Preventive Services Covered by Private Health Plans under the Affordable Care Act
I Was Diagnosed With Aggressive, Invasive Breast Cancer. Here's Why I Feel So Lucky.
In late June of last year, I was told I had three tumors that tested positive for triple negative, aggressive, invasive breast cancer. It was different from the Stage 1, HR-positive, HER2-negative tumor the size of a thumbnail I had the first time I was diagnosed with the disease 17 years ago.
That time I was treated quickly and declared cancer-free. This time, my cancer treatment was grueling and lasted 10 months. Still, I was lucky.
At my annual physical last year, I told my primary care physician about the shooting pain in my left breast that I thought was due to the substantial scar tissue from my first surgery. During a palpation exam she found what turned out to be 7 centimeters of tumors — together they were bigger than a soda can top but smaller than a baseball.
I was lucky. My doctor listened, didn't hurry me along, and didn't overbook her patients to meet the quotas required by the insurance companies or hospital administrators. She didn't insist my visit could be a video visit.
I thought about all the women in doctors' offices who are rushed, told they are fine — "Go home! Don't worry!" — or that the pain is all in their head. I thought about all the women who do not have access to breast health care, mammograms or doctors who listen to them. I thought about everyone who doesn't have a laptop or internet access for telehealth visits. These disparities can be fatal.
A 2019 Today-Survey Monkey poll found that more than half of women "say gender discrimination towards patients is a serious problem in the health care system." The survey also shows that 21% of women compared with 14% of men say, "a health care provider ignored or dismissed my symptoms."
I was lucky. I went home and phoned the radiologist I have been seeing for a dozen years, and he scheduled me for the earliest available appointment. Using an ultrasound, he found masses that minutes earlier were not visible on a 3D mammogram or during my annual mammogram a few months earlier. The radiologist told me he would take the biopsy specimen to the lab on his way home. I cried in his office.
So many women would be told by their radiologist or health care provider that they are fine after receiving a clear mammogram. So many women would have undetected breast cancer — Stage 3 like me, or worse — and it would not show up in routine testing. And many would die because they were not believed or treated soon enough.
I had been on Medicare for a few weeks, as I had just turned 65 that month, but the woman working my radiologist's front desk told me they did not accept Medicare. I had been insured by a major private insurer for years, so payment had never been an issue at this provider's office.
I was told I could pay for the upcoming lab tests in monthly installments, but I needed to pay over $2,000 for that day's visit, so I handed her a credit card. I was lucky to have that option. Those who can't pay for their cancer treatments can quickly go into incredible debt, and some even lose their homes. Or they forgo treatment and die.
A 2017 study of 763,884 cancer cases showed that "substantial and consistent disparities in quality of cancer care exist according to type of health insurance." I was lucky. My hospital and all the affiliated providers except my radiologist took my Medicare.
I had 21 appointments for tests, exams and consultations in the first two weeks after my diagnosis. Then came three months of weekly chemotherapy with so many side effects and potential complications — black fingernails, hair loss, nausea, exhaustion, mouth sores, body rashes — that they filled a three-ring binder.
I was lucky. My sister Madeleine arranged a group of volunteers to drive and assist me to and from therapy, and they attended more than 50 appointments over several months. I never went alone; I was cocooned in a bubble of compassion by my family and friends.
My sons, friends, sisters, brother and nieces took notes during each visit. I brought a notebook for them because I could remember nothing from any appointments. It was as if the doctors and nurses were all speaking but someone had pressed mute.
I saw other cancer patients struggle with walkers and wheelchairs in hospital hallways and waiting rooms. Many told me they took the bus or train by themselves to get there. They said once they arrived, they took a shuttle bus from one building to the next and tried to navigate the maze-like corridors.
Once, when I was standing in line at the registration desk for my pre-surgery appointment, I noticed an older man in front of me who was alone and holding onto his walker.
"I'm sorry," the receptionist told him. "You are an hour late, so we have to reschedule you." She asked him to please go sit in one of the chairs over by the window and she would get to him as soon as she could. There were four other people ahead of him already waiting for their appointments to be rescheduled.
Grateful for excellent care, I did what I was told. I applied salves, swallowed the prescriptions I had delivered, did the physical therapy exercises to try to amend the neuropathy in my hands and feet. The numbness, instability and inability to walk unassisted was a shocking and humbling reminder of the immobility so many millions cope with every day — not to mention the lifetime of mobility I had taken for granted.
For close to six months, I could not walk without a cane, or I had to be pushed in a wheelchair or hold on to a friend, sibling or son. I could not button clothes or use a pen to write. But I could type and sit at my desk, so I worked as best I could whenever I could.
I stayed quarantined, as the doctors told me to do, because for several months my test results showed I was not well enough for a COVID-19 booster and COVID was surging in my area. I masked at the hospital and mostly stayed in my house when I was not seeing a doctor or being treated. I did not go out unless it was for a medical appointment or with a gathering of no more than four people who were always masked too. I had my groceries delivered.
