for in the last 52 weeks or since the start of your last claim (whichever is fewest)
Employers are obliged to provide these records within five days of your notification. It’s important that you file your claim within four weeks or you may lose benefits. If you are unable to obtain these records within four weeks, you may file your claim using pay stubs or T4 slips to verify your employment history.
Coverage may last up to 15 weeks. After the coverage ends, you may be able to receive regular EI benefits if you are able to show that you have regained the ability to work and have no job to return to.
For more information about EI – Sickness Benefits, click here.
More Financial Aid Programs
Kelly Shires Breast Cancer Foundation The Kelly Shires Breast Cancer Foundation`s Snow Run for Fun Trust was established in 1999 by the late Kelly Shires (then just diagnosed with breast cancer) and her best friend Suzy Cayley. They wanted to find ways to ease the financial stresses confronting women undergoing breast cancer treatment so they started the Snow Run for Fun, a sponsored snowmobile ride that has been an amazingly successful fundraising event.
The Kelly Shires Breast Cancer Foundation offers up to $1,000 per application to qualifying individuals and you can apply up to four times a year (lifetime financial assistance capped up to $10,000). Click here for the criteria of financial assistance.
For more information about the Kelly Shires Breast Cancer Foundation and financial assistance, click here.***
Ontario Disability Support Program (Ontario only) Managed and delivered by the Ministry of Community and Social Services, provides financial help for people with disabilities. It can help pay for living expenses, like food and housing.
You may qualify for income support if you:
- are in financial need
- are 18 years of age or older
- live in Ontario, and
- have a substantial physical or mental disability that: is expected to last a year or more, and makes it hard for you to care for yourself, take part in community life or work.
The amount of income support you receive will depend of your:
- family size
- assets, and
- housing costs
If you qualify for income support, you and your family may also qualify for other benefits, such as:
- drug coverage
- dental coverage
- vision care
- transportation to medical appointments
For more information on the Ontario Disability Support Program, click here.
London Regional Cancer Program – Patient Assistance Program (London, Ontario area only) If you are undergoing treatment within the London Regional Cancer Program and its affiliated regional sites you may be eligible to apply for financial assistance. Funding is available for emergency, short-term situations when funding from other sources and services is not available. The funding can be used for various expenses such as wigs, prostheses and bras, child care during treatment, and supportive medications to treat symptoms related to treatment.
For more information on the London Regional Cancer Program, click here.
Patient Financial Assistance Program (PFAP) (Alberta) provides short-term help for cancer patients so families can focus on recovery instead of how to pay for transportation or cover the cost of medications.
Royal Canadian Naval Benevolent Fund Current and former members of the naval forces of Canada and their dependants may qualify for financial assistance from the Royal Canadian Naval Benevolent Fund. Benefits may take the form of either a loan or grant depending on your circumstances. Applications are available at Veteran Affairs Canada office or Royal Canadian Legion Branches.
For more information of the Royal Canadian Naval Benevolent Fund, click here.
Veteran Affairs Canada Veteran Affairs Canada provides treatment and other health-related benefits to veterans and their survivors/dependants. Benefits include medical, surgical and dental care, prosthetic devices, home adaptations, supplementary benefits such as travel costs for examinations or treatment, and other community healthcare services and benefits.
To learn more about Veteran Affairs Canada’s financial assistance programs, click here.
Medical and Drug Coverage:
Group Health Care Insurance For those covered by supplemental health insurance, either through a group plan at your place of employment or your partner’s place of employment, or carried independently if you are self-employed, many of the additional costs you might face may be covered. However, the level and duration of such coverage varies greatly from policy to policy, so you will need to carefully check your policy.
Areas that may be covered are drugs, semi-private or private room accommodation in hospital, assistive devices, home nursing care and prostheses. Some policies may also include acupuncture, physiotherapy or message therapy.
Should you have an insurance-related complaint that you cannot resolve with your insurance company, you can contact the OmbudService for Life & Health Insurance** (OLHI). OLHI is an independent service that assits consumers with concerns and complaints about life and health insurance products and services. Their objective is to provide fair and prompt resolution of problems.
For more information on Group Health Care Insurance, click here.
Ontario Drug Benefit Program The Ontario Drug Benefit Program provides prescription drugs at a small cost to eligible Ontario residents, including:
- People 65 years of age and older
- People in social assistance (Ontario Disability Support Program and/or Ontario Works)
- Residents of homes for special care and long-term care homes
- People receiving professional home care services
- People enrolled in the Trillium Drug Program
Under the ODB program, recipients are eligible for the over 3,200 drug products listed in the Ontario Drug Benefit Formulary.
Through its Exceptional Access Program, the Ministry of Health may also consider requests for coverage of drugs not listed on the formulary if your doctor submits a written request on your behalf.
Depending on your annual income, single seniors who have an annual income of $16,018 or more and senior couples with a combined annual income of $24,175 or more may be asked to pay some portion of their prescription drug costs. If you fall into one of these categories, you would pay an annual deductible of $100 plus up to $6.11 toward the dispensing free each time you fill a prescription. All other ODB eligible patients may be asked to pay up to $2 each time they fill a prescription.
For more information on the Ontario Drug Benefit Program, click here.
Trillium Drug Program (Ontario residents) This program helps people who have high prescription drug costs relative to their household income.
