Of all types of cancer, breast cancer has the highest treatment cost.
Being diagnosed with hormone-receptor-positive (HR+), HER2-negative breast cancer can send you on a new financial path — one you might not be prepared for, even if you have health insurance. Costs related to breast cancer treatment add up fast and in ways you hadn’t thought of. Sure, there are treatment-related costs, but will you be able to continue to work? How much will it cost to get to and from your appointments? What if you have a complication? You may have some questions, but support is there, so long as you know where to look and what to ask.
Understanding Breast Cancer Treatment Costs
The cost of treating breast cancer isn’t the same for everyone. It depends on the type of cancer you have, how far it’s advanced, and if you have health insurance. Even if you have insurance, not all policies are the same. Out-of-pocket costs — including your deductible and copays — can be huge.
Early breast cancer treatment is typically less costly to treat than later stages, such as locally advanced breast cancer. Looking at averages, the CDC estimates:
- During the first year after diagnosis, the average cost per person is about $35,000 for medical services, with an extra $1,100 for oral prescription medications.
- Continuing care after, without complications, is about $3,500 for medical services and $830 for prescription drugs.
- For end-of-life care, the average increases to $76,100 and $2,700 for prescription medication.
Don’t forget, these numbers are averages, and many things can cause them to go up or down.
Insurance Terms | Definition |
| Copay (copayment) | A specific amount you’ll pay for a service that’s covered by your insurance (the amount you pay depends on your plan and the service) |
| Deductible | How much you have to pay before your insurance kicks in (if your deductible is $2,500, your insurance plan won’t pay anything until you reach that amount through paying for services) |
| Premium | How much your health insurance plan costs (you might pay it every month, quarter, or year, and it may come out of your paycheck if you have health insurance through your work) |
| Claim | A payment request you or your doctor sends to your health insurance company when you get covered services, such as treatment or doctor visits |
| Appeal | When you ask your health insurance company to take another look at a decision they made or a complaint you made |
| Coinsurance | How much you pay for covered services once you’ve met your deductible, in a percentage (for example, if your coinsurance amount is 20%, your health insurer would cover the remaining 80%) |
| Out-of-pocket max (or out-of-pocket maximum) | The most you’d have to pay for covered services before your health insurance plan pays 100% (if your out-of-pocket max is $6,000, once you reach that amount while paying for services or treatment, your insurance will pay the rest of your covered health services for the policy, usually a year) |
| Explanation of benefits (EOB) | A document that shows you all the charges for a doctor visit to help you figure out what your insurance company pays and what you’ll pay (but the EOB itself isn’t a bill) |
| Preauthorization (or prior authorization) | A decision your health insurance company makes about whether a service, treatment, or medical equipment is “medically necessary” (needed to diagnose, treat, or prevent a condition) before you actually get that service, treatment, or medical equipment. |
| In-network vs. out-of-network | In-network includes health care providers, hospitals, and other services that work with your insurance company, so you usually need to pay your copay or coinsurance and any deductible (you may not need to pay anything, in some cases). Out-of-network health care providers don’t work with your insurance company, so you may have to pay more or all of the charges when you use out-of-network services. |
Most Common Breast Cancer Treatment and Costs
The exact treatment you’ll get depends on the type and stage of cancer, how fast it is growing, and other factors. For example, after diagnosis, some people with breast cancer get surgery first.
“You’re going to need a biopsy, a scan —probably multiple scans — to determine stage and where the cancer’s at and what it looks like,” says Mari Montesano, a patient navigator and manager of Susan G. Komen’s Breast Care Helpline. “Hopefully, then you would meet your deductible, potentially going into surgery.”
Unfortunately, if you start this process close to the end of the year — even if you meet your deductible when you start — you’ll need to start over when the new year starts.
Lumpectomy
The total cost of just one lumpectomy, including a year of follow-up care and treatment, can be about $36,750 (around $1,639 in out-of-pocket costs). If you need a secondary procedure, such as another lumpectomy, the median cost rises to around $44,494 (about $2,324 in out-of-pocket costs).
