Key Takeaways
Medicare Part A, Part B and Part D plans all provide cancer coverage for different parts of a cancer treatment plan.
Medicare Advantage plans typically cover 80% of cancer care up to the plan’s maximum out of pocket limit. Some studies show there have been much better medical outcomes for cancer patients using Original Medicare coverage.
Cancer protection insurance can provide you with a one-time, tax-free lump sum of money directly to you after a cancer diagnosis. You can then use it for any cancer-related expenses at your discretion.
Does Original Medicare Cover Cancer Treatments?
Original Medicare (Part A and Part B) provides insurance coverage for inpatient and outpatient cancer treatments and cancer preventive care, including chemotherapy, radiation therapy, surgery, and certain prescription drugs used to treat cancer. Some cancer drugs may also fall under your Medicare Part D prescription drug plan. If you add a Medicare supplement, you can reduce your maximum out of pocket liability to less than $300.
What Is Covered By Medicare Part A For Cancer Patients?
Medicare Part A is inpatient insurance. When you are an inpatient in a medical facility, Medicare Part A covers everything from your room and nursing care to your medications.
Inpatient hospital stay
Medicare Part A covers hospitalization for cancer treatment, including inpatient surgery, radiation therapy, chemotherapy, and other cancer-related treatments for lung cancer, etc.
Skilled nursing facility care
Medicare Part A covers skilled nursing care in a skilled nursing facility for patients who require ongoing cancer treatments or rehabilitation after being discharged from a hospital.
Hospice care
Medicare Part A covers hospice care for terminally ill patients, which includes palliative care, symptom management, and emotional support for the patient and their family.
Home health care
Medicare Part A covers some home health care services for cancer patients, including skilled nursing care, physical and occupational therapy, and speech therapy.
Surgically implanted breast prostheses
After a mastectomy following breast cancer, the cost of breast implants can be covered by Medicare.
The Cost Of Cancer Hospital Treatments With Medicare Part A
In 2023, if you’re hospitalized for
1-60 consecutive days
Medicare coverage pays most confinement costs after the required Medicare deductible (and you pay a $1,600 deductible).
61-90 consecutive days
Medicare covers all eligible expenses after the patient pays a per-day copayment (and you pay $400 a day copay, up to $11,600).
91-150 consecutive days
Medicare covers all eligible expenses after the patient pays a per-day copayment (these are Lifetime Reserve Days that may never be used again). You pay $800 a day copay, up to $47,200.
151 consecutive days and more
Medicare covers nothing and you pay all costs.
Medicare Part A + a Medicare supplement
A Medicare supplement typically pays your Medicare Part A deductibles and coinsurance so that your expenses are covered up to a year at 100%. (If you are still an inpatient after 365-days, long-term care would be more appropriate coverage.
Inpatient Coverage Under a Medicare Advantage Plan
The benefits of each Medicare Advantage plan are different. The Advantage Plan replaces your Original Medicare with a private, for profit version. In general, you can expect to pay a deductible similar to the Part A deductible, after which you have coverage for the remainder of the year.
Depending on the plan and your inpatient status, you may be required to pay an additional deductible if your inpatient status carries into a new calendar year.
What Does Medicare Part B Cover For Cancer Treatment?
Medicare Part B outpatient cancer services including oral chemotherapy outpatient surgery as well as:
Doctor visits
Medicare Part B covers visits to doctors who provide cancer treatment, including oncologists, radiation oncologists, and surgeons.
Chemotherapy and radiation therapy
Medicare Part B covers outpatient surgery, chemotherapy cancer treatment, and radiation treatments in an outpatient setting.
Diagnostic tests
Does Medicare cover cancer screenings? Yes, Part B covers a wide range of diagnostic tests used to detect and monitor cancer cells, including X-rays, CT scans, and PET scans.
This step can be extremely important to avoid lung cancer, etc., and reduce further Medicare costs. For example, cervical cancer has become less common recently thanks to increased screenings and early detection.
