Does Medicare Cover Cancer Treatment – Overview?
Cancer treatment is costly. However, Medicare offers relief by covering some treatments under its Part A and Part B Plans.
These plans can cover the expense of consultation visits all the way to surgical treatment for cancer. You may also need to pay some expenses from your pockets, depending on the type of Medicare plan you have.
In this article, we’ve shown which Medicare insurance plans cover the cost of cancer treatment. We have also detailed some of the common out-of-pocket expenses you may encounter during cancer treatment.
Does Medicare Cover Cancer Treatment?
Medicare insurance plans are named Part A, B, C, and D. Each of these insurance plans covers different aspects of cancer treatment. Let’s take a look at it.
Medicare Part A and Cancer Treatment
Medicare Part A offers coverage for eligible cancer treatments, especially if the treatment involves an inpatient hospital stay.
For instance, Medicare Part A cover expenses of:
- The inpatient stays in the hospital for surgical treatment of cancer
- Inpatient chemotherapy
- More than 3-day stay at a skilled nursing facility
- Physical and occupational therapy costs
- Hospice care expenses
- The surgical implant of breast prostheses after a mastectomy procedure
- Blood transfusion
- Clinical research expenses at hospitals
Medicare Part B and Cancer Treatment
If you have a Medicare Part B insurance plan, then you can expect the insurer to cover the cost of the following for cancer treatment:
- Outpatient radiation therapy
- Outpatient chemotherapy
- Oral chemotherapy
- Outpatient surgery for chemotherapy
- External breast prostheses following a mastectomy
- Durable medical equipment such as a walker or supplemental oxygen
- Feeding tubes and pumps
- Cost of medical research as an outpatient
- Diagnostic tests such as CT scans
- Doctor’s office visits
- Certain diagnostic screening tests
Medicare Part C and Cancer Treatment
Medicare Part C, also known as Medicare Advantage, also offers some coverage for cancer-related diagnostic and treatment procedures.
This plan offers to cover the expenses which are covered under Original Medicare insurance plans. These include benefits provided under Medicare Part A and Part B combined.
However, the rules and rates for this health insurance policy vary greatly from the cost of Original Medicare plans.
Medicare Part D and Cancer Treatment
At times, Medicare Advantage (Part C) may also include benefits from Part D to cover expenses of prescription medications for cancer treatment.
For instance, in the case, Medicare Part B is unable to cover a specific drug and the person has Medicare Part D, then this covers the cost.
Medicare Part D also covers the cost of medications that help to counteract the effects of cancer treatment, such as anti-nausea drugs.
Medicare and Chemotherapy for Cancer Treatment
Chemotherapy involves administering drugs orally, intravenously, or through an implanted port to treat cancer. This treatment is provided as an outpatient or an inpatient procedure, based on the type of cancer the patient has.
Medicare insurance covers the cost of chemotherapy as cancer treatment provided the doctor considers the treatment as medically necessary.
Usually, chemotherapy is administered in hospital settings but can also be administered at home.
Medicare Part D may cover the cost of chemotherapy if it is administered orally and also covers other cancer treatment drugs.
Non-Medicare covered expenses for Cancer Treatment
Under Medicare Part B, the insurer covers 80% of the total cost of cancer treatment. This includes the expenses of chemotherapy and radiation therapy after a US$ 203 deductible.
You will need to pay the remaining 20% of the cost out of your pocket.
Under Medicare Part A, the expenses for inpatient cancer treatment are covered. You may need to pay a US$ 1,484 deductible for every benefit period.
The specific out-of-pocket expenses vary according to the number of days the patient spends in the hospital.
The overall cancer treatment cost also depends on the doctor, facility, patient’s income, and treatment location.
On average, the yearly out-of-pocket costs for Medicare beneficiaries range between US$ 5,970 and US$ 8,110.
To help cover these out-of-pocket expenses, you can choose to supplement Medicare with Medigap plans.
Different parts of Medicare cover different aspects of cancer treatment. