More than 4,500 people are diagnosed with cancer in the U.S. every day, according to the American Cancer Society, and the risk increases as you age. That means that cancer coverage is an important consideration for Medicare enrollees.
The good news is that Medicare does cover cancer treatment. If you have a Part D prescription drug plan and a comprehensive Medigap plan, most of your treatment will be 100 percent covered. Here are the facts on Medicare and coverage for cancer.
Medicare Coverage for Cancer
Your cancer coverage will work a little differently depending on whether you are treated in the hospital or at a doctor’s office or outpatient center.
Medicare Part A Cancer Coverage
Cancer testing and treatment administered during a hospital stay is covered by Medicare Part A’s hospitalization coverage. Before Part A begins to pay, however, you must meet a deductible ($1340 in 2018). If you have multiple hospital stays, you may end up paying the deductible more than once. Medicare Part A also pays the full cost of the first 20 days in a skilled nursing facility after cancer surgery, and it covers hospice care at a certified hospice facility.
A Medigap plan can reduce your out of pocket costs by paying your Part A deductible. It also provides expanded benefits for hospital stays and hospice care.
Medicare Part B Cancer Coverage
Medicare Part B covers cancer screenings and treatments at a doctor’s office or clinic. Part B’s preventive care benefits pay the full cost of some cancer screenings. In addition, Part B pays 80 percent of the cost of chemotherapy, radiation and tests done on an outpatient basis or at a doctor’s office. If you have a Medigap plan, your Medigap coverage takes care of the other 20 percent that you would have to pay if you only had Part B.
Medicare Advantage Cancer Coverage
Medicare Advantage plans give you Medicare Parts A and B benefits through private insurance coverage. Overall, though, Advantage plans usually are not the best choice for cancer patients. This is because most plans’ benefits aren’t as good as Original Medicare plus a Medigap policy.
- Advantage plans either require you to go to certain doctors within a network, or you will pay less if you use a network doctor. With Original Medicare plus Medigap, you can see any healthcare provider that accepts Medicare.
- Many MA plans require you to pay coinsurance of up to 20 percent of the cost of covered services, until you meet your annual out of pocket maximum. Medigap plans can pay this coinsurance for you.
- You can’t add a Medigap plan to your Advantage coverage. If you want better cancer coverage, you will have to buy a separate cancer policy.
Medicare Coverage for Cancer Medications
Medicare Part B covers some cancer medications, but others are not covered unless you have a Part D prescription drug plan. Cancer drugs can be extremely expensive, and this means that Medicare prescription drug coverage is an essential part of your cancer protection strategy.
- Coverage under Part B. Part B covers 80 percent of the cost of intravenous cancer treatment and anti-nausea drugs. It also covers oral versions of these drugs if your doctor could have given you an intravenous dose but decided to give you a pill instead, and the pill is taken within 48 hours of your cancer treatment. If you don’t have a Medigap plan to supplement your Part B coverage, you will be responsible for 20 percent of the cost of these drugs.
- Coverage under Part D. Part D covers cancer drugs that are not covered by Part B, including anti-nausea drugs that are only available in pill form, injections that you give yourself, and drugs designed to prevent cancer from recurring. Your Part D prescription coverage offsets the high cost of cancer drugs. Your copays or coinsurance may be far less than what you would pay if you didn’t have drug coverage at all.
Healthcare Providers for Medicare Covered Cancer Treatment
If you have Original Medicare Parts A and B plus a Medigap policy, Medicare will pay for you to receive cancer treatment from any doctor or hospital in the country, as long as they take Medicare. This means you are free to choose the very best healthcare provider for your condition.
If you have Medicare Advantage, your choices are more limited. If your plan is an HMO, you may need to choose from a limited network of doctors and hospitals. A PPO you will save money by choosing a doctor within your plan’s network. You will pay more for doctors outside the network.
Frequently Asked Questions About Medicare Cancer Coverage
Does Medicare Cover Wigs for Cancer Patients?
Chemotherapy causes hair loss, and many cancer patients choose to wear a wig. Unfortunately, wigs are not covered by Original Medicare or Medigap. Some Medicare Advantage plans or cancer insurance plans may offer coverage for wigs.
Does Medicare Cover Cancer Treatment After Age 76?
Contrary to rumors you may have heard, Medicare doesn’t limit your cancer coverage after age 76. Parts A and B pay for the same care no matter how old you are.
Does Medicare Cover Cancer Screenings?
Medicare covers 100 percent of certain cancer screenings as a preventive health service, as long as your doctor accepts Medicare assignment. This includes:
- A mammogram every year for women over 40.
