If you are on Medicare and have cancer, Medicare will cover most of your cancer treatment. Medicare plus Medigap can usually cover 100% of services you need.
According to Danielle Kunkle of the Forbes Finance Council, cancer benefits under Medicare include:
- Inpatient hospital cancer care
- Surgeries for cancer
- Visits to oncologists and other physicians
- Second opinion consultations
- Chemotherapy
- Radiation
- Medications for chemotherapy
- Medications to ease side effects, such as nausea
- Participation in clinical trials for experimental treatments through clinical studies
- Skilled nursing for cancer recovery
- Home health services
- Physical therapy and rehabilitation
- Short-term nursing home care
- Hospice or End of Life care
What Each Part of Medicare Covers
Medicare Part A covers cancer treatments received in a hospital. Part A has a deductible you must meet before your benefits begin.
Medicare Part B covers cancer screenings and chemotherapy or radiation received in a doctors’ office or clinic. After paying the Part B deductible, you will pay 20% on Part B benefits, while Medicare covers 80%. A Medigap plan might be helpful in covering the other 20% you have to pay.
It is very important to have Medicare Part D if you have cancer, because without it the cost of fulfilling your prescriptions could be very high. The confusion that might arise is when discerning whether a drug is covered under Part B or Part D. Some inpatient cancer drugs (such as chemo and anti-nausea drugs), since they are infused or injected in a treatment center or doctor’s office, are covered under Part B. Other drugs, which are taken at home, are covered under Part D, i.e. prescriptions filled a pharmacy. Whether the drug is covered under Part B or D is an important distinction to make when planning your finances. Talk with your doctor first to discern whether the medication will be covered under Part B or D, as this will affect what you pay.
If you opted for a Medicare Advantage plan (Part C), you’ll be covered for the same services but it will work a bit differently. You will look for care within your plan’s network that has the lowest copays. You will keep paying copays for your services until your reach your plan’s out of pocket limit, which could be as high as $6700 per year within the network.
Tips for Managing Health Insurance with Cancer
If you have cancer and are undergoing treatment, it is good to have a friend or family member help you manage your insurance paperwork to make sure your coverage stays up to date and active.
Contact your local American Cancer Society for help and more information. The Managing Your Health Insurance section of their website is very helpful for navigating insurance questions and financial assistance information.
As stated, Medicare covers many early detection tests and screenings to detect cancer early. Medicare also covers tobacco cessation counseling. Take advantage of these screening and the covered Welcome to Medicare visit and Annual Wellness Exam to stay on top of your health.
If you are on Medicare and have cancer, check that the doctor you choose accepts Medicare and accepts assignment to ensure you will be covered before receiving treatment. A doctor who accepts assignment is called a participating doctor, and using one will save you lots of extra paperwork and costs.
Related Links
Preventative Measures that Reduce Your Chance of Cancer
Today in Medicare: Investigating the financial burden of cancer drugs on Medicare patients
