Medicare Annual Enrollment Period: October 15 - December 7

Does Medicare Cover Cancer Treatment?

You are more likely to be diagnosed with cancer if you are over 65. Therefore, it’s important to know what coverage Medicare provides for cancer.
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Introduction

Statistics show that most people diagnosed with cancer are 65 and older. But with early detection and treatment, the death rate quickly declines.

Cancer treatments are costly. So, if you’re 65 or older, you may want to know: Does Medicare cover cancer treatment? Fortunately, the answer is yes.

Medicare covers cancer-related hospitalization and medical costs. However, cancer patients will cover out-of-pocket costs like deductibles, copayments, and coinsurance themselves.

 

Does Medicare cover cancer diagnosis and treatments?

The American Cancer Society encourages regular screenings for early cancer detection. Medicare covers diagnostic procedures like colonoscopies, X-rays, mammograms, blood tests, and biopsies.

If you do find out that you have cancer, many doctors recommend these treatments:

Full Medicare coverage provides the best support for the treatments mentioned above:

  • Part A will cover inpatient hospitalization costs
  • Part B pays for outpatient medical expenses
  • Part D covers cancer medicines and prescription drugs

Original Medicare includes Parts A and B, but you need to enroll in a standalone prescription drug plan for Part D.

You may also choose to enroll in a Medicare Advantage (MA) or Part C plan. These plans must offer at a minimum the same coverage as traditional Medicare, and most offer extras like vision, hearing, dental, and telehealth benefits.

Although most MA plans are bundled with Part D (prescription drug coverage), their list of covered drugs (or ‘formulary’) varies. Therefore, you should always consult the plan’s formulary or ask your CoverRight agent if the medicines you need for cancer are covered.

Another thing to remember is that you are restricted to using doctors and hospitals within your plan’s network under a Medicare Advantage plan. Some plans offer you the flexibility to consult specialists outside this network, but this will typically cost you more.

Does Medicare cover cancer alternative treatments like holistic therapy (nutrition changes, supplements, oils, and natural extracts)?

Unfortunately, these are not covered by Medicare.

 

Does Medicare cover cancer surgeries?

Yes, Medicare covers cancer-related surgeries. Coverage is as follows:

Part A:

  • Doctor’s fees
  • Operating room fees
  • Medical services to recover from surgery – blood transfusions, home health care, physical or occupational therapy, hospice care, skilled nursing facility care after the minimum three-day hospital stay.

Part B:

  • Outpatient surgery, like removal of polyps during cancer screening
  • Biopsies
  • Outpatient implantation of breast implants after mastectomy
  • Doctor’s visits after cancer surgery
  • Durable medical equipment (DME)

 

Additional cancer coverage under Medicare

Radiation for cancer treatment

If you require radiation treatment, Medicare Part A will cover your expenses. But if you receive radiation treatment as an outpatient in a freestanding clinic or Medicare-approved facility, this is covered by Part B.

With a Part C plan, you are typically covered wherever you get radiation treatment, as long the provider is within your plan’s network.

Immunotherapy

Medicare Part A covers immunotherapy if you are admitted as an inpatient for immunotherapy. Staying in a skilled nursing facility is also covered by Part A after a three-day stay in the hospital.

You can also receive immunotherapy as an outpatient in a doctor’s office or a freestanding clinic. These cases are covered by Part B.

Part D covers immunotherapy vaccines if they are medically necessary.

Chemotherapy

For chemotherapy treatment, you may need all parts of Medicare.

Part A:

  • Hospitalization for chemotherapy treatment, under instruction from your doctor
  • Skilled nursing care after staying three days in a hospital
  • Home health rehabilitation
  • Breast reconstruction surgery in a hospital after mastectomy
  • Hospice care

 Part B:

  • Outpatient chemotherapy (oral, intravenous, or injections) in a doctor’s office, freestanding clinic, or chemotherapy facility
  • Outpatient implantation of chemotherapy ports
  • Drugs controlling nausea and vomiting.
  • DME like wheelchairs or oxygen

Part D:

  • Oral and injectable drugs taken at home to counteract side effects
  • Prescription cancer drugs not covered by Part B

 

What cancer-related costs are not covered by Medicare?

Medicare does not cover these services:

  •  Assisted living
  • Caregivers
  • Long-term care facilities
  • Room and board
  • Travel

 

How much does Medicare cover for cancer? How much is your contribution?

As a general rule, under Original Medicare your coverage starts after you pay the deductible.

  • Part A: Medicare pays the first 60 days of hospitalization for cancer (for each benefit period). After that, you pay coinsurance.
  • Part B: Medicare pays 80% for cancer treatments in a doctor’s office or freestanding clinic while you pay 20%. For treatments in a hospital’s outpatient clinic, you will have copayments.
  • Part D: The private insurer pays, but you are responsible for coinsurance and copayments.

 

If you need help with out-of-pocket costs, consider getting a Medigap plan. Remember – there is no limit on out-of-pocket expenses under Original Medicare.

Alternatively, if you enroll in a Medicare Advantage plan, this plan may also cover your cancer treatment costs, similarly to Parts A, B, and D above.

 

Does Medicare cover cancer clinical trials?

If you want to participate in a hospital’s clinical trial, Medicare Part B will cover 80% while you pay for 20% after meeting your Part B deductible.

 

If you get sick before becoming Medicare-eligible, does Medicare cover cancer?

You are eligible for Medicare upon reaching 65. Therefore, Medicare will only cover your cancer treatments once you reach the eligibility age and enroll in Medicare.

 

What should you ask your doctor after a cancer diagnosis?

Your doctor may provide helpful information to reduce your out-of-pocket costs:

  • Are there less expensive cancer treatments covered by Medicare?
  • Is it necessary to travel or stay overnight to complete your treatment?
  • Can your doctor prescribe other medicines if your cancer drugs are costly or excluded from your plan’s formulary?
  • Where will you get treatment – in a doctor’s office, freestanding clinic, or hospital clinic?
  • Under a Medicare Advantage plan, will you be required to obtain prior authorization or referral?
  • Does your doctor accept Medicare assignments? You might have to pay extra if they opt out of Medicare.

It is also advisable to check if you are eligible for Medicare Savings Program or Low Income Subsidy.

 

Final Words

Does Medicare cover treatment for cancer? Fortunately, Medicare pays for the majority of cancer treatments. However, you can lower your out-of-pocket costs by getting essential information before beginning treatment. Speak to your CoverRight agent to learn more about your coverage options if you have cancer.

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