There’s a term people in cancer treatment run into that never shows up on a consent form. Clinicians call it financial toxicity. The National Cancer Institute keeps an entire page on it, and the definition is blunt: the problems a patient has related to the cost of medical care. Medicine already files nausea, fatigue and neuropathy under toxicities of treatment; at some point researchers conceded that what the bills do to a household belongs in the same file. Which is a strange sort of progress. There’s a protocol for the tumor. There isn’t one for the mortgage.
The Arithmetic of a Diagnosis
The costs arrive from everywhere at once. Deductibles and coinsurance, sure, but also the drug the plan won’t cover, the drive to a treatment center two counties over, the parking garage attached to it. The National Cancer Institute has documented cancer survivors spending more than 20% of their annual income on care. And while the spending climbs, the earning drops. Patients who keep working through treatment miss about 22 more workdays a year, per the same agency, and it’s often a spouse or an adult daughter cutting her own hours to do the driving and argue with the billing office.
Two lines, crossing. That crossing, more than any single bill, is what tips a family over.
The scale surprises people. The KFF Health Care Debt Survey found 41% of American adults currently carrying debt from medical or dental bills. Half of those with the debt say cost kept them from a test or treatment a doctor recommended within the past year, so the money problem circles back and becomes a medical problem again. And it isn’t a retiree’s problem anymore, if it ever was: early-onset cancer cases rose 80% between 1990 and 2019. A diagnosis at 47 lands differently than a diagnosis at 77. There’s a mortgage. There are kids. There were supposed to be twenty more earning years.
The Asset That Gets Canceled First
Families in this squeeze sell things, in a fairly predictable order. Savings first, then the brokerage account, then the retirement fund, penalties and all. The NCI’s documented outcomes run further down the same slope: selling possessions, selling property, cheaper housing, bankruptcy.
Somewhere along that slope, somebody reviews the monthly bills and crosses off the life insurance premium. You can see why. Canceling doesn’t feel like selling an asset; it feels like dropping a subscription. Except the policy isn’t a subscription. It’s property, it can be sold, and there’s a regulated resale market for it: 43 states and Puerto Rico oversee these sales, and those jurisdictions hold roughly 90% of the US population between them. Hardly anyone this market exists for actually knows about it. When the Life Insurance Settlement Association surveyed seniors, 55% didn’t know a policy could be sold at all. The product’s own paperwork does a lot of the hiding, since the one exit price printed on an annual statement is the insurer’s surrender value. Nobody mails the policyholder the competing number.
That competing number, for 2025: the average completed life settlement paid the seller $212,066, on policies whose average cash surrender value was $24,360. Both figures come from the Life Insurance Settlement Association’s annual data, and the first is nearly nine times the second. Same asset. Different door. Individual results vary, and it’s a selective market; buyers generally want insureds 65 or older and a face value of $100,000 or more.
When the Prognosis Changes the Math
For the seriously ill, the pricing changes, and it changes in the patient’s favor. Buyers price a policy on the insured’s life expectancy, nothing else comes close in importance, so the sicker the seller, the more the policy is worth. A policyholder with a physician-certified terminal illness, generally a life expectancy of 24 months or less, or a chronic illness severe enough that daily living requires help, can sell through a viatical settlement. The sale itself works like any other: lump sum now, and the buyer takes over the premiums, which for a family mid-treatment is no small thing. The buyers are institutional funds that purchase policies, keep paying on them, and wait. What changes is the price. Viatical offers typically run 50 to 80% of the policy’s face value; a standard life settlement usually pays 10 to 25% of face. Individual results vary here as well. There’s no minimum age. And there’s something bleak in the symmetry, that the same diagnosis making a person uninsurable makes the policy they already own worth more.
The tax side is friendlier than most people expect. Section 101(g) of the US tax code generally exempts the proceeds of a viatical sale, when the terminal illness is certified, from federal income tax. Chronic-illness sales come with more strings attached, and anyone weighing one of these should put the specifics in front of a tax professional before signing anything.
What Selling Does Not Fix
This isn’t found money, and the cost is the death benefit. Sell a hypothetical $500,000 policy at 60% of face and the family banks $300,000 now, giving up the $500,000 that would have arrived later. Where beneficiaries genuinely depend on that future payout, and the premiums can still be scraped together, keeping the policy is often the right call. Anyone who says otherwise in every case is making a sales pitch, not giving advice.
There are limits on the other side too. A policy generally needs about two years in force before it can be sold. Term insurance sells only while its conversion option is still open; expired term can’t be sold by anyone. And the offer depends on who is asked. A single buyer approached directly will name one number. Settlement brokers, Citizens Life Group among them, send the same policy out to a list of institutional buyers and let them bid against one another.
Nobody screens for any of this. Intake forms ask about allergies and insurance cards, not assets, and no oncology checklist has a line item for the policy in the filing cabinet. So the job lands on the patient, or more often on the exhausted family around the patient, in the worst months of their lives. Timing decides most of it. A policy that lapses in month three of treatment pays for nothing. The same policy, priced while it was still in force, might have covered a good part of the treatment.
Editor’s Note: The opinions expressed here by the authors are their own, not those of Impakter.com — In the cover: Financial toxicity can emerge when medical bills, treatment expenses and reduced income place sustained financial pressure on patients and their families.— Cover Photo Credit: DC Studio
