Many cancer treatments are covered by Medicare, with each part of Medicare covering the same aspects of treatment as they would for any other medical condition.
Part A of Original Medicare covers hospital-related expenses; Part B covers medically necessary treatments, services and equipment; Part D covers drugs not covered by Parts A or B.
All parts of Medicare require that you cover some of the associated costs, among them premiums, deductibles and coinsurance.
Medicare Advantage can replace Original Medicare while offering at least the same coverage as Parts A and B along with additional coverage options.
Cancer is among the conditions for which Medicare Advantage offers a Chronic Condition Special Needs Plan (in some areas) specially designed to deal with the unique challenges that cancer patients face.
According to the National Cancer Institute, two of every five Americans will face a cancer diagnosis at some point in their lives.
If you or a family member age 65 or older is dealing with cancer, Medicare will cover many of the necessary treatments. You may need Part A and Part B of Original Medicare in conjunction with a Part D drug plan or a Medicare Advantage plan that bundles services to get coverage for the various aspects of your cancer treatment.
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“Cancer” ranks among the most dreaded words in the English language. Only heart disease claimed more lives in the United States in 2019.
The good news is that from 1991 to 2019, the death rate associated with cancer dropped 32%. Cancer is more treatable than ever, but treatment is as expensive as ever.
Medicare can help with the financial burden brought on by a cancer diagnosis.
Medicare cancer coverage works in much the same way as medically necessary treatment of other conditions works.
- Medicare Part A covers most aspects of inpatient hospital care related to cancer, while Medicare Part B covers most aspects of outpatient care for cancer.
- Having both Parts A and B, collectively known as Original Medicare, allows you to add a Part D prescription plan that can help with many drug costs that aren’t covered by Parts A and B.
- Having Parts A and B also offers you the option of switching to Medicare Advantage, replacing Parts A and B while providing at least the same coverage. Most Medicare Advantage plans bundle drug coverage, and some offer other coverages that might be helpful to cancer patients, such as transportation services.
Some notable details about the coverage provided by each part of Medicare:
- Part A: Covers inpatient hospital stays and surgical procedures related to cancer treatment and care in a skilled nursing facility, hospice care, and some home health care.
- Part B: Covers a lengthy list of outpatient cancer services, among them doctors’ visits and resulting lab work; radiation, intravenous chemotherapy and oral chemotherapy (in some cases); durable medical equipment and mental health services.
- Part D: Typically covers oral chemotherapy drugs not covered by Part B and other medication related to issues like nausea and pain management.
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Does Medicare pay for cancer treatment? Yes, although Medicare cancer costs work much the same way as costs related to other conditions, meaning the patient faces some financial responsibility.
Costs for Part A cancer treatments include a benefit period deductible ($1,632 in 2024) that you must pay for every inpatient stay. After you pay the deductible, you don’t have to pay coinsurance for Days 1-60 of your stay but do pay coinsurance from Day 61 on.
The Part B cost model requires that you pay 20% coinsurance after you have paid your annual deductible ($240 in 2024). Medicare pays 80% of covered services.
Are Cancer Drugs Covered by Medicare?
For cancer-related medications covered by Part D, cost can vary widely based on the individual plan, the pricing within its drug tiers and where you are in the stages of the Part D cost model. Part D, like Part B (and Part A on rare occasions) usually requires a monthly premium; the projected average Part D premium in 2024 is $55.50.
As you can see, while Medicare helps with the financial burden of a cancer diagnosis, it doesn’t pick up all of the expenses associated with treatment. If you have at least Part B (most people with Part B also have Part A), then you qualify to add a Medicare Supplement Insurance (Medigap) plan that can further assist with costs related to your treatment.
As the name suggests, Medigap plans — offered by private insurance companies under federal guidance — help fill in the gaps when it comes to your costs.
All 10 of the standard Medigap plans pay 100% of Part A coinsurance, and all but one pays at least 50% of the Part A deductible. All 10 also pay at least 50% of Part B coinsurance and copayments.
Two of the 10 Medigap plans protect you with an out-of-pocket maximum. Medicare Advantage plans are required to include the benefit of an out-of-pocket maximum.
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Trying to identify the best Medicare plans for cancer patients isn’t straightforward because every situation is different.
You may find comfort in being able to plan your worst-case scenario based on having the out-of-pocket maximum provided by Medicare Advantage, or you may value Original Medicare’s cost model that doesn’t require out-of-pocket expenditures for inpatient hospital stays for 60 days after you pay your deductible. A Medicare Advantage plan that helps you with transportation to and from your providers may lift a big burden for you. Still, you may not have any transportation concerns and want to travel to any cancer specialist that accepts Original Medicare.
Whatever your needs, GoHealth licensed insurance agents have the knowledge and tools to help you select the health insurance that fits your specific set of circumstances.
Can You Get on Medicare if You Have Cancer?
While Medicare covers many cancer treatments, a cancer diagnosis itself doesn’t qualify you to enroll in Medicare. Similarly, a cancer diagnosis doesn’t prevent you from enrolling in Medicare if you qualify otherwise.
Most people first qualify for Medicare enrollment when they reach age 65.
If you are eligible for Medicare and enroll in Parts A and B, you can switch to Medicare Advantage. That could be notable for cancer patients because Medicare Advantage offers Chronic Condition Special Needs Plans (C-SNPs for short). Cancer is among the chronic conditions that qualify for specially designed C-SNPs (available in some areas), which automatically include Part D drug coverage.
While being treated for cancer neither qualifies you nor excludes you from enrolling in Medicare, you could face an obstacle if you waited to add a Medigap plan to Original Medicare. Keep in mind that if you try to add a Medigap plan more than six months after you first enrolled in Part B, you could be subject to an underwriting process that includes medical questions. The ability to add Medigap is only guaranteed during that initial six-month period when your health condition won’t impact your eligibility or your premium.