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There is a high rate of pancreatic cancer in my family, and this makes me more thoughtful of my health insurance coverage. I’m about to qualify for Medicare, and I’m wondering which plan would protect my health and finances the most if I were to get cancer. I’m wondering, does Medicare cover cancer treatment, and are all plans equal?
Considering my Medicare plan options,
James from San Diego, California
Thank you for writing and asking such an important question. I’m sorry to hear that cancer runs in your family, but I’m happy to help you think through safeguard measures for your health and finances.
Original Medicare covers most cancer treatments. The most common are surgery, chemotherapy, and radiation therapy. But Medicare may also cover stem cell and bone marrow transplants, immunotherapy, hormone therapy, targeted drug therapy, cryoablation, radiofrequency ablation, and clinical trials.
Original Medicare Part A and Medicare Part B cover primary hospital and medical for cancer treatment. Original Medicare Part A would cover inpatient services and procedures—for example, inpatient surgeries, chemotherapy, or radiation therapy. Medicare Part B would cover outpatient surgeries, prostheses implants, outpatient chemotherapy, or radiation therapy at freestanding clinics. A Medicare Part D prescription drug plan would cover your cancer drugs, chemotherapy, or other prescription medications.
The general rule is that Medicare Part A covers inpatient hospital coverage while Part B covers outpatient medical services. Deductibles, coinsurance, and copayments apply for Original Medicare A and B, plus there is no out-of-pocket maximum. You must meet your Part A and B deductibles before Medicare will pay for services. Then, you must pay copayments and a 20% Part B coinsurance on all Medicare-approved amounts. There is no maximum amount of coinsurance you could pay during cancer treatment.
Medicare Part D plans have separate deductibles and copayments. You must review your plan’s “Summary of Benefits and Coverage” to determine the deductible and costs for covered medications.
“A cancer diagnosis often means that nearly 25% of total annual household income is spent on out-of-pocket medical expenses with Original Medicare alone. That is why we recommend you consider supplemental insurance.“
If you are at high risk for cancer, you may want to consider supplemental insurance. That is because a cancer diagnosis often means that nearly 25% of total annual household income is spent on out-of-pocket medical expenses with Original Medicare alone.
You may want to consider keeping Original Medicare with a Part D prescription drug plan but adding Medicare Supplement (Medigap) insurance. These plans cover most, if not all, of your out-of-pocket expenses that Original Medicare doesn’t cover. And you can see any hospital or provider that accepts Medicare. You could also pair this with a cancer care insurance plan if you’d like a lump sum payment at the time of a cancer diagnosis.
The other supplemental insurance option is a Medicare Advantage plan. These plans provide equal coverage as Original Medicare Part A and B, plus frequently include prescription drug coverage, an out-of-pocket maximum, and extra benefits such as dental, vision, and hearing.
These plans traditionally have a lower monthly premium than Medigap plans but include an annual deductible and different cost-sharing. You may also have a more narrow network of hospitals and providers since Medicare Advantage plans are not accepted everywhere. If you have specific doctors or networks in mind, you should ensure your chosen Medicare Advantage plan accepts them. There are many plans to select from, and you can find one that fits your health and financial needs.
A cancer care insurance plan can provide a safety net if you enroll in Original Medicare alone. These plans offer a lump sum payment should you receive a cancer diagnosis.
While we hope you never face a cancer diagnosis, we hope that this information has helped you understand how Medicare would cover you – if you do. Should you have questions about plans or want to speak with a local licensed agent—call (623) 223-8884. We’re here to support you throughout your Medicare journey.
Yes. Both Original Medicare and Medicare Advantage plans cover cancer treatment after age 75. You must pay Medicare Part A and B deductibles before Original Medicare will pay. A 20% Part B coinsurance is required for any Medicare-approved services; copayments may apply.
For Medicare Advantage plans, consult your “Summary of Benefits and Coverage” to determine the deductible and coinsurance or copayments. Medicare Advantage plans provide equal coverage to Original Medicare but with extra benefits, different deductibles, and cost-sharing.
Yes. Original Medicare Part A and Part B may cover prostate cancer treatment. The most likely courses of treatment for prostate cancer are radiation therapy and hormone therapy, but there may be others. Be sure that any providers or hospitals accept Medicare assignments to reduce out-of-pocket costs.
Part A will provide coverage for treatment if you’re an inpatient, and Part B will provide coverage as an outpatient or a patient of a freestanding clinic. You must pay the Part A and B deductibles before Medicare pays, a 20% Part B coinsurance on any Medicare-approved amounts, and copayments.
Medicare Advantage plans must provide equal coverage to Medicare Parts A and B. Sometimes, their cancer treatment coverage is even greater than Original Medicare. You should check your “Summary of Benefits and Coverage” to learn about your plan’s coverage, deductibles, copayments, and coinsurance.
Yes. Most Cancer Treatment Centers of America facilities accept Original Medicare (Part A and B) and Medicare Advantage plans. You should contact your treatment center to ensure it accepts Medicare because there are exceptions, and coverage varies. Some Cancer Treatment Centers of America also accept Medicaid.
Medicare covers all medically necessary cancer treatments. In order for a cancer treatment to be covered by Medicare, the hospital or provider must accept Medicare assignment. You must pay the Part A and Part B deductibles before Medicare pays.
Medicare Part A covers inpatient expenses related to cancer treatment. Medicare Part B covers 80% of outpatient cancer-related services such as chemotherapy or radiation therapy. You would be responsible for 20% Part B coinsurance. Medicare Advantage plans provide equal, and often better, coverage to Original Medicare but with different deductibles and copayments. Check your plan’s “Summary of Benefits and Coverage” to learn about your Medicare Advantage plan’s coverage and out-of-pocket expenses.
Yes. Medicare covers BCG treatments for bladder cancer. Medicare considers immunotherapy a medically necessary cancer treatment and may be approved for the treatment of bladder cancer. Depending on how the treatment is administered – and where – will determine what part of Medicare covers the procedure.
Medicare Part A would cover BCG treatments as an inpatient, while Medicare Part B would cover outpatient immunotherapy treatments. Medications could be covered by Part B or your Medicare Part D prescription drug plan. You will need to pay Part A, B, and D deductibles before Medicare will pay, plus coinsurance or copayments for the Medicare-approved amounts. Medicare Advantage plans provide equal and often better coverage than Original Medicare. Check your “Summary of Benefits and Coverage” to understand your Medicare Advantage plan’s coverage.
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