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Medicare and the Cost of Cancer Treatment

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This article is for both the person facing cancer today, wanting to know what to expect from their Medicare insurance as well as for the person turning 65 and weighing the pros and cons of staying with Original Medicare or moving to Medicare Advantage. Medicare and the cost of cancer treatment is written to help everyone on Medicare.  If you find this article helpful, please share.  We have also included a link to a printer friendly version so that you may save this article for your files.

For those who prefer video:  Medicare & the Cost of Cancer Treatment

I realise the article is a bit long, but the subject matter is critically important.  When first diagnosed with cancer, there is a lot going through your mind. One small part is the question of “What is this going to cost me?”  The battle with cancer can be emotionally draining without worrying or wondering about your health insurance and how it works.  This information on how Medicare handles the cost of cancer treatment is much more difficult to find and piece together than it should be.  I believe the information in this article can be a great relief, benefit, and resource for anyone about to embark on a very tough personal battle.  The information has been compiled from numerous sources including Medicare.gov and the National Cancer Society.

For those new to Medicare, this information will help you decide if you are more comfortable with Original Medicare or Medicare Advantage.  For the person who has cancer or a history of cancer, we hope the information will ease any financial uncertainty of not knowing what part of your treatment may or may not be covered by your current Medicare plan and how much out-of-pocket expense can be expected from you.

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Medicare Part A

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With over 70% of seniors in the United States participating, original Medicare remains the top healthcareMedicare Part A Part B program in the country.  Because seniors can choose any doctor that takes Medicare without having to consider networks or referrals, Original Medicare offers seniors more freedom of choice than any alternative Advantage program. In addition, because virtually every medically necessary medical procedure is covered by either Medicare Part A or Medicare Part B, seniors using Original Medicare do not have to worry about their insurance program denying coverage.  As long as you and your doctor believe it is necessary, the odds are your Original Medicare will cover it. In this article, we answer the question; what is Medicare Part A?

Original Medicare has three basic parts; Part A, Part B and Part D.  In general, Part A covers inpatient hospital care, Part B covers outpatient care and Part D covers prescription drugs.  This article focuses on Medicare Part A which seems the simplest, but is in fact the most misunderstood part of Original Medicare.

Medicare Part A covers:

  • inpatient hospital care,
  • skilled nursing,
  • nursing home care,
  • hospice and home health services.

Part A MedicareMost insurance agents simply explain that Medicare Part A is your inpatient hospital coverage and Medicare Part B is outpatient coverage.  While that is technically true, it ignores the potential pitfalls and surprises are in the details of the plans.   Part A operates very differently that Part B.  It’s in these details that Part A is misunderstood and can lead to surprises and significant unexpected health costs for the Medicare beneficiary.

Medicare Part A offers health insurance coverage in time units called “Benefit Periods”.  A benefit period begins the day you are admitted as an inpatient in a hospital.  The benefit period ends when you have not been an inpatient in either a hospital or skilled nursing facility for 60 consecutive days. You can have an unlimited number of benefits periods.  Note: your skilled nursing benefits only take effect after you have a qualifying hospital stay (i.e. an admitted inpatient for 3-days)

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