Medicare covers a pap smear and a pelvic exam (also includes a clinical breast exam). These two items are covered every 24 months for most women and every 12 months if you’re considered high-risk for cervical or vaginal cancer.
Durable Medical Equipment (DME)
Part B covers certain durable medical equipment used in cancer treatment, such as infusion pumps and oxygen equipment.
Clinical trials
Medicare Part B covers the costs of some clinical trials for cancer treatment.
Medicare Part B also includes a yearly “Wellness Visit” that can help detect cancer early and provide preventive care.
Does Medicare Part B Cover Cancer Drugs?
Part B cancer coverage includes certain cancer medications, while others are covered
under Part D.
Under Part B, cancer drugs that are administered in an outpatient setting, such as a doctor’s office or clinic, are covered. These drugs are usually given through an IV or injection and include chemotherapy drugs, immunotherapy drugs, and supportive care drugs.
But keep in mind that there are some limitations to Part B coverage for cancer drugs. For example, some cancer drugs may not be covered if they are not approved by the FDA for the specific type of cancer being treated. Additionally, there may be a coinsurance or copayment amount that the patient is responsible for paying, unless they have a Medicare supplement.
Because many cancer drugs are covered under Part B, with a Medicare Supplement plan, your costs will be close to $0.
Remember, cancer drugs that are taken orally or self-administered are often covered under Part D. These drugs are obtained through a pharmacy, and beneficiaries must enroll in a Part D plan to get this coverage.
According to Medicare.gov, beginning April 2023, you may be responsible for a different copay, depending on the prescription drug’s price. Also, starting April 2023, you might have to pay a lower coinsurance amount for some drugs covered by Part B. Medication price increases cannot exceed the rate of inflation. Please reach out to us if you need further clarification!
Does Medicare Cover Chemotherapy?
Yes, Medicare covers chemotherapy for Medicare beneficiaries.
Medicare Part A (Hospital Insurance) covers chemotherapy cost if you’re a hospital inpatient.
Medicare Part B (Medical Insurance) covers you if you’re a hospital outpatient or a patient in a doctor’s office or freestanding clinic.
Does Medicare Cover Chemotherapy Drugs?
Chemotherapy drugs are designed to kill cancer cells. They are covered under Part B if they are administered in an outpatient setting such as a hospital, doctor’s office, or clinic. According to Medicare.gov, these are “the drugs you wouldn’t typically give to yourself”.
Under Part B, chemotherapy drugs that are administered intravenously or by injection are covered. This includes both the cost of the drug and the cost of administering the drug.
Medicare also covers certain supportive care drugs that are used to manage the side effects of chemotherapy, such as anti-nausea drugs.
Keep in mind that you may still be responsible for a coinsurance or copayment amount for chemotherapy drugs (that depends on the plan and the drug), and the annual deductible must be met first).
Does Medicare Part D Prescription Drug Plan Cover Chemotherapy Drugs?
According to the American Cancer Society, oral chemotherapy treatments can cost thousands of dollars per month but Medicare Part D can help offset those costs.
Medicare Part D covers cancer drugs that are taken orally or self-administered at home. Some oral chemotherapy drugs may be covered under Medicare Part D if they are approved by the FDA for the specific type of cancer being treated and are included on the Part D prescription drug plan’s formulary (list of covered drugs).
Chemotherapy drugs that are taken orally, such as capecitabine or temozolomide, are typically covered under Medicare Part D.
Do Medicare Advantage Plans Cover Cancer Treatment?
Yes, Medicare Advantage (Part C) plans are required to cover the same services as
Original Medicare (Part A and Part B), including cancer treatment services such as chemotherapy, radiation therapy, surgery, and certain prescription drugs used to treat cancer.
As always, the specific benefits and cost-sharing requirements can vary depending on the plan and the insurance company. Some Medicare Advantage plans may have lower out-of-pocket costs for cancer treatment services than Traditional Medicare but may have more restrictive networks of healthcare providers.
