Every day in the United States there are close to 5000 cancer diagnoses. People over the age of 65 make up 54 percent of new cancer cases every year, but Medicare recipients of any age may be diagnosed with a wide range of cancer diagnoses.
Hearing your doctor say the word “cancer” can be frightening. Most patients will go through a myriad of emotions getting this devastating news, but finding a way to remain positive is absolutely crucial to your recovery. You will have to fight the disease physically and mentally during treatment, but there are positive outcomes and long lives after a cancer diagnosis thanks to innovative treatments, therapies, and medications. Having knowledge about what your cancer treatment entails, and if your Medicare insurance covers the expenses can help relieve your stress and allow you to focus on what’s important – your health.
You should discuss every detail of your treatment with your healthcare providers so you know what to expect from your Medicare insurance coverage.
Medicare Coverage for Cancer Treatments
How Medicare covers your cancer treatment depends on where you have your treatment. Generally, Part A covers treatment received when you are formally admitted in a hospital or skilled nursing facility. Part B covers treatment you receive in an outpatient setting, including a physician’s office, or in an outpatient center.
Original Medicare Part A (hospital insurance) helps pay for the medically necessary cancer-related services and care that you receive while you are a hospital inpatient or in a skilled nursing facility. Coverage may include:
• Costs related to your inpatient hospital stay
• Cancer treatments you receive while you are a patient admitted to the hospital
• Skilled nursing facility care when it follows a three day stay in the
hospital
• Home health care for physical, occupational, or speech-language pathology
therapy, or skilled nursing care that relates to rehabilitation from cancer treatments
• Hospice care
• Blood
• Some of the expenses involved in clinical research studies done
while you are an inpatient
• Surgically implanted breast prostheses after a mastectomy if the
surgery is performed as an inpatient
Original Medicare Part B (medical insurance) helps cover medically necessary cancer-related services and treatments that you receive as an outpatient. Part B coverage may include:
• Visits to your physician or other health care provider
• Chemotherapy drugs that are given intravenously in an outpatient setting
• Some oral chemotherapy drug treatments
• Outpatient radiation treatments
• X-rays, CT scans, and other diagnostic tests
• Durable medical equipment (DME)
• Surgeries performed on an outpatient basis
• Mental health services
• Cancer prevention and screenings
• Some expenses involved in clinical research studies done as an outpatient
• Surgically implanted breast prosthesis administered as an outpatient
Medicare Part B may also cover a second opinion for surgery if it is not an emergency surgery. You may also be covered for a third opinion if the first and second differ.
If you have Original Medicare, you may be responsible for coinsurance and annual deductibles may apply. The final cost for each service depends on whether you visit a physician or facility that accepts assignment.
Original Medicare beneficiaries with Medigap plans may have coverage for additional expenses such as coinsurance, copayments, and deductibles. Be sure to check your policy or speak to an agent to get detailed information about your coverage.
How Can Medicare Advantage Help Cover Cancer Treatment?
Medicare Advantage (Part C) plans are required to provide the same coverage as Original Medicare Part A and Part B, but many Medicare Advantage plans offer additional benefits, such as prescription drug coverage. Medicare Advantage plans are offered by private insurance companies approved by Medicare, but costs and benefits may vary. Compare plans to find the one that meets your specific needs. If you are enrolled in a Medicare Advantage plan, you will likely have to visit physicians within the plan’s network and visit hospitals and pharmacies they contract with. You may be responsible for copayments and annual deductibles may apply.
How Medicare Part D Can Help Cover Cancer Treatments
Medicare beneficiaries who are enrolled in a stand-alone Part D Prescription Drug Plan (PDP), or a Medicare Advantage policy that includes prescription drug coverage (MA-PD), may include coverage for some chemotherapy treatments and drugs.
Be sure to check the formulary for your plan to see if your prescribed drugs are included on their list of covered drugs. Having coverage for these drugs will determine your final out-of-pocket costs. Some of the drugs covered under Part D are:
• Prescription drugs for chemotherapy (taken orally)
• Drugs to prevent nausea
• Other prescription drugs, such as pain medication, that are used during
your cancer treatment
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