What you need to know about Medicare & Cancer Coverage- Cancer happens at a cellular level; normal cells turn into cancer cells that divide and spread, removing these cancer cells without compromising the nearby healthy cells can be difficult. The treatment can be lengthy and complicated, including surgeries, radiation, chemotherapy, and strong medications to strengthen your immunity.
The greatest risk factor for developing cancer is age, 60% of people who have cancer are 65 or older. Age isn’t the only factor in your cancer and treatment, the best treatment option for you will depend on your lifestyle, wishes and other factors.
Getting cancer at any age can be terrifying, especially when we know the high cost of cancer treatment is about $150,000. When you have Medicare and a Medicare Supplement policy, you can focus on eradicating cancer instead of your bank account.
Medicare Cancer Coverage
The American Cancer Society estimated that Medicare pays for nearly half of the $74 billion spent on treatment for cancer each year. It is important to know what cancer coverage is included with Medicare.
Medicare Part A and Cancer
The Medicare costs will depend on whether cancer treatment was done as an inpatient or outpatient service. Medicare Part A covers hospital stays and has a $1340 (2018) deductible that must be met before coverage begins. Medicare Part A will cover the entire cost of skilled nursing facility care for 20 days following cancer surgery. If hospice care is needed, Medicare Part A will cover it.
Having a Medigap plan, which is a Medicare Supplemental insurance policy that covers the expenses that Medicare doesn’t cover. A Medicare Supplement can reduce the cost of cancer treatment for Medicare beneficiaries.
A Medigap policy can cover the $1340 Part A deductible and give beneficiaries more days in a skilled nursing facility. Skilled nursing care is an important part of recovery for cancer surgery patients. Skilled nursing care gives patients time to heal properly while being cared for by professional experts, extra time with qualified care will benefit the patient and their family members immensely.
Medicare Part B and Cancer
Part B should cover some cancer screenings, like breast and prostate cancer. It is important to have cancer screenings done when you have no cancer symptoms, this way your healthcare provider can find cancer early while it is easy to treat or cure. Once symptoms appear, the cancer may have grown and spread, making it harder to treat.
Medicare Part B will cover 80% of doctor office visits and treatments on site; including chemotherapy, radiation and cancer screenings administered in the doctor’s office, tests and many other outpatient services. Part B will cover some of the cost for medication for cancer treatment.
Part B covers 80% of the cost on intravenous cancer treatment and intravenous anti-nausea drugs. If you and your healthcare provider decide to treat your nausea with oral medication instead, Medicare will cover 80% of those medications if they are taken within 48 hours after cancer treatment.
Purchasing a Medigap policy will mean having the most comprehensive coverage for any Medicare beneficiary. A Medicare Supplement will cover the 20% of expenses for doctor’s office visits and treatments. This Supplemental insurance will even cover the 20% of medication costs Part B doesn’t cover.
Medicare Part D and Cancer
Medicare beneficiaries need to understand the Part D penalty if they don’t enroll in a Medicare approved prescription drug plan when they first become eligible. Having a Part D plan will give beneficiaries coverage on cancer prevention medications, pill form of anti- nausea drugs, and any self-administered injections needed during your cancer treatment.
Cancer prescriptions, from chemotherapy to immunotherapy, can be brutally expensive. Medicare Part D plans help keep those costs substantially lower for patients. It is important when choosing your Part D plan, you check with the plan to know which of your drugs are covered. If there is a drug that is not covered you should check with the drug manufacturer for coupons, discount codes, or rebates.
Medicare Advantage Plans and Cancer
Medicare Advantage plans have the potential to meet the needs of many Medicare beneficiaries. These plans are offered by private insurance companies, they are Medicare-approved and include all your Medicare Part A and Part B benefits. Medicare Advantage plans typically include prescription drug coverage as well as other extra benefits that are useful for cancer patients undergoing treatment.
The Medicare Advantage plan has some disadvantages that are important to understand. You may need a referral to see a specialist and you may be limited to the doctors in-network. These are things that can slow down the process for getting treatment and prevent patients from seeing an expert in treating their form of cancer.
Medicare’s Preventive Services
An easy way to stay healthy is to have disease prevention and early detection services. These services can help you find health problems early, when treatment works best. Talking to your health care provider and finding out what tests you may need and how often you need them to stay healthy is important. When you have Medicare Part B, you will be able to get many preventive services covered at no cost to you.
Screenings Medicare will Cover
Many of these preventive services you will pay nothing for, if you get them from a qualified doctor or other health care provider who accepts assignment. With some preventive services a deductible, coinsurance or copayment may be required.
- Abdominal Aortic Aneurysm Screening
- This is a one-time screening ultrasound for people at risk.
- Cardiovascular Disease Screenings
- Medicare will cover the tests for lipid, cholesterol and triglyceride levels every 5 years.
- Colorectal Cancer Screenings
- If you are over 50 or are at risk for colorectal cancer, Medicare covers one or more of the tests.
- Mammogram Screening
- Medicare covers mammograms once every 12 months for all women 40 and over. Medicare will even cover a baseline mammogram for women between 35-39.
- Pap Test and Pelvic Exam
- Medicare covers lab tests and exams for cervical and vaginal cancers for women every 24 months, or one a year for women at risk.
- Prostate Cancer Screenings
- All men over 50 with Medicare are covered for digital rectal exams and Prostate Specific Antigen lab testing once every 12 months.
Understanding Your Policy
Understanding your coverage before you are diagnosed with cancer is very important. Having a Medicare Supplement policy will allow you to be properly insured when you need it the most. Medigap policies will cover what Medicare doesn’t, meaning you have financial security and peace of mind.
Medicare covers an array of preventive services, talk with your doctor about the screening options recommended for you. Having Medicare Part B means you will be able to get many preventive services at no out of pocket cost to you. It is easier to combat cancer when it is caught in an early stage. Staying healthy is easier than curing disease.
Make sure you have a policy that fits your needs and budget. Talking with an insurance agent can give you confidence in choosing the right policy for you. Insurance agents have a fiduciary responsibility that requires they have your best interest in mind.