Does Medicare Cover Cancer Treatment?
Does Medicare Cover Cancer Treatment After Age 76
My mother had her routine physical in Nov of 2011. There were many tests. One test came back positive for cancer. We were stunned. She had no symptoms. Everything was fine, we thought.
As the doctors performed more tests, they determined my mother had stage four ovarian cancer. The next week, she was in chemotherapy.
I learned a lot about Medicare and cancer after that. Yes, cancer treatment is covered by Medicare.
Medicare covered her cancer treatments, radiation treatment for cancer, and chemotherapy. She had a Medicare Supplement Plan F. Medically, everything was covered. My mother was 76. Medicare covers cancer treatment after age 76. There is no age at which Medicare will not cover radiation treatment for cancer or chemotherapy.
Cancer Is Scary, And So Are Medical Bills
The C-word is a scary word. I don’t know your relationship to the C-word. You may have had a family member or friend contract cancer? Did she die, recover, or is still struggling? Or maybe it was you?
Cancer is a dirty word that ignites intense feelings because you are fighting for your life.
You also realize there is a price tag, and you immediately begin to ask, ‘Is cancer treatment covered by Medicare?‘ ‘What will I have to pay?’
I suggest you ask yourself several serious questions about your Medicare health coverage.
- How much would you be willing to pay out of your pocket in a year–$2,000, $5,000, $7,550?
- How much would you be willing to pay to avoid paying hefty bills?
The cost of cancer is high, both emotionally in terms of pain and financially. I remember seeing some of my mother’s EOBs (Explanation of Benefits). There were no small bills.
Does Medicare Part A Cover Cancer Treatment?
Medicare Part A covers the hospital, and Part B takes care of doctors and outpatient services. You will not be in the hospital as an inpatient with cancer most of the time. The oncological treatments are done as an outpatient, but there may be instances when you need hospitalization.
My mother was admitted to the hospital during the year because the pain was too intense. The doctors needed to use intervenience medications to beat back the pain that was overwhelming mom. In those instances, Medicare Part A picked up the tab.
Medicare Part A also includes skilled nursing, home health care, and hospice, not just inpatient hospital.
After a 3-day stay in the hospital, a person may be admitted to skilled nursing for a number of reasons. The person can continue cancer treatment while in the skilled nursing facility, and Medicare Part A will pay. My mother did that toward the end.
Does Medicare Part B Cover Cancer Treatment?
Medicare Part B is where most patients will experience Medicare for cancer treatments. The doctors administer chemotherapy drugs through your veins in an outpatient clinic or doctor’s office. Some oral chemotherapy is administered in the doctor’s office, though more are moving toward self-administration. The doctors also give radiation treatments in an outpatient setting. Medicare Part B covers cancer treatment when administered in this way.
The doctors need to check on the progress of treatments, so Medicare Part B covers cancer treatment for diagnostic tests like X-rays and CT scans.
Cancer treatment is incredibly taxing for the person, so durable medical equipment is often needed. Medicare covers wheelchairs, walkers, and feeding pumps for cancer treatment.
When appropriate, surgeons will operate to stop or curtail cancer. You see this most often with skin cancer. Outpatient surgeries are likewise covered.
The strain is not only physical for the patient but mental. Counseling and other mental health support may be appropriate and would be covered by Medicare.
What Does Medigap Do to Cancer Costs?
Beneficiaries on Original Medicare would be responsible for the Part A deductible and the Part B coinsurance unless they have a Medigap policy. Depending on the type of Medigap policy, it will come in and pay most or all of the remaining amounts. Regarding cancer treatments, Medigap policies, such as Plan G and Plan N, are very powerful in the amount of coverage, filling in the 20% Part coinsurance gap after the Part B deductible.
What Are Cancer Policies?
Medicare does not cover some benefits that may be helpful for people going through cancer treatment, like room and board in assisted living facilities, adult day care, long-term nursing home care, and services of daily living–bathing and feeding. Neither Medicare nor the Medigap policy will cover those expenses. Another type of insurance could be helpful in these instances–indemnity plans.
You should ask us about cancer policies.