You may qualify for the Trillium Drug Program if:
- You have a valid Ontario health card
- You live in Ontario
And you are not covered under ODB as:
- a senior over 65 years of age
- someone who receives financial help through Ontario Works or the Ontario Disability Support Program
- a resident of a long-term care home or home for special care
- someone who receives home care services
- You don’t have private health insurance or your private insurance does not cover 100 per cent of your prescription drug costs.
For more information about the Trillium Drug Program for Ontario residents only, click here.
Toll-free: 1 800 575-5386
Canada Revenue Agency – Tax Credits and Deductions There are certain credits that you may be able to claim on your federal income tax return to reduce the amount of tax you pay.
- The Medical Expense Tax Credit is a non-refundable tax credit that provides tax relief for above-average medical expenses (a non-refundable tax credit only to be used to reduce taxes to zero but will not generate a refund payment from the government if no taxes are payable).
- An expense is generally eligible to be claimed if it is directly related to a medical condition, including prescription drugs, wigs and prostheses. If you have private health insurance, you can claim the portion of expenses that your plan does not cover, as well as the premiums you pay.
There is a minimum amount of medical expenses that you must have incurred before they are able to start reducing the amount of tax you need to pay. This is equal to three per cent of your net income or $2,024 (as of 2010), whichever amount is less. If you have a spouse or a common-law partner, it may be better for the one of you with the lower net income to claim the allowable medical expenses.
- The Refundable Medical Expense Supplement is a refundable tax credit for working individuals with low incomes and high medical expenses. Refundable tax credits can be used to reduce the amount of tax you pay to zero and any excess may be refunded by the government.
- The Disability Tax Credit is a non-refundable tax credit for those that the Canada Revenue Agency defines as having “a severe and prolonged mental or physical impairment which markedly restricts the ability to perform a basic activity of daily living”. It is not available to all persons with disabilities and is not automatically given to those receiving CPP disability benefits or disability from insurance.
- If your medical treatment is not available locally (within 40 km) and you must travel to get treatment elsewhere, you may be able to claim the cost of public transportation (e.g. taxi, bus or train) to get the treatment somewhere else. If public transportation is not readily available, you can claim vehicle expenses to get medical treatment. If you have to travel more than 80 km for treatment, you may also be able to claim travel expenses for someone to accompany you if a medical practitioner certifies in writing that you are unable to travel without assistance.
For more information on tax credits and deductions, click here.
Northern Health Travel Grant Program(Ontario) The Ontario Ministry of Health and Long-Term Care provides grands to help defray the costs of transportation and accommodation for eligible residents of Northern Ontario who much travel at least 100 km (one-way) to receive medical services that are not available locally.
For more information about the Northern Health Travel Grant Program, click here.
Assistive Devices Program (Ontario)
- Lymphedema Garments. The Assistive Devices Program (ADP) is part of the Ontario Ministry of Health and Long-Term Care ADP contributes towards the cost of medical equipment including breast prostheses and compression garments for chronic (secondary) lymphedema. You are able to apply for assistance if you are an Ontario resident, have a valid OHIP card and require a device or garment for at least six months of regular daily use.ADP forms can be accessed through a medical specialist, such as an oncologist or plastic surgeon. Your specialist will also refer you to an authorizer to assess your specific needs and prescribe the appropriate equipment or supplies. An “authorizer” may be an occupational therapist or physiotherapist registered with ADP.
- Prosthesis. ADP will contribute to the cost of one or two prostheses depending on whether you have had a single or double mastectomy or lumpectomy. It will not cover bras, temporary prostheses, silicone nipples or breast implants. The prostheses vendor must provide you with a written warranty against manufacturer’s defects for at least two years, as well as guarantee the fit for at least two years, barring changes in your size or medical condition.
For Either Lymphedema Garments or Prostheses
Purchase of your required equipment must be from a vendor registered with ADP. As long as the cost of your item does not exceed the maximum set by ADP, you will pay approximately 25 per cent of the cost and ADP covers the remaining 75 per cent.
Should your items exceed the ADP guidelines, you will be responsible for the coverage. Discuss this with the vendor before purchasing. They are very accustomed to dealing with ADP and are familiar with the billing procedures and cost guidelines.
If you have extended health insurance, remember to check to see if any of your costs are covered.
ADP will pay for replacement items as your needs change or as wear and tear take their toll. However, this too is on a limited basis. Although the funding formula is the same as it is for the initial purchase, generally lymphedema compression garments (i.e. three sets, two garments each) can be replaced ever 12 months.
Prosthesis may be replaced after a minimum two-year period unless your doctor verifies a change in your medical condition or body shape/size.
For more information about the Assisted Devices Program, click here.
Toll-Free: 1-800-268-6021 (within Ontario only)
Other Programs for Assistive Devices
Canadian Red Cross – Health Equipment Loan Program (HELP) (B.C., Alberta and Ontario only) For everything from wheelchairs to commodes to walkers, your local Red Cross may be able to lend it to you temporarily.
For more information about HELP, click here.
March of Dimes Canada (Ontario Residents only) offers an Assisted Device Program that provides partial funding for the purchase and maintenance of equipment such as wheelchairs, walkers, braces and communication devices.
For more information about the March of Dimes, click here.
MODmobility is a partnership between Motion Specialties Inc. and March of Dimes Canada – the service offers recycled mobility equipment for sale to the public.
For more information on MODmobility, click here.