Cancer & Medicare: What You Need to Know

Cancers of all types can affect anyone at any age, and while there are many risk factors associated with the disease like family history or tobacco and alcohol use, age is the single greatest risk factor for developing cancer. In fact, sixty percent of people who have cancer are over the age of 65. That’s why it is particularly important for seniors with cancer to understand how Medicare plans cover the costs of cancer care and treatment options.

There is a lot of uncertainty and complexity when it comes to cancer and Medicare. As Medicare’s annual Open Enrollment Period approaches (October 15–December 7), it is important to make sure you know all the options available to you. Navigating the plans available in your area often takes the expertise and knowledge of an agent who specializes in the senior health market and can help you select an appropriate plan based on your needs. Here is a general overview of how the Medicare plans may cover care and treatment of cancer.

Cancer Surgery: Medicare generally covers many medically necessary surgical procedures including surgery for cancer treatment.

  • Medicare Part A generally covers inpatient surgical procedures to remove a cancerous mass.
  • Medicare Part A generally covers surgically implanted breast prostheses after a mastectomy.
  • Medicare Part B generally covers outpatient surgery.
  • Medicare Part C generally covers cancer treatment surgery.

You pay: A deductible for hospital admissions under Part A as an inpatient. A deductible under Part B as an outpatient, and you pay 20% of the Medicare-approved amount for Part B.  

Radiation: Radiation therapy can be administered as external beam radiation or internal radiation therapy and the cost may depend on how the therapy is administered.   

  • Medicare Part A generally covers radiation cancer treatment for hospital inpatients.
  • Medicare Part B generally covers radiation therapy for outpatients in freestanding clinics.
  • Medicare Part C, or Medicare Advantage plans also generally cover radiation.

You pay: A deductible and copayment for radiation therapy under Part A as an inpatient. A copayment and deductible under Part B as an outpatient, and you pay 20% of the Medicare-approved amount for radiation therapy, and a Part B deductible applies.

Chemotherapy: Medicare plans generally cover chemotherapy cancer treatment, but the cost may depend on how the chemotherapy mediation is administered.  

  • Medicare Part A generally covers chemotherapy administered by vein in a hospital.  
  • Medicare Part B generally covers chemotherapy administered by IV at a doctor’s office.
  • Medicare Part C, or Medicare Advantage plans also generally cover radiation.
  • Medicare Part D may cover oral chemotherapy cancer treatments

You pay: A copayment for chemotherapy covered under Part B in a hospital outpatient setting. For chemotherapy administered in a doctor’s office or freestanding clinic, you pay 20% of the Medicare-approved amount, and a Part B deductible applies.

Immunotherapy: Immunotherapy is an innovative cancer treatment that modifies the cells of your immune system to help fight and kill cancer cells. Some Medicare plans may cover the therapy if it is deemed medically necessary by a doctor.

  • Medicare Part A generally covers immunotherapy administered as an inpatient in a hospital.
  • Medicare Part B generally covers immunotherapy administered as an outpatient in your doctor’s office.
  • Medicare Part C, or Medicare Advantage plans also generally cover immunotherapy for cancer if ordered by your doctor.

You pay: A copayment and deductible under Part B as an outpatient, and you pay 20% of the Medicare-approved amount for radiation therapy, and a Part B deductible applies.

 

D-SNP and C-SNP plans

In addition to Medicare Parts A, B, C, and D plans, D-SNP (Dual Eligible Special Needs Plan) plans which include individuals enrolled in both Medicare and Medicaid, and C-SNP (Chronic Condition Special Needs Plan) which includes individuals with specific severe or disabling chronic conditions, may also cover cancer treatments.  

Cancer treatment can be costly. That is why it is so important to work with a specialist who has the expertise to help you go over all of the options in your area and select the plan that meets your unique needs.  Discover Your Plan: www.medicarevalue.com.

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