- Pap smears and pelvic exams to screen for cervical and vaginal cancer, once every 24 months, or once every 12 months for women who are at increased risk.
- Colorectal cancer screening, including a colonoscopy every 10 years for anyone over 50, and additional screenings for people at increased risk.
- Annual lung cancer screenings for smokers or former smokers aged 55-77 whose doctors order a screening
- Prostate cancer screening once a year for men over 50
Other types of cancer screening may be covered 80 percent under your regular Medicare Part B coverage.
Does Medicare Cover Chemotherapy?
Yes, Medicare covers chemotherapy. If it is administered during a hospital stay, you may have to pay a Medicare Part A deductible. If it is administered at a doctor’s office or clinic, you will be responsible for 20 percent of the cost under Medicare Part B. You can avoid having to pay either of these by signing up for a Medigap plan.
Does Medicare Cover Immunotherapy?
Immunotherapy is a cutting-edge cancer treatment that stimulates your immune system to attack cancer cells. Medicare will pay for immunotherapy in many cases, either under Part A (if administered in a hospital) or Part B (if administered in an outpatient setting).
Does Medicare Cover Clinical Trials?
Medicare pays the cost of some clinical research studies, either in the hospital or while you are an outpatient.
Does Medicare Cover Cancer Drugs?
Medicare Part B pays for some cancer drugs, but not others. According to the American Cancer Society, drugs that are administered intravenously in a doctor’s office or outpatient clinic are covered. If your doctor could have given the drug intravenously but decided to give it to you in pill form instead, it is also covered. This includes anti-nausea drugs, as long as they are given within 48 hours of your cancer treatment. For drugs covered under Part B, you will still pay 20 percent as coinsurance, unless you have a Medigap policy that picks up that cost.
Drugs and injections that you administer yourself, or that are only available as pills, are not covered by Medicare Part B. However, many of these drugs will be covered by a standalone prescription drug plan. You will usually pay a copay or coinsurance, but the amount you pay will usually be steeply discounted from the retail cost of the drug.
Does Medicare Cover Breast Cancer?
Medicare pays 100 percent of the cost of an annual breast cancer screening. Part A pays for inpatient breast cancer surgery or breast implant surgery after a mastectomy. Breast surgeries done at a doctor’s office or outpatient center are covered by Part B. Part B also covers breast prostheses after a mastectomy.
Does Medicare Cover Radiation Treatments?
Radiation administered at a doctor’s office or clinic is covered by Medicare Part B. If you receive radiation treatment during a hospital stay, it is covered under Medicare Part A.
Does Medicare Cover Lung Cancer?
Medicare pays the full cost of an annual lung cancer screening ordered by your doctor, if you are aged 50-77 and you have a history of smoking. If you have lung cancer, Medicare will cover surgery, chemotherapy, radiation treatments, and hospice care if you need it.
Find Affordable Medicare Cancer Coverage
A cancer diagnosis is scary, and treatment is expensive if you don’t have good insurance coverage. After helping thousands of people find good Medicare coverage, we believe the ideal coverage for cancer patients is Original Medicare with a prescription drug plan, in addition to a Medigap policy and an insurance policy specifically for cancer.
- Original Medicare pays many of the costs of cancer, including hospital charges and 80 percent of costs that fall under Part B’s medical coverage.
- A Medigap plan such as Medigap Plan F or G will pay hospitalization deductibles and coinsurance under Part A and Part B’s 20 percent coinsurance, meaning you may pay nothing out of pocket for medical and hospital services.
- A Part D prescription plan will cover many prescription drugs that are not covered by Part B.
- A supplemental cancer policy can give you additional coverage for things that may not be covered under Medicare and Medigap. Such as certain cancer drugs and room and board while traveling out of town for treatment.
If you have Medicare Advantage, you may not have optimal cancer coverage. You can switch from Medicare Advantage to Original Medicare with an supplemental Medigap policy during Open Enrollment Periods. However, if you have already been diagnosed with cancer you may be turned down for Medigap coverage. For this reason, we recommend you buy a separate cancer policy if you have Medicare Advantage.
Get Help with your Out of Pocket Medicare Costs
The best way to ensure that you can afford the best possible treatment for cancer is to sign up for a Medigap plan when you first become eligible. If you sign up during your initial enrollment period, you can’t be turned away or denied coverage – even if you already have cancer or have had cancer in the past.
At MedicareFAQ, we know how devastating a cancer diagnosis can be, and we want you to have the right kind of coverage. That’s why we will work with you to decide what coverage you need, and search all the top carriers in your area to find you the best rates on a Medigap policy. Call or click to compare Medicare rates now.