The author ringing the bell for her last day of radiation treatments in March 2024.Courtesy of Michele Weldon
I was lucky. Because I was not tolerating the chemo well, my medical team moved my surgery from December to October, and I had a radical mastectomy on my left side. Thankfully, my chemotherapy had worked and all 11 of the lymph nodes my surgeon removed were cancer-free.
Post-surgery, taking and applying medications, emptying drains, and tending wounds kept me locked in a cancer-sick mindset. The sores on the inside of my mouth and tongue were healing, but eating was still torturous. Most food tasted like it had been doused in gasoline. Still, I was lucky. Friends brought over simple, healthy foods or had meals delivered.
After surgery, I had two more months of weekly chemotherapy appointments, followed by 30 radiation treatments that burned my insides and made my body feel like it was a thin sheet of crumbled newspaper stoking a campfire.
The pain from the surgery and a cavalry of fear-filled thoughts marching across my brain kept me from sleeping well, but I was lucky to have a calm, quiet place to sleep. I felt depleted when I woke up, unable to work my normal long days in one stretch. I grew tired in the early afternoon and would nap before going back to my desk to continue working.
Someone was always checking on me. So many do not have that support or even a peaceful place to lie down.
Despite my devastating diagnosis and my painful treatment, I know I was extraordinarily lucky and, of course, I know not everyone is. I have insurance, a team of doctors who listened, a wide support network of family and friends, and flexible remote work as an independent contractor. I live in a middle-class suburb near a major hospital system. I am white.
A new study from the Kaiser Family Foundation found that Black people, Hispanics, American Indians and Alaska Natives are worse off than white people in a majority of measures it studied related to health and health care.
The American Cancer Society reports that "one-third of Black American women reported experiencing racial discrimination during a visit with a health care professional." There is also a higher mortality rate for Black people with cancer.
It shouldn't be this way. Everyone should have access to the care I received and the means to afford it. They should have medical teams that listen to them, as mine did, no matter what they look like, where they live, or what kind of treatment they need.
I was lucky, but with better health care education and medical training to eliminate bias, research that involves inclusive clinical trials, and providers who are informed, compassionate and offer solutions for best outcomes regardless of patient identity, survival would not need to depend on luck or circumstance. It must be and can be universally fair and equitable.
Following my final chemo treatment, my nurses gathered on the chemo floor as I rang the bell, the global ritual for finishing cancer treatment.
It was a glorious sound every person undergoing treatment deserves to hear for themselves, so I rang it twice.
Michele Weldon is an award-winning author, journalist, TEDx speaker, and emerita faculty in journalism at Northwestern University and senior leader with The OpEd Project. She is the author of seven nonfiction books, including her latest, "The Time We Have: Essays on Pandemic Living" and has written chapters in seven anthologies. Her work has appeared in The New York Times, The Washington Post, CNN, USA Today, Salon, Chicago Tribune and more.
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How Do PCP And Ketamine Work And How Do They Affect The Body?
PCP and ketamine are hallucinogenic drugs with anesthetic properties. They are chemically similar drugs with similar effects and risks on the body. Overdosing on either substance can cause severe complications.
Hallucinogens are drugs that can alter a person's mood and perception of the world around them. Both phencyclidine (PCP) and ketamine are dissociative drugs. These refer to a type of hallucinogen that can cause people to feel detached from reality.
Both PCP and ketamine work in similar ways by blocking the actions of neurotransmitters in the brain. This can cause a person to experience giddiness, euphoria, anxiety, paranoia, and hallucinations. High doses of either drug can cause severe and potentially fatal complications.
PCP is a common recreational drug. It is a dissociative hallucinogenic, which people commonly take in liquid, capsule, or white crystal forms. This type of substance makes people feel euphoric and disconnected from their bodies or surroundings.
PCP is an abbreviation of its scientific name, phencyclidine. Its other names include:
PCP has several short-term health effects. It can cause serious or fatal complications with higher doses, long-term use, or overdose.
Other names for ketamine include:
Ketamine can produce negative side effects, including some which may last weeks. A ketamine overdose may cause unconsciousness and dangerously slow breathing.
Ketamine and PCP are chemically similar. They work due to the way they both affect neurotransmitters and receptors.
Neurotransmitters are chemical messengers that a person's brain uses to transmit signals in their body. They carry signals to other cells by traveling to them and attaching to specific receptors on specific cells.
A person's brain uses neurotransmitters to regulate several bodily functions. Different neurotransmitters attach to different receptors for each type. When they attach, they trigger an action in their target cells.
