Breast Cancer – Learn What Medicare Covers

Breast cancer is the second leading cause of cancer death in women. One in eight women in the United States will develop breast cancer in their life. Over the years the death rate from breast cancer has declined a bit; perhaps due to awareness, screenings, and better treatments for this type of cancer.

Breast cancer is a disease that occurs when cells in breast tissue mutate, keep reproducing and refuse apoptosis. These abnormal cells cluster together to form a tumor, when the tumor is cancerous the abnormal cells invade other parts of the breast or they metastasize to other areas of the body through the bloodstream or lymphatic system.

The milk-producing glands of the breast called lobules is usually where breast cancer originates. Less often, cancer starts in the fatty and fibrous connective tissue of the breast.

While breast cancer is about 100 times more common in women, men can get breast cancer too. Anyone with breast tissue can develop breast cancer.

A genetic mutation in the DNA of breast cancer cells causes breast cancer. How and why this occurs is not entirely understood. Some mutations may develop randomly over time, while other are inherited, the result of environmental exposures, or lifestyle factors. Some breast cancer risks may be preventable, and some variables you cannot control.

Age affects your risk for breast cancer. Older women are more likely to develop breast cancer, the risk begins to climb at age 40 and is highest from women in their 70’s.

If you have a close blood relative with breast cancer, your risk of developing the disease increases. If a woman’s mom, sister, or daughter has or had breast cancer, her risk is almost double and triple if she has two or more first-degree relatives with breast cancer.

A defect in one or more genes, especially the BRCA1 or BRCA2 genes means greater risks for breast cancer. These mutations are more common in Jewish women of Eastern European descent. Of course, having these defected genes does not mean you will get breast cancer, it just means there is more risk.

Women with dense breasts, personal history of breast lumps, previous breast cancer, or certain non-cancerous breast conditions have a greater risk of developing breast cancer than women who do not have these conditions.

Ethnicity statistics show white women are slightly more likely to develop breast cancer than any other ethnicity. African American women are more likely to develop more aggressive breast cancer at a younger age and both African American and Hispanic women are more likely to die from breast cancer than white women.

If a woman starts her menstrual cycle before age 12 or has late menopause (after age 55) she is at greater risk of getting breast cancer. Scientists believe the longer exposure to the female hormone estrogen may be the factor, since estrogen stimulates growth of the cells of the breast.

The use of hormone therapy after menopause appears to boost the risk of breast cancer. Having no children or a first child after age 30 may increase a woman’s risk for breast cancer.

Women who are overweight after menopause are more likely to get breast cancer. This may be due to higher levels of estrogen produced by fat cells after menopause.

When it comes to alcohol the American Cancer Society (ACS) recommends that women stick to one drink a day or less. When women drink two or more alcoholic beverage a day they are 1.5 times more likely than non-drinkers to develop breast cancer.

If a woman has had chest radiation for another disease as a child or young adult her risk for developing breast cancer may be higher than normal. Any woman who was given the now-banned drug diethylstilbestrol to prevent miscarriage decades ago faces a slightly higher risk of breast cancer, as do their daughters.

Cancer symptoms vary from person to person; knowing what your breasts normally look and feel like can help you recognize possible signs and symptoms. You can have breast cancer without feeling anything abnormal. If you do find an area of thickened breast tissue, a lump in your breast, or an enlarged underarm lymph node, see you physician.

There may be change in the shape or size of your breast, there could be an area of skin that dimples or a nipple that leaks fluid. There are no early warning signs of breast cancer, a lump may be too small to feel. Breast cancer screenings are important.

Medicare Part B will cover a mammogram screening once every 12 months for women over 40 and a diagnostic mammogram when medically necessary. For women 35-39 one baseline mammogram is covered. If your doctor or health care provider accepts Medicare assignment you will pay nothing for the mammogram screening. For diagnostic mammograms you will pay 20% of the Medicare-approved amount and the Part B deductible will apply.

Medical organizations and breast cancer advocacy groups encourage women to undergo routine screenings to find and treat breast cancer early. The National Comprehensive Cancer Network recommends annual screening beginning at age 40.

