If you get cancer, what does medicare cover?
A cancer diagnosis after the age of 65 can be overwhelming, but with Medicare and the right supplemental coverage, paying for medical care doesn’t have to be. Understanding the facts and benefits of Medicare regarding cancer coverage will make going through the process of treatment, from oral medication to surgery, a little bit easier for patients and their loved ones. If you get Cancer what does Medicare Cover?
Medicare does a very good job of covering cancer treatment for those 65 and over. The American Cancer Society reports that Medicare pays for nearly half of the $74 billion spent on cancer treatment each year.
Medicare covers most of the expenses involved with cancer treatment, and a Medigap plan can cover the rest.
What Does Medicare Part A Cover?
Medicare Part A covers hospital stays for cancer treatment. There is a deductible of $1340 (2018) that must be met before coverage begins. That expense can be covered by a Medigap plan, which is a supplemental insurance policy that pays for expenses that Medicare does not. A Medigap plan can greatly reduce the cost of cancer treatment for Medicare recipients.
Medicare Part A also pays for the full cost of skilled nursing facility care for 20 days after cancer surgery. This amount can also be increased with a Medigap plan.
Skilled nursing care is vital to the successful recovery of patients who have cancer surgery, as it allows for time to heal while being expertly cared for by professionals, as opposed to returning home and having loved ones caring for patients. The idea of more time away from home may not be appealing, but in the long run the extra time in qualified hands will benefit not only the patient but their family members as well.
If hospice care is needed, Medicare Part A will cover it.
What Does Medicare Part B Cover?
Medicare Part B covers 80% of the cost of doctor’s office visits and treatments onsite, including cancer screenings, chemotherapy and radiation administered in the doctor’s office, tests and other outpatient care. A Medigap plan will pay for the other 20% of expenses for doctor’s office visits and treatments.
Part B covers some of the cost of medication for cancer treatment. Part B will pay for 80 percent of the cost of intravenous cancer treatment and intravenous anti-nausea drugs. If your doctor decides to treat your nausea with oral medication instead, it will cover 80% of those medications as long as they are taken within 48 hours of the cancer treatment. A Medigap plan will take care of the 20% of medication costs not covered by Part B.
What Does Medicare Part D Cover?
Medicare Part D, the prescription drug coverage plan, covers cancer prevention medications, anti-nausea drugs in pill form, and any injections that you give yourself during your cancer treatment. The cost of cancer drugs, from chemotherapy to immunotherapy, can be extremely high. Medicare Part D is essential to keeping those costs at a minimum for the patient.
What Does a Medicare Advantage Plan Cover?
Medicare Advantage plans, offered by private, Medicare-approved insurance companies, include all your Medicare Part A and Part B benefits. Medicare Advantage plans often include extra benefits, such as prescription drug coverage that are useful for a patient undergoing cancer treatment.
The downsides of a Medicare Advantage plan for cancer treatment is that patients may need referrals and will be limited as to which doctor they can choose to see based on who is in their plan. This can both slow down the process for getting treatment and prevent patients from seeing doctors who may be experts in treating their form of cancer.
Additional Things to Know About Medicare and Cancer
Medicare is invested in screening and prevention of cancer. Medicare members can and should take advantage of:
- Mammograms every year for women over 40, including 3D mammograms in some states.
- Pap smears and pelvic exams to screen for cervical and vaginal cancer, once every 24 months, or annually for women who are at increased risk.
- Colorectal cancer screenings. A colonoscopy every 10 years is recommended for anyone over 50. Those with a higher risk can be screened more frequently under Medicare plans.
- Annual lung cancer screenings for smokers or former smokers aged 55-77, if their physicians request the procedure.
- Prostate cancer screening annually for men over 50. One in seven men is diagnosed with prostate cancer, but only one in 41 will die from it, due to early screening and intervention.
- Although hair loss is a problematic side effect of some cancer treatments, Medicare does not cover the cost of wigs.
- Medicare Parts A and B cover cancer treatment no matter how old you are.
Be prepared if you are diagnosed with cancer by understanding the coverage you have under Medicare and Medicare Advantage plans. Consider a Medigap plan to cover the costs that Medicare does not pay for. Get the care and treatment that is available to you through Medicare to stay healthy and get well.
If you get Cancer what does Medicare Cover?
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About the Author
Jagger Esch is the President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.View All Articles