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Medicare Coverage for Cancer

Each year 12.7 million people discover they have cancer. Half of all men and one third of all women will develop cancer during their lifetime and the risk increases as you age. That means that cancer coverage is an important consideration for Medicare enrollees.

The good news is that Medicare does cover cancer treatment. If you have a Part D prescription drug plan and a comprehensive Medigap plan, most of your treatment will be 100 percent covered.

As you will see below, Medicare and your Medicare Supplement provide excellent coverage for cancer. Unfortunately, nearly 61% of all cancer treatment costs are indirect (non-medical) expenses.

  • Deductibles/co-payments
  • Loss of income for both patients and caregivers – your ability to work will be affected
  • Transportation and hotel during treatment – treatment is often out of your local area
  • Mortgage, rent, utilities, car payments and groceries – the bills do not stop even if you are sick
  • Medical Supplies, prescription drugs, anti-nausea medication, etc. – these always have associated costs.

Cancer and Heart Attack/Stroke insurance can help manage these expenses and help avoid medical bankruptcy.

Medicare Coverage for Cancer

Your cancer coverage will work a little differently depending on whether you are treated in the hospital or at a doctor’s office or outpatient center. Remember, Part A is inpatient, Part B is out-patient.

Medicare Part A Cancer Coverage

Cancer testing and treatment administered during a hospital stay is covered by Medicare Part A’s hospitalization coverage. Before Part A begins to pay, however, you must meet a deductible ($1,340 in 2018). If you have multiple hospital stays, you may end up paying the deductible more than once. Medicare Part A also pays the full cost of the first 20 days in a skilled nursing facility after cancer surgery, and it covers hospice care at a certified hospice facility.

A Medigap plan can reduce your out of pocket costs by paying your Part A deductible. It also provides expanded benefits for hospital stays and hospice care.

Medicare Part B Cancer Coverage

Medicare Part B covers cancer screenings and treatments at a doctor’s office or clinic. Part B’s preventive care benefits pay the full cost of some cancer screenings. In addition, Part B pays 80 percent of the cost of chemotherapy, radiation and tests done on an outpatient basis or at a doctor’s office. If you have a Medigap plan, your Medigap coverage takes care of the other 20 percent that you would have to pay if you only had Part B.

Medicare Coverage for Cancer Medications

Medicare Part B covers some cancer medications, but others are not covered unless you have a Part D prescription drug plan. Cancer drugs can be extremely expensive, and this means that Medicare prescription drug coverage is an essential part of your cancer protection strategy.

Coverage under Part B. Part B covers 80 percent of the cost of intravenous cancer treatment and anti-nausea drugs. It also covers oral versions of these drugs if your doctor could have given you an intravenous dose but decided to give you a pill instead, and the pill is taken within 48 hours of your cancer treatment. If you do not have a Medigap plan to supplement your Part B coverage, you will be responsible for 20 percent of the cost of these drugs.

Coverage under Part D. Part D covers cancer drugs that are not covered by Part B, including anti-nausea drugs that are only available in pill form, injections that you give yourself, and drugs designed to prevent cancer from recurring. Your Part D prescription coverage offsets the high cost of cancer drugs. Your copays or coinsurance may be far less than what you would pay if you did not have drug coverage at all.

Medicare Covers Cancer Screenings

Medicare covers 100 percent of certain cancer screenings as a preventive health service, as long as your doctor accepts Medicare assignment. This includes:

  • A mammogram every year for women over 40.
  • Pap smears and pelvic exams to screen for cervical and vaginal cancer, once every 24 months, or once every 12 months for women who are at increased risk.
  • Colorectal cancer screening, including a colonoscopy every 10 years for anyone over 50, and additional screenings for people at increased risk.
  • Annual lung cancer screenings for smokers or former smokers aged 55-77 whose doctors order a screening
  • Prostate cancer screening once a year for men over 50
  • Other types of cancer screening may be covered 80 percent under your regular Medicare Part B coverage.

Medicare covers chemotherapy.

If it is administered during a hospital stay, you may have to pay a Medicare Part A deductible. If it is administered at a doctor’s office or clinic, you will be responsible for 20 percent of the cost under Medicare Part B. You can avoid having to pay either of these by signing up for a Medigap plan.

Medicare Covers Immunotherapy

Immunotherapy is a cutting-edge cancer treatment that stimulates your immune system to attack cancer cells. Medicare will pay for immunotherapy in many cases, under either Part A (if administered in a hospital) or Part B (if administered in an outpatient setting). Medicare Covers Clinical Trials

Medicare pays the cost of some clinical research studies, either in the hospital or while you are an outpatient.

Medicare Covers Cancer Drugs

Medicare Part B pays for some cancer drugs, but not others. According to the American Cancer Society, drugs that are administered intravenously in a doctor’s office or outpatient clinic are covered. If your doctor could have given the drug intravenously but decided to give it to you in pill form instead, it is also covered. This includes anti-nausea drugs, as long as they are given within 48 hours of your cancer treatment. For drugs covered under Part B, you will still pay 20 percent as coinsurance, unless you have a Medigap policy that picks up that cost.

Drugs and injections that you administer yourself, or that are only available as pills, are not covered by Medicare Part B. However, many of these drugs will be covered by a standalone prescription drug plan. You will usually pay a copay or coinsurance, but the amount you pay will usually be steeply discounted from the retail cost of the drug.

Medicare Covers Radiation Treatments

Radiation administered at a doctor’s office or clinic is covered by Medicare Part B. If you receive radiation treatment during a hospital stay, it is covered under Medicare Part A.

Cancer and Heart Attack/Stroke insurance is NOT expensive.
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