Does Medicare Advantage Cover Cancer Treatment?
Each Medicare Part C (or Medicare Advantage) plan is unique. Looking at the Medicare Advantage plans in the Omaha Metro area, most cover cancer treatment at 80%. Beneficiaries will need to pay the 20% for chemo and radiological treatments for cancer. Your coinsurance payments will go against the maximum out-of-pocket for the particular plan, and because of the high cost of cancer treatment, it would not be unusual for you to reach the maximum out-of-pocket (MOOP). Each plan has a designated MOOP amount, for example, $4,900, $5,500, or even $6,700. Once the Medicare beneficiary reaches the MOOP, you pay no more. The Medicare Advantage plan covers everything at 100%. The MOOP, however, is a large expense for most people in a given year.
Drugs Are An Essential Part
Medications are also an essential part of cancer treatment. Beneficiaries may purchase a stand-alone Medicare Part D prescription drug plan. Most Medicare Part C/Medicare Advantage plans have a Medicare Part D prescription drug plan included in the plan.
Part D covers some oral chemotherapy drugs not covered under Part B. Anti-nausea drugs and other prescriptions used in cancer treatment, like pain medications, will come under Part D.
Questions To Ask Yourself About Medicare & Cancer Treatment
There are two important questions I would ask myself about Medicare and cancer treatment in the Omaha metro area.
- How likely do you think you will contract cancer?
- How easily will you cover the costs out of your pocket?
The American Cancer Society says that the elderly are ten times more likely than younger people to get cancer. Medicare beneficiaries over age 65 account for 54% of all new cancer cases. Cancer is the leading cause of death among the elderly.
While those are generalizations, you can further add your own analysis to the formula if you have had cancer. Cancer among family members raises your chance of you contracting cancer.
The reality is that there is a probability that you may develop cancer during your time on Medicare. What is your estimate of that probability?
The second question to consider is cost. There is no one number for the cost of cancer. It depends on the type of cancer, the number of treatments, the type of treatments, etc. But there are ranges.
A study by Avalere Health gives prices as low as $25,000 to as high as $45,000 for chemotherapy. What do you think of that cost?
With Medicare, you will only pay 20% of the expense. Most of it will probably be covered if you have a Medigap policy. The relevant cost for a Medigap policy will be the ever-growing monthly premium.
A Medicare Advantage plan will guarantee you pay no more than the maximum out-of-pocket (MOOP). In 2022, the largest possible MOOP nationally is currently $7,550. The MOOP in the Omaha Metro area is about $4,500 on average.
Is that something you can afford?
Does Medicare Cover Breast Cancer, Prostate Cancer, and Lung Cancer Treatment?
Medicare does not make any distinction between the types of cancer. All cancer is covered by the customary treatments doctors and hospitals use to combat cancer.
The Wheel of Fortune Or Misfortune?
James Bond was so cool when I was growing up. When he would sit down at the Roulette table in the casino across from the pretty girl, I was rooting for him to win. But would you want to leave the cost of your health care to the spin of the wheel?
There are 37 slots in a roulette wheel–0-36. The numbers divide into the colors red and black. Predicting the color is much easier than choosing a winning number. The house takes it most of the time, but people keep playing! It is incredible.
Most people will not get cancer, though a certain percentage will. Do you want to spin the wheel and take your chances that you won’t end up with back-breaking bills, or do you want to offload the problem?
You could purchase a Medicare Supplement for a reasonable monthly premium. The Medigap policy will cover the 20% that Medicare does not. You then can go to any of the excellent medical systems we have in the Omaha, Lincoln, and Council Bluffs metro area or anywhere in the country without concern about costs.
You could choose a Medicare Advantage plan that limits your maximum out-of-pocket to a manageable number, and you will pay very little or nothing beyond your Part B premium.
The choice is yours. Choose wisely.
My mother died on February 4, 2013. We worried a lot about her during the illness. There was fear, pain, and grief. I think about her daily and all she did for me to make me the man that I am. I pray for the repose of her soul. But during the trial that was her treatment and ultimately her death, there was no concern about medical bills. She had prepared.