But the total cost could be lower or higher, depending on what the surgeon did the first time. For example, for people getting a second lumpectomy, using a quick tissue test (frozen section) from the first surgery can lower the cost to a total of about $39,63 (around $2,083 out-of-pocket). But without that type of biopsy, the cost may go up to around $42,309 total (about $2,337 out-of-pocket).
Mastectomy
Getting a full mastectomy can cost you anywhere from $15,000 to more than $39,000. How much you’ll pay out-of-pocket will depend on your exact plan. Breast reconstruction surgery adds to this cost, coming out to an extra $6,000, depending on what kind of reconstruction you get. For example, a reconstruction using implants is the least expensive, but a reconstruction using natural grafts (also called tissue flap surgery) is the most expensive.
If your surgeon says breast reconstruction after mastectomy is medically necessary, Medicare will usually cover the cost. If you have Medicaid, it depends on your state whether breast reconstruction is covered. In most cases, VA health care plans cover post-mastectomy breast reconstruction.
Chemotherapy
Chemotherapy costs can change because the drugs may be switched during treatment. Some may be added on to the original medications. But the drugs you get may even be swapped out altogether if it isn’t working properly or if you have serious side effects. Every medication has a different cost, so it’s challenging to give an absolute idea of cost.
In general, chemotherapy is costlier for early-stage breast cancer than for locally advanced type. One study put the average chemotherapy cost — including both intravenous (IV) and oral (in which you take it by mouth) — for the first year after diagnosis at:
- About $5,170 for people with stage 0 breast cancer
- Around $13,818 for those with stage I or II breast cancer
- About $34,425 for people with stage III breast cancer
Radiation therapy
Costs for radiation therapy vary according to stage as well. How advanced your cancer is determines how many sessions you may need. The costs of radiation therapy may be higher for those with stage III breast cancer than for those with earlier stages. For example, in the first year after diagnosis, cost estimates include:
- Around $14,454 for those with stage 0 breast cancer
- About $14,910 for people with stage I or II breast cancer
- Around $21,133 for those with stage III breast cancer
Targeted therapy
Targeted therapy is a very costly drug treatment, but it can also be lifesaving. Cyclin-dependent kinase (CDK) 4/6 inhibitors, a kind of targeted therapy, can cost thousands of dollars. For example, one study estimates that the average monthly medication cost of CDK4/6 inhibitors is around $12,524. Exactly how much you’ll pay depends on your insurance plan.
Other factors that can affect breast cancer treatment cost
Treatment for breast cancer can go beyond what you might think of as being cancer-related. For example, before starting some chemotherapy treatment, you may need a cardiologist checkup to see if your heart can handle the medication. And there are potential issues that could arise during and after treatment that require visits to other specialists, such as a nephrologist for your kidneys.
Other unexpected costs can come from things such as:
- Traveling to and from appointments, even if they’re local
- Investing in childcare if you can’t or don’t want to take your kids to your appointments
- Needing eldercare if you take care of an older family member
- Losing your job or having to take time off work because of treatment
- Other treatments for side effects, such as over-the-counter or prescription medications, or scalp cooling for hair loss during chemo
- Tools you may need after surgery, such as special bras or pillows
- Complementary treatment, such as massage or acupuncture
How to Plan for Breast Cancer Treatment Costs
Unfortunately, plans don’t always go the way we want. But if you have a basic plan in place, it can help guide you, even if you have to pivot at some point. If your treatments are getting too costly for you, speak with your cancer team to see if there might be alternatives — other treatments you could switch to. It may not be possible, but it doesn’t hurt to ask.
It’s also important to talk about what happens after breast cancer treatment. There are more costs, such as the medications you might take to keep the cancer from recurring. Some treatments can be as long as 10 years, as with hormone therapy. There’s also repeat testing to watch your progress. You may also need medical equipment, such as compression sleeves for lymphedema.
