Cancer is a terrifying diagnosis that can, and often does, affect the entire family. And, this fear is entirely reasonable. In 2019 alone, it’s estimated over 1.7 million new cases will be diagnosed and over 600,000 people will die from a form of cancer. Unfortunately, there are more concerns with a cancer diagnosis than just your health. For many, treating cancer can be financially devastating, with the average cost of treatment around $150,000.
A complex illness like cancer can require a complex web of screenings and treatments. Luckily, Medicare can help make watching for and potentially treating cancer a more affordable option!
How Cancer Treatment is Covered by Original Medicare
Original Medicare, or Medicare Parts A and B, often provides beneficiaries in need of cancer treatment or screenings a decent coverage option. Which part of Original Medicare that can provide insurance coverage for cancer screenings or treatment depends on whether you’re an inpatient or outpatient.
Medicare Part A
If you’re an inpatient (e.g., in a hospital or health care facility), Medicare Part A can help cover your stay at the hospital, as well as many of the services required during your inpatient stay. Part A may also cover your time at a skilled nursing facility. Specific to cancer treatment, Part A may cover chemotherapy in an inpatient setting.
Medicare Part A can help cover your stay at the hospital, as well as many inpatient services.
If you’re not an inpatient, Part B may help to cover it (more on that later). Should you need it, Part A can also cover inpatient mental health services and hospice care.
Medicare Part B
If you’re not staying at an inpatient facility, Medicare Part B may help cover your cancer treatment. The most common services, doctors’ visits, are often covered by Part B. This part of Original Medicare may also cover outpatient chemotherapy and radiation treatments. Should you need them as part of your cancer treatment, it’s worth noting that Medicare Part B additionally covers outpatient mental health services. Lastly, Part B can also cover outpatient diagnostic tests and preventative screenings like mammograms and prostate cancer screenings.
The most common services, doctors’ visits, are often covered by Part B.
Keep in mind, both Medicare Part A and B have costs associated with them, which can change each year. At the same time, what part of Original Medicare you’re covered under can and will help to define what you owe. Keep in mind, it’s possible to be treated in a hospital or health care facility and be considered outpatient if you’re in observation status. For this reason, it can pay to verify what part of Medicare you’ll be covered under ahead of time if you can.
Medicare Part D and Cancer Treatment Coverage
Along with cancer treatment comes prescription drugs. Common medications in cancer treatment are chemotherapy, anti-nausea, or pain-management drugs, to name a few. If you’re a Medicare beneficiary with a Medicare Part D plan, your prescriptions drugs may be covered in some way. It’s important to check your formulary for the specific tiers and costs associated with your necessary prescriptions. Should your prescriptions not be covered, or be covered in a tier that you think is too expensive, you can request a type of coverage determination called an exception.
If you’re a Medicare beneficiary with a Medicare Part D plan, your prescriptions drugs may be covered in some way.
One benefit of coverage through Medicare Part D is that your spending is limited at a certain point, the initial coverage limit. Then, you fall into the coverage gap where you pay a certain percentage of the cost of your prescriptions. Once you’ve spent enough on prescriptions, however, you’ll reach your true out-of-pocket (TrOOP) limit and enter the catastrophic phase of coverage. While in catastrophic coverage, your plan covers all but a small portion of your coinsurance and copayment for covered drugs. This means that, if you’re hit particularly hard financially by your cancer treatment, your plan can help it be more affordable.
Other Medicare Coverage for Cancer Treatment
Medicare Part A, B, and D aren’t the only options for coverage. In fact, some aspects of Medicare can offer extra help for cancer treatment. Medicare Part C, or Medicare Advantage, is the federally-approved, privately-offered Original Medicare alternative. As such, it’s required to offer you the same coverage as Original Medicare, at the very least. In many cases, Medicare Advantage plans will offer prescription drug coverage in the plan, as well as coverage for additional services. Check out your own Part C plan for specifics on what benefits are offered or use the Medicareful Plan Finder tool to compare local plans.
In many cases, Medicare Advantage plans will offer drug coverage and coverage for additional services.
Medicare Advantage isn’t the only other way to get Medicare coverage for your cancer treatment. Medicare Supplements, or Medigap plans, can be useful if you have Original Medicare. While they don’t directly cover cancer-specific treatments, many Medigap plans can help cover some of the out-of-pocket costs associated with Original Medicare. For example, most Medigap plans help cover Part A and B coinsurances in some way. Many plans also help with the Part A deductible or skilled nursing facility care coinsurance.
Additional Options for Cancer Coverage
For some, it may make sense to look beyond Medicare to other types of cancer coverage. For example, if cancer runs in your family, but you have not had cancer or a pre-existing condition that predisposes you to cancer, two forms of ancillary insurance may be worth investigating.
If cancer runs in your family, two forms of ancillary insurance may be worth investigating.
One is cancer insurance. Generally, cancer insurance pays out a lump sum that you can use for medical and non-medical expenses, though the specifics depend on each plan. The second type of insurance is critical illness insurance, which can be used to cover several different types of critical illnesses, like heart attack, stroke, and cancer. This type of plan can often assist with medical costs not covered by Medicare, as well as non-medical costs like transportation and childcare.
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If you or a loved one receive a cancer diagnosis, the last thing on your mind is likely the price tag. Returning to good health is of the utmost concern. Fortunately, any form of Medicare can be an excellent way to help pay for what you need during what is surely a difficult time. With its coverage, you can stop worrying about how to pay for your treatment and focus on getting better.
Centers for Medicare & Medicaid Services — Medicare Coverage of Cancer Treatment Services