Do Medicare Advantage Plans Cover Part B Drugs?
Typically, Medicare Advantage Plans pay 80% of Part B drugs. The consumer pays 20% up the plan maximum out of pocket. It is possible to pay the maximum out of pocket for two consecutive years if you get ill late in a calendar year. The median cost of a cancer drug is just over $10,000 per month before insurance. A Medicare beneficiary with an Advantage plan should also have Cancer Insurance to reduce out of pocket expenses.
Cancer Protection plans are supplemental insurance plans that provide additional coverage for cancer-related expenses not covered by Traditional Medicare (Part A and Part B). They can help cover even more costs associated with cancer treatment. Cancer insurance plans can be purchased as standalone policies or as an addition to existing insurance policies.
Do Medicare Supplement Plans Cover Cancer Treatment?
Yes, Medicare Supplement (Medigap) plans can provide additional coverage for cancer treatment services not covered by Traditional Medicare.
Even though Medigap plans are standardized, not all Medigap plans offer the same level of coverage for cancer treatment services. Still, if Medicare pays for the service or procedure, your Medicare supplement will pay its portion of the gap in coverage.
Don’t forget that while Medigap plans can provide additional coverage for cancer treatment services, they do not offer coverage for prescription drugs.
Because Medicare supplements cover the copays and deductibles the beneficiary is responsible for with Original Medicare, one can have nearly zero out-of-pocket costs for inpatient and outpatient treatment.
Medicare supplement plans offer the best maximum out of pocket coverage of all of your choices.
Which Medicare Plan Does My Oncologist Prefer?
According to the study published in Nov ‘22 in the Journal of Clinical Oncology, patients enrolled in Medicare Advantage plan are more likely to die within a month of undergoing complex cancer surgery, compared to those in traditional Medicare.
Those covered by Medicare Advantage were 1.5 times more likely to die within a
month after having their stomach or liver removed, and twice as likely if they had cancer surgery of the pancreas.
The study also found that people with traditional Medicare are more likely to be treated by a hospital more experienced in dealing with cancer, chemotherapy treatments, etc.
Traditional Medicare beneficiaries were more likely to be treated at hospitals with a higher average number of total beds, intensive care unit beds, and operating rooms. Those hospitals also tended to perform many more cancer surgeries on average.
A National Cancer Institute-designated cancer treatment center, such as City of Hope, or hospitals with high surgery volumes or that are accredited by the Commission on Cancer have repeatedly shown improved surgical outcomes for cancer patients.
Medicare Advantage beneficiaries also tend to experience a delay of more than 2 weeks between diagnosis and their first round of treatment. This is possibly because those plans require that patients get prior authorization for their cancer therapy.
Does MD Anderson Cancer Center Accept Medicare?
Yes, Original Medicare is accepted at MD Anderson.
Can I Get Insurance That Pays if I Get Cancer?
Yes. Cancer protection insurance pays a tax-free lump-sum check when you’re first diagnosed with cancer. It pays you or someone you designate, not the doctor, regardless of any other health insurance coverage.
You can then use that benefit in any way you need as you battle cancer.
Policy proceeds can replace lost income. It can cover everyday expenses like bills and groceries. You can use it to pay for home health care or child care services. It can help pay for travel and hotel stays if the oncologist you choose is far away. It can be used to pay copays or deductibles, prescription medications, etc. It’s your decision!
The policy pays a tax-free one-time payment after a cancer diagnosis. You choose the amount of the payment when you enroll in a plan.
Contact us today and let us show you how inexpensive this coverage is.
Sources
https://www.medicare.gov/Pubs/pdf/11931-Cancer-Treatment-Services.pdf
https://www.medicare.gov/coverage/chemotherapy
https://www.medicare.gov/coverage/prescription-drugs-outpatient
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
