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Getting a cancer diagnosis is never easy. Apart from the emotions that a diagnosis can bring, questions will come up such as what type of treatment(s) your oncologist will recommend and what services, supplies and prescription drugs will be covered by your Medicare insurance. Of course, not all seniors choose the same Medicare coverage, so there will be some differences. In this article we’ll take a look at what Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) covers as well as Medicare Part D (prescription drug coverage) and Medicare Part C (Medicare Advantage Plans).
What Does Medicare Cover for Cancer Treatment?
Medicare Part A
All kupuna receiving social security are automatically enrolled in Medicare have Part A and, thankfully, it is free for most people. When it comes to cancer treatment, Part A is very important because it covers the following services:
Inpatient hospital stays
Any cancer treatments received while you’re an inpatient at the hospital
Blood you receive as a hospital inpatient
Skilled nursing facility care (if it follows a three-day related hospital stay)
Hospice care
Home health care for services provided by medical professionals including skilled nursing care and rehabilitation services such as speech therapy, physical therapy, and occupational therapy.
Some costs of clinical research studies while you’re an inpatient in the hospital
Surgically-implanted breast prostheses after a mastectomy if the surgery takes place in an inpatient setting
Medicare Part B
Any senior aged 65 years or older who is eligible for Medicare Part A is also eligible for Medicare Part B. However, unlike Part A, because there is a monthly premium, Part B is optional. Part B is important for cancer patients because it covers cancer services provided on an outpatient basis, including:
Doctor’s visits
Diagnostic tests
Durable medical equipment
Mental health services
Outpatient surgeries
Blood you receive as an outpatient
Enteral nutrition equipment (feeding pump) for use at home
Some of the cost of outpatient clinical research studies
External breast prostheses such as a post-surgical bra after a mastectomy
Surgically implanted breast prostheses after a mastectomy if the surgery was performed in an outpatient setting
Cancer treatments provided in a hospital when the patient is on observation status rather than admitted as an inpatient
The following cancer treatments when they are provided in an outpatient clinic or doctor’s office:
o chemotherapy drugs that are administered intravenously
o Radiation treatments
o Some oral chemotherapy treatments
Medicare Supplement Insurance (Medigap) Policies
Medicare supplement plans are designed to cover some of the out-of-pocket costs that Original Medicare does not cover. Medigap policies may pay for some of the costs associated with cancer treatments. Speak to a Medicare agent to discuss your Medigap options.
Medicare prescription drug coverage (Part D)
Medicare Part D is prescription drug coverage available for anyone enrolled in Medicare. There are many options available and each plan comes with its own deductible and drug formularies (the list of drugs covered by the plan). Some Medicare recipients enroll in a standalone Part D plan while it’s included in most Medicare Advantage Plans.
Part D covers some chemotherapy and other cancer-related drugs and supplies. Drugs that may be covered include:
Prescription drugs for chemotherapy that are taken orally
Anti-nausea drugs
Pain medication
Something to keep in mind is that if Part B doesn’t cover a certain cancer drug, your Part D plan may cover it. Find out which cancer drugs are recommended for your treatment and make sure they are listed on your plan’s formulary. You should be able to find this list in your plan’s materials or by calling your plan.
Medicare Advantage Plans (Part C)
Medicare Advantage Plans include all the services that come with Original Medicare – Part A and Part B – and they usually also include Part D along with other additional services. It is very important to make sure that any health care provider you seek cancer services from accepts your plan before you receive treatment. Your Medicare agent can help confirm the care providers that accept your plan.
Cost of cancer treatments
Even with Medicare coverage, there will be some out-of-pocket costs such as copayments, coinsurance and deductibles. Whenever possible, Medicare recipients should seek care from medical providers that accept Medicare assignment and are within your insurance network. It’s important to know that Medicare does not cover all cancer treatments and it’s possible that your doctor will recommend certain services that are not covered. For example, Medicare does not cover medical food or nutritional supplements or home services that help a cancer patient with daily activities such as eating that do not require skilled care. You will want to talk to your health care providers, plan administrator or Medicare insurance agent to get information about costs before starting treatment.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.