What is a biopsy?
A biopsy is a test needed to tell if you have cancer. A doctor takes a small amount of tissue or cells from an area where there seems to be an issue. Then, a pathologist examines the tissue under a microscope to detect if it is cancer. A biopsy is the most fail-proof way to tell if you have cancer, what type it is, and what level it has progressed to. If you are diagnosed with cancer, then your doctor will take steps to make a plan for treatment.
Results of a biopsy should be available within a few days. In some cases, such as a surgical biopsy, you will be able to get results tight away. Your doctor should be able to tell you how long it will take to get results.
How does a biopsy work?
There are many different kinds of biopsies, including bone marrow biopsy, endoscopic biopsy, needle biopsy, skin biopsy, or surgical biopsy. The biopsy should not be painful. In some cases, local anesthesia and/or sedation will be used.
Will Medicare cover your biopsy?
The short answer is yes. Medicare always covers medically necessary tests to detect cancer or other diseases. Outpatient care (lab tests, doctor visits, etc.) will be covered under Medicare Part B, while care in the hospital will be covered under Part A. First, you’ll have to meet your Part A and B deductibles. Under Medicare Part B, Medicare will pay for 80% of the costs, while you are responsible for 20%, plus any other copay and coinsurance costs.
Those with cancer often find it beneficial to have a Medigap plan in place. Most Medigap plans will cover the extra 20% that you must pay, and with cancer tests and treatments, this amount can add up. Some Medigap plans will also cover your deductible, virtually eliminating any costs for you.
If you have Medicare Advantage, your plan should cover everything that Original Medicare covers. However, with Medicare Advantage you want to make sure you pick a doctor within the network so you don’t incur extra costs. In addition, with Medicare Advantage there is a cap on out-of-pocket costs. In 2019, this cap is $6,700. It can differ by plan, but it won’t be higher than $6,700. While there being a cap is helpful, $6,700 is a lot of money. And it can be even more if you receive services out of network.
Any medications or anesthetics you take for biopsy or cancer treatment will be covered as well. If medications are taken at the doctor’s office, they are covered under Part B. If taken at home, Part D will cover them as long as you have a Part D plan.