Cancer has been one of the top two leading causes of death in the United States. Treating cancer can be expensive. If you have Medicare and are 65 years old, you might be thinking, “Can Medicare cover cancer treatment?” or “Does Medicare cover chemotherapy or surgery?”
In this blog post, we’ll discuss which parts of Medicare cover cancer treatment and how much out-of-pocket costs are associated with such treatment.
What Parts of Medicare Cover Cancer Treatment?
Medicare, the federal health insurance program primarily for people aged 65 and older, covers various aspects of cancer treatment. It’s important for individuals to review their specific Medicare coverage, including what services and treatments are covered and whether they have any coverage gaps that may require additional insurance or out-of-pocket expenses. Additionally, coverage and costs can vary depending on factors such as the type of cancer, the stage of cancer, and the specific treatments received.
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital care, including stays in hospitals, skilled nursing facilities, hospice care, and some home healthcare services. This coverage may include hospital stays for cancer treatment, such as surgeries, inpatient chemotherapy, and other necessary treatments.
Medicare Part B (Medical Insurance)
Part B covers outpatient medical services, including doctor visits, preventive services, and medically necessary services and supplies. Part B typically covers a wide range of cancer treatments, such as chemotherapy, radiation therapy, doctor visits, and laboratory tests.
Medicare Part D (Prescription Drug Coverage)
Many cancer patients require prescription medications, including oral chemotherapy drugs and other supportive medications. Part D plans vary in terms of covered medications, copayments, and deductibles, so it’s essential to review your specific plan’s formulary to understand coverage for cancer drugs.
Medicare Advantage Plans (Part C)
Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. These plans provide all the coverage of Medicare Parts A and B (and often Part D) and may offer additional benefits, such as vision, dental, and hearing coverage. Some Medicare Advantage plans may also include coverage for cancer treatments beyond what’s covered by original Medicare.
Does Medicare Cover Cancer Treatment?
Yes. Medicare provides coverage for several cancer treatments, such as radiation, chemotherapy, surgery, and associated supplies and services. Medicare covers various treatments in different areas, so the specifics of what is covered and your out-of-pocket expenses may change.
- Surgery — Medicare Part A typically covers inpatient hospital stays for surgical procedures related to cancer treatment.
- Chemotherapy and Radiation Therapy — Medicare Part B covers outpatient chemotherapy and radiation therapy. This includes visits to oncologists and other specialists for treatment administration.
- Prescription Medications — Medicare Part D prescription drug plans cover oral chemotherapy drugs and other medications prescribed for cancer treatment.
- Diagnostic Tests and Imaging — Medicare covers necessary diagnostic tests and imaging studies, such as MRIs, CT scans, and PET scans, to aid in cancer diagnosis and monitoring.
- Hospital Care — Medicare Part A covers hospital stays for cancer treatment, including stays for chemotherapy, radiation therapy, and surgeries.
- Doctor Visits — Medicare covers visits to doctors, specialists, and other healthcare providers involved in cancer treatment.
Out-of-Pocket Costs for Cancer Coverage
The out-of-pocket costs for cancer treatment coverage under Medicare can vary depending on several factors, including the specific treatments received, whether the beneficiary has additional insurance coverage, and which parts of Medicare they are enrolled in. Medicare will assist in settling the costs associated with your cancer-related medical and mental health issues.
Medicare covers 80% of the costs billed by your healthcare provider for authorized, prescription cancer therapies. Until you reach your yearly deductible, you are liable for 20% of the total amount billed. Medicare will only approve certain doctor visits and procedures if certain requirements are met.
Deductibles
Both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) have annual deductibles that beneficiaries must pay before Medicare coverage kicks in. In 2024, the Part A deductible is $1,632 per benefit period, and the Part B deductible is $240 per year.
Coinsurance and Copayments
After meeting the deductible, beneficiaries typically pay coinsurance or copayments for covered services. For example, under Medicare Part B, beneficiaries generally pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment.
Prescription Drug Costs
Medicare Part D (Prescription Drug Coverage) plans have their own cost-sharing structures, including deductibles, copayments, and coinsurance for prescription medications. Beneficiaries may face varying costs depending on the specific drugs prescribed and the tier in which they are placed on the plan’s formulary.
Medicare Advantage Plans
Beneficiaries enrolled in Medicare Advantage plans (Part C) may have different cost-sharing requirements than those in traditional Medicare. While these plans often have out-of-pocket maximums that cap yearly spending, beneficiaries may face higher copayments or coinsurance for certain services.
Supplemental Insurance
Some beneficiaries may have supplemental insurance, such as Medigap policies or employer-sponsored retiree health coverage, which can help cover some out-of-pocket costs not covered by Medicare. These policies vary in terms of coverage and cost.
Frequently Asked Questions
Are there any restrictions on accessing certain cancer treatments with Medicare?
Medicare typically covers medically necessary treatments that healthcare providers deem appropriate. However, Medicare may restrict coverage for certain experimental or investigational treatments it does not approve.
Does Medicare cover cancer screenings and early detection tests?
Yes, Medicare covers various cancer screenings and early detection tests, such as mammograms, colonoscopies, Pap smears, and prostate cancer screenings. Coverage may vary based on age, risk factors, and frequency guidelines.
What if I need to travel for cancer treatment? Does Medicare cover transportation costs?
Medicare generally does not cover transportation costs. However, some Medicare Advantage plans or supplemental insurance policies may offer benefits or reimbursement for transportation expenses.
Will Medicare cover costs for participation in clinical trials for cancer treatment?
In many cases, Medicare covers routine patient care costs associated with participation in approved clinical trials. This includes services like physician visits, hospital stays, laboratory tests, and imaging studies. However, coverage specifics may vary, and it’s important to check with Medicare and the clinical trial provider for details.
Conclusion
To find out if Medicare will pay for part of the cancer treatments, screenings, and medications, people should consult a doctor or talk to an insurance broker. If you have any questions about your Medicare coverage, simply reach out to our professional insurance brokers. We can help you make informed decisions about what coverage is best for your unique needs. Contact us today.