Ketamine and PCP affect multiple neurotransmitters and receptors in a person's brain, including:
Both PCP and ketamine also block a type of receptor called N-methyl-D-aspartate (NMDA) receptors. This effect blocks a neurotransmitter called glutamate, an important neurotransmitter that affects a person's:
Both PCP and ketamine carry a risk of having adverse side effects. Overdosing with either can also have serious or fatal complications.
Side health effects of PCP can include:
Side health effects of ketamine can include:
Some effects of ketamine may continue to affect a person for several weeks after taking it. Ketamine may also be fatal if a person has high levels of alcohol in their system.
However, doctors can often effectively treat PCP or ketamine overdoses.
Best PCP Car Deals - October 2024
PCP is the most popular way to buy a new car thanks to affordable monthly payments and great incentives if you know where and when to look. We round up the best PCP deals around.
If you're in the market for a new car deal, then PCP is likely to become very familiar to you. That's because between 80% and 90% of new cars hitting UK roads are bought using some form of Personal Contract Purchase, or PCP for short.
PCP is really simple. You pay a deposit that's affordable, then agree on monthly payments that won't overstretch your finances, then have the option to buy your car, trade it in for a new PCP deal on a new car, or hand it back once your deal reaches its end.
As with all things, not all car PCP deals are created equal, with some tantalisingly low monthly payments calculated on unrealistically low annual mileage allowances to lure you in. Or other PCP deals having very high interest rates, which can be bumped up if you have a lower credit rating.
However, the popularity of PCP deals means car dealers and car makers often sweeten their deals with things like free services, 0% interest rates and significant deposit contributions, especially if you buy from a franchised dealer and use that firm's financial services for the loan. If you're flexible in your approach, then great deals await.
Keeping on top of the latest, greatest PCP deals can be exhausting work, which is where we come in. Here we round up the best PCP car deals in the UK available to new car buyers right now. We search far and wide to hopefully find the right car PCP deals that works for you.
After more deals on new cars? Check out our round-up of all the best new car deals around.
PCP Deals - A-Z by Car MakerHere's a list of the PCP deals being offered by carmakers right now. If a deal pops up, we'll feature it here.
Volkswagen
Our round-up of the best car PCP deals highlights the deals we think are the best balance between a low deposit and affordable monthly payments. We update this page every week to make sure we bring you the best deals.
Renault Captur Evolution TCe 90 £166 a month: 2 year PCP at 0% APR
The Renault Captur has just been treated to a mid-life refresh, bringing a sharper look, new tech and plenty of equipment. Renault offers two PCP options. We've featured the 0% APR deal, although the deposit is sizeable, but there is also a 4-year, £229 a month option at 6.9% APR with a £3614 deposit.
>> Find this deal here
Deposit Monthly Payments Optional Final Payment Total Payable Mileage Per Year Deal Available Until £6419 24 x £166 (£3984) £11,004 £21,395 6000 16th December 2024 Audi A3 Sportback Sport 30 TFSI £269 a month: 4 year PCP at 8.9% APR with £3500 deposit contribution
The Audi A3 Sportback does a fine job of squeezing classic Audi attributes like a classy interior, solid tech and understated design into a small package. Even better, you don't have to pay a premium to enjoy all that the A3 has to offer, thanks to a decent deposit contribution and generous 10,000 miles a year mileage limit.
>> Find this deal here
Deposit Monthly Payments Optional Final Payment Total Payable Mileage Per Year Deal Available Until £5571 47 x £269 (£12,643) £13,647 £31,870 10,000 2nd January 2025 Kia Sportage Shadow £301 a month: 3 year PCP at 7.9% APR with £1500 deposit contribution.Jpg?Rmode=max&width=630)
The Kia Sportage is one of the best family SUVs on the market. And buyers tend to agree, as it's currently the best-selling new car in the UK. Try this Sportage Shadow, complete with black 19-inch wheels, black chrome detailing and front and rear heated seats, for size on a three-year PCP deal. Kia will chip in £1500, too.
>> Find this deal here
Deposit Monthly Payments Optional Final Payment Total Payable Mileage Per Year Deal Available Until £8300 36 x £300.83 (£10,829.88) £16,987.32 £37,617.20 10,000 16th December 2024 Volkswagen ID.3 Pro Match 59kWh 204PS £302 a month: 4 year PCP at 5.9% APR with £7300 deposit contribution
The freshened up Volkswagen ID.3 is now available in Match spec, and there are two PCP deals available, both with the same deposit. The four-year option includes a large deposit contribution and lower monthlies, but you pay more in the long run. If you plan to buy, consider the three-year 0% APR instead.
>> Find this deal here
Deposit Monthly Payments Optional Final Payment Total Payable Mileage Per Year Deal Available Until £5484 47 x £302.32 (£14,209.04) £13,899.60 £40,902.64 10,000 6th January 2025 SEAT Ateca SE 1.0 115PS £339 a month: 4 year PCP at 6.9% APR with £4000 deposit contribution
The SEAT Ateca may have been around for approaching eight years. But a facelift here and a few odd tweaks there have kept the Ateca on the pace as a fine family SUV. Order from stock and you get £4000 towards your deposit on a four-year deal, and you can add the car's first two services for £199.
