An estimated 12.3% of women in the U.S. will receive a breast cancer diagnosis in their lifetime, making it the most common type of cancer for American women. Since it’s so common, you’d think there’d be a standardized way to price treatment.  But it turns out the cost of breast cancer depends largely on the stage of diagnosis and the treatment options you choose. Add these variables to the geographical differences in health care pricing and the wide arrange of health plans available, and each diagnosis could have a unique price tag.

The Average Cost of Breast Cancer

In response the wide range in cost, the National Institute of Health published a study in 2016 attempting to answer the question: how much does breast cancer cost? Researchers only studied people with commercial insurance (versus people with Medicare or who lack insurance) and they came to the following conclusions:

• In the first 12 months after diagnosis, the average cost for breast cancer treatment was as follows:

  • Stage 0: $60,637

  • Stage I/II: $82,121

  • Stage III: $129,387

  • Stage IV: $134,682

• Average cost in the 24 months after diagnosis was:

  • Stage 0: $71,909

  • Stage I/II: $97,066

  • Stage III: $159,442

  • Stage IV: $182,655

• Total cost was largely driven by the cost of chemotherapy and non-cancer treatments.

• The lower costs for those diagnosed at “Stage 0” vs. “Stage IV” reflected the curative nature and cheaper cost of surgery for early stages of the disease.

• For those diagnosed with Stage IV breast cancer, chemotherapy was responsible for the highest percentage of costs within the first 12 months.

• In months 13-24 of treatment, chemotherapy was responsible for the greatest percentage of costs for all stages of the disease.

What Does That Mean for You?

The costs above are just averages so what a breast cancer diagnosis will cost you personally depends on your stage, the treatment options you choose (e.g. a double mastectomy and breast reconstruction costs more than breast-conserving surgery) as well as your health plan.

If you’ve been diagnosed with breast cancer you need to look at three things:

1. Your deductible.

2. The co-pays and co-insurance you’re responsible for.  Something to note, an oncologist is often considered a specialist and as such, your insurance could charge a higher co-pay for these visits than it would charge you for a regular doctor visit.

3. Your maximum out-of-pocket cost.

Unless you have an extremely high maximum out-of-pocket cost combined with an easily treatable form of breast cancer, you’re most likely going to hit your out-of-pocket maximum before you finish paying for your cancer treatment.  If that happens, your insurance company will pick up the remainder of the bill for the rest of the year. 

Something else to note, however, is your deductible and out-of-pocket maximum reset every calendar year. So if you’re diagnosed in October and your treatment straddles two calendar years, you could end up paying more out of pocket than you would if you’d been diagnosed in earlier in that first year.

What if You Don’t Have Insurance?

First, the best thing to do is to get some sort of insurance coverage. Not just because it will help you pay for the total cost of treatment, but because people without health insurance often pay between 2 and 43 times what insured people pay for treatment.  That’s because commercial insurers and Medicare have the ability to bargain and negotiate treatment costs with doctors and hospitals, but individuals don’t have that same bargaining power.

If you’re unable to buy some sort of insurance coverage, contact the hospital to see if they have an assistance program or payment plan that will help alleviate some of the financial strain. Some additional ways to cut down on costs include taking generic drugs, asking for samples of prescribed medicine and calling drug makers to see if you qualify for financial assistance.

The bottom line is: the cost of breast cancer varies widely so it’s best to work with your doctor to ensure you’re getting effective treatment that’s also affordable. 

Medical Expense Series

• The Cost of Breast Cancer

• The Cost of Knee Replacement Surgery

• The Cost of Hip Replacement Surgery

• The Cost of ByPass Surgery

• The Cost of Childbirth

• The Cost of Hospitalization with COVID-19