As you become a Medicare beneficiary, you’re likely to begin wondering about the various treatments that Medicare covers. When thinking about cancer, there isn’t a simple answer to the question, “Does Medicare cover cancer treatment?” However, the following breakdown should give you a better idea of what to expect when searching for the best Medicare plans for cancer patients.
• Medicare Part A (Hospital Insurance)– Part A Medicare cancer coverage typically covers medically-necessary cancer treatments and services. These are only of services provided while you are an inpatient at a hospital. This includes skilled nursing facility care, home health care, hospice care, blood work, and surgically-implanted breast prosthesis after in-hospital mastectomy for breast cancer treatment.
• Medicare Part B (Medical Insurance)– Generally, Part B covers many medically-necessary outpatient cancer treatments and services. Even if you receive treatment in a hospital, doctors and Medicare might still consider you an outpatient. Part B Medicare cancer coverage includes doctors’ visits, intravenous chemotherapy drugs administered in a clinic or doctor’s office, oral chemotherapy treatments, diagnostic exams, outpatient surgeries, mental health services, certain preventative and screening services, and other qualifying, cancer-related treatments.
Cost of Cancer Treatment
Although certain services might technically be covered under your Medicare plan, copayments, coinsurance, and/or deductibles may apply. The cost of cancer treatment will depend on several factors. These factors may include the type of facility, whether your health care provider accepts assignment, the location of the services, and any other insurance you might have. Keep in mind that Medicare may have maximum payment amounts on certain services or may not even cover some services at all.
Contact your health care provider and ask how much they charge for a specific service for a specific price. You can also visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227, TTY users should call 1-800-486-2048) to get direct answers about Medicare cancer coverage and costs.
Medicare Cancer Coverage for Chemotherapy
Medicare Prescription Drug Plans (also called “Part D”) may cover prescription drugs for chemotherapy and other cancer-related drugs and supplies. However, this Medicare cancer coverage isn’t automatic and requires patients to enroll in a Medicare Prescription Drug Plan. Part D plans may also cover cancer drugs that Part B does not. Always check with your plan to be sure that it covers the cost of chemotherapy, and utilize online resources from Medicare.gov to compare drug plans. Medicare Part D plans may cover the following drugs:
• Prescription drugs for chemotherapy taken orally.
• Anti-nausea drugs.
• Prescription drugs used throughout your cancer treatment, such as pain medication.
Does Medicare Cover Immunotherapy for Cancer?
Immunotherapy is an innovative cancer treatment that stimulates the immune system to attack cancer cells. Medicare cancer coverage may pay for immunotherapy in most cases. For instance, Part A may cover treatment administered in a hospital. On the other hand, Part B may cover treatment administered in an outpatient setting. The best Medicare plans for cancer patients should cover a significant portion of immunotherapy treatment.
Medicare for Cancer Patients Under 65
Cancer patients under 65 who would like to apply for Medicare must first receive Social Security Disability benefits for 24 months in order to qualify. Traditionally, there is a five-month waiting period after a beneficiary claims disability before he or she can collect Social Security Disability benefits. However, it may take less time to be approved for patients with certain types of cancer.
What Medicare Doesn’t Cover
The following treatments or services may be necessary as a result of cancer treatment, however, Medicare may not typically cover them.
• Room and board in assisted living facilities.
• Long-term nursing home care.
• Services for activities of daily living (eating, bathing, etc.) that don’t require skilled care.
• Medical food or nutritional supplements.
• Adult day care.
So, does Medicare cover cancer treatment? The answer is yes. However, there are additional factors that can influence whether or not a particular service is covered and the overall average cost of cancer treatment. A Medicare supplement plan may help cover the costs that Medicare may not cover. Keep in contact with one of our friendly agents and your health care providers to get direct answers about the best Medicare and Medicare supplement plans for cancer patients.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.