Insurance Overview & Oversight
Insurance Overview
A patchwork of public and private sources provides health insurance in the U.S. Most Americans with health coverage have private health insurance through their employer or a marketplace plan. Others get health insurance through public programs such as Medicare, Medicaid, TRICARE or the VA.
The Patient Protection and Affordable Care Act (ACA) contains key provisions and services that most private insurance plans must provide. Importantly, the ACA:
- bans the practice of charging more or denying health insurance coverage due to a pre-existing health condition.
- prohibits health plans from putting annual or lifetime dollar limits on most benefits.
- requires coverage of certain essential health benefits and preventive services with no out-of-pocket costs to the patient and more.
Visit the Laws & Protections section of our website for comprehensive information about the ACA.
Public health programs, such as Medicare, Medicaid and self-funded, grandfathered and short-term private health plans, are not required to abide by all of the ACA rules.
Insurance Oversight
If you have private individual or group health insurance and believe your legal rights under the Affordable Care Act have been violated, contact your health insurer to understand its coverage decision. If the issue cannot be resolved directly with the insurer, the next step is to contact your state insurance commissioner’s office. Finally, contact the Health Insurance Hotline at the Center for Consumer Information and Insurance Oversight (CCIIO) at (410) 786-1565 or email phig@cms.hhs.gov.
Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about what Medicare covers and how to manage claims and appeals.
Each state manages its Medicaid program independently. Contact your state program if you have questions or concerns about Medicaid eligibility, benefits or coverage.
More Information on Insurance Coverage
Genetic Services
Learn about coverage for genetic counseling and testing services through private insurance, Medicare and Medicaid.
Screening
Learn about private insurance, Medicare and Medicaid coverage of recommended cancer screening for high-risk individuals.
Prevention
Learn about private insurance, Medicare and Medicaid coverage of prevention options for individuals at high risk of certain cancers.
Cancer Treatment
The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply.
Fertility Preservation
Fertility preservation is not typically covered by insurance. However, some states have laws that require coverage of fertility services for people experiencing infertility due to cancer or other diseases.