>> Find this deal here
Deposit Monthly Payments Optional Final Payment Total Payable Mileage Per Year Deal Available Until £3083.52 47 x £338.70 (£15,918.90) £9869.40 £32,581.82 10,000 18th December 2024 How does a PCP work?Rather than paying cash for a new car all in one go, a PCP agreement allows you to pay an initial deposit towards the cost of the car, either with cash or a part exchange, or combination of both.
You then take out a loan to be paid back over a set time in the form of monthly payments - usually over two to five years. This breaks the repayment of the loan down into much more manageable chunks, and is effectively you covering the cost of the car's depreciation.
At the end of the agreement, you have the option to give the car back and walk away, part-exchange the car and start a fresh PCP agreement on a new car, or pay off the outstanding amount.
This latter point is a major appeal of a PCP over a lease deal. Unlike PCH, where there is no ownership option, a PCP always allows you the flexibility of buying the car at the end of the deal. However, you don't take ownership of the car until you've paid the deposit, all monthly payments and the final balloon payment.
What are the negatives of PCP?Although a PCP offers you the flexibility of owning the car, you only take ownership after paying a deposit, all the monthly payments and the final balloon payment, so careful budgeting is essential if you plan to own the car outright. If so, you might also wish to consider hire purchase, too, as that's geared specifically towards car ownership but with monthly payments.
A low credit score can mean higher interest rates to pay, too, while PCP plans can come with extra costs. Any damage outside of regular wear and tear, and exceeding the agreed mileage limit are chargeable. Likewise, if you decide to end your PCP agreement early, you'll be liable for significant extra outlay.
How can I make the monthly cost as low as possible?
The first golden rule is to make sure you don't get sucked in by a deposit and monthly payment amount that you can only just afford. Think about what might happen if your circumstances change and the impact that this could have on your ability to keep up with your monthly payments. Nicer cars can mean bigger bills for things like insurance and other running costs that you are liable for, too.
As to making the PCP deal itself more affordable, if you can afford a larger deposit, this can trim the monthly payment. Keep an eye out for deals on your chosen car too, as manufacturers regularly offer deposit contributions. The length of your agreement and the number of miles you agree to drive per year make a difference, too. Generally a longer deal with fewer miles makes for the lowest monthly payment. PCP is effectively financing the car's depreciation, so choose a car that will hold its value well.
How is the final payment to own the car calculated?The final, optional payment of a PCP agreement is the guaranteed future value (GFV), often called the balloon payment, of the car. This is the car's residual value after the PCP term has reached its end, and will be part of your finance agreement when you sign up for your PCP deal. This GFV amount has to be paid off in order to have ownership of the car transferred from the finance company to you.
The GFV is calculated based on the make and model of car, which impacts how much it will depreciate in the time you're paying off the loan, and also considers the length of the finance agreement, and how many miles you're likely to drive.
The GFV amount is agreed when you make the PCP deal, so make sure you understand the figures before signing on the dotted line, and budget accordingly if you plan to buy the car so that you don't miss out if you can't afford the balloon payment.
Who owns a car bought with PCP?For the duration of the PCP, the car is owned by the finance company that you sign the deal with. So while you've paid your deposit and are paying monthly payments, the car still belongs to the finance company.
At the end of the agreement, the car's ownership can be transferred to you only if you settle up and pay the final balloon payment (GFV) to keep the car. You don't have any ownership rights until this point.
Often, PCP deals are offered by the financial services companies of major carmakers. For example, if you buy a new Ford Puma on PCP, you'll be signing an agreement with Ford Credit, so Ford Credit would own the car for the duration of the PCP deal. Pay the deposit, all your monthly payments and then the final balloon payment and it's yours.
Who pays for repairs on a car financed with PCP?When you sign a PCP agreement, the specifics of what's covered and what's not when it comes to the car's maintenance or crash damage will be contained within the contract. It's worth making sure exactly what's covered, who is responsible, and the process should you be involved in an accident, before you sign up.
Usually it's the car driver's responsibility to arrange insurance and take car of any maintenance, like annual servicing or replacement of wear and tear items like tyres. Packages are often available that bundle your first two or three services into one payment when you sign up. It's worth checking where the car can be serviced, as some PCP agreements specify a dealer or approved garage only.
If the car develops a fault, this is generally covered by the manufacturer warranty, while any accident damage would be up to your insurance company to pay the bill to cover. It's worth being honest with your PCP provider should any untoward situation occur, as an unauthorised repair could be charged when you return the car as this will impact the car's value.
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