The only way to confirm a cancer diagnosis is through a biopsy to extract cells or tissue from the area of the breast that is causing concern.

Treatment for breast cancer will depend on the type of cancer, the stage, its sensitivity to hormones, the patient’s age and health as well as other factors. Surgery and radiation therapy are known as local therapies because they target the tumor without affecting the rest of the body.

A lumpectomy is when only the portion of the breast containing cancer is removed. A mastectomy is when the entire breast and possibly some of the surrounding tissue are removed. Lymph nodes may also be removed as part of breast cancer surgery.

Radiation uses high-energy waves to kill cancer cells and shrink tumors. Chemotherapy medicines are delivered intravenously or taken by mouth. Chemo is used in treating advanced cancer cases and may be given before or after surgery.

Medicare Part A and Part B cover certain cancer treatments for beneficiaries with cancer, including chemotherapy and radiation therapy. The costs you incur depend on if you receive your cancer treatment from a facility that is inpatient or outpatient. Be sure to get services from a provider that accepts Medicare assignment so that Medicare will cover its share of the costs.

Medicare Part A covers chemotherapy that you get as a hospital inpatient, after you pay the Part A deductible of $1,340 for 2018.

Medicare Part B covers outpatient chemotherapy cancer treatments at a freestanding clinic or a doctor’s office. In this case, if you only have Traditional Medicare, you would pay 20% of the Medicare approved amount after you paid the Medicare Part B deductible of $183 per year for 2018.

Medicare also covers radiation therapy for breast cancer patients. If you are covered under Medicare Part A, you will pay the inpatient deductible and any copayment that applies. If the radiation is done as an outpatient service, you will typically pay 20% of the Medicare approved amount and the Medicare Part B deductible applies.

Medicare has no out of pocket maximum, if you receive many treatments you may owe a significant amount of coinsurance payments. The best way to avoid having high out of pocket healthcare expenses, protect yourself with a Medicare supplement.

Unfortunately, Medicare does not cover wigs for cancer patients who are undergoing cancer treatment. However, you may be able to get help from a non-profit organization for a low cost or free wig. Cancer Horizons has an entire section of their site devoted to Organizations that provide free wigs, head coverings and more at no cost, such as Free Wigs & Hair Care , as well as Free Hats & Scarves .

Medicare Part B covers limited prescription drugs, including some cancer prescription drugs taken by mouth that may be administered to you. Anti-nausea drugs to treat symptoms caused by chemotherapy may also be covered. In these situations, you would pay 20% of the Medicare-approved amount, after the annual Medicare Part B deductible is applied. Part A typically covers prescription drugs given to you as part of your inpatient cancer treatment.

Medications that are not given in a facility will require you to have Medicare Part D coverage or pay the full costs of those prescription drugs. Before enrolling in a Part D drug plan, check the formulary to see which drugs will be covered.

Keep in mind that not every cancer treatment medication is covered by each Medicare Prescription Drug plan. Also, a plan’s formulary may change at any time, you will receive notice from your plan when necessary.

Each year these plans change, it is important to review your upcoming coverage and formulary during the annual enrollment period, so you can make any needed plan changes while the opportunity has presented itself.

Medicare Advantage plans are offered by private, Medicare-approved insurance companies. These plans include all your Medicare Part A and Part B benefits (except hospice care, which Part A still covers when you have a Medicare Advantage plan). Medicare Advantage plans often include extra benefits, like prescription drug coverage and routine dental care that could be useful for a cancer patient.

Traditional Medicare coverage comes with costs that you would need to pay, such as coinsurance and deductibles. If you have Medicare Part A and Part B, you may be able to enroll in a Medigap or Medicare Supplement plan to help pay for what Original Medicare does not cover. Depending on the Medicare Supplement plan you select, you could have coverage on the copayments, coinsurance and deductibles associated with Medicare.

Talking with a licensed insurance agent in your state can help you decide what plan is right for you. Insurance agents have a fiduciary responsibility to enroll you in the plan most compatible with your needs.