Planning for treatment costs when you have insurance
One of the first things you should do after you get your HR+/HER2- diagnosis is contact your insurance company, says Montesano. If you have health insurance through your employer, talk to the company’s benefits representative. Asking for a case manager through your insurance is helpful, too. They can help you understand and maximize your health insurance benefits.
You can also use the resources at your hospital or cancer center. Ask for a meeting with a financial counselor so they can help break down the costs for you, including what things will look like, copays, and the other issues related to your insurance. There should be no charge for this service.
Your insurance company can also tell you which health care professionals are in-network to avoid unexpected bills.
“I would always suggest calling your insurance because they're going to be the ones to know the most up-to-date information,” Montesano says.
If you depend on what a hospital or cancer center says, the information they have may suggest a provider is in-network, but the info could be old and outdated.
Planning for treatment costs when you don’t have insurance
Whether you’ve lost your job and your medical insurance with it, or you’ve been living without medical insurance, planning for treatment costs can seem even more daunting. But there are resources for you.
“We always refer people [who call our helpline but don’t have insurance] to their state breast and cervical program,” Montesano says.
Where these programs are available, they help with screening and diagnostic testing. There are also programs through organizations such as Susan G. Komen and Living Beyond Breast Cancer that offer resources to cover daily living costs, medical equipment, and medication.
Many programs are income-based, so if you have a higher income and don’t qualify, there are options.
“I would really encourage calling around to different hospitals to see what their out-of-pocket costs would be,” Montesano says. “Sometimes, they offer discounts until you can then sign up for health insurance.”
One hospital she knows of, for example, offers a 40% discount for people who are uninsured.
Questions to ask your doctor’s office
You may have many questions, but it’s easy to forget what you want to ask when you’re in the moment. It’s a good idea to write questions down as you think of them, so you have a running list to rely on. Here are some questions you might ask about the cost of your care:
- How will I be billed? Is it per visit? Bundled?
- How can I keep track of my bills?
- What is my copay going to be every time I come?
- Are there other out-of-pocket costs?
- Are all my doctors, surgeons, treatment facilities, and labs in my network? (Double-check this with your insurance company to verify, though.)
- What will each treatment cost? What’s the breakdown, and what’s my portion?
- What resources are available to me to help understand my payments?
- What resources are available to help me financially?
- Please explain [word or phrase you don’t understand] on my statement.
Easing Financial Stress Where You Can
While the financial aspect of breast cancer treatment can be overwhelming, you can try to get ahead of it by being as proactive as possible. This means speaking to the financial counselor at your hospital or cancer care center to find out what you’re going to owe and how best to pay it back.
If you have insurance, check to see if they offer any other benefits. For example, some insurance companies put money into your app if you complete certain health goals, such as getting 10,000 steps a week. These are sometimes called “wellness rewards.”
“Really trying to maximize what your health insurance potentially offers is really important to understand everything that you have available,” Montesano says.
8 tips to help ease financial stress
Here are eight more tips to ease the financial stress of breast cancer treatment:
- Ask for generic drugs, such as the generic versions of pain medications, when possible.
- Ask your doctor’s office for samples of drugs and shop around before you buy. Mail-order pharmacies may be less expensive.
- Learn more about discount drug programs and pharmaceutical companies that can help with the costs.
- Watch for medical billing errors. It can be tough to go line by line through your statements, but it’s important you do this, whether you have insurance or not.
- Ask the billing office or financial counsellor if you’re eligible for patient assistance or help from any related charities.
- Learn what is available from resources such as Cancer Care, A Helping Hand, the Cancer Financial Assistance Coalition, the HealthWell Foundation, and breast cancer organizations.
- Speak to banks and other entities — such as credit card companies or utility companies — to see if you can set up a payment schedule to keep from falling behind.
- Ask if there are any clinical trials you may be eligible for.
Breast cancer is more than a diagnosis. It’s a financial journey that can be overwhelming, whether or not you have insurance. Being proactive —seeking support from health care providers, financial counselors, patient organizations, and people you know —can help you understand the costs and your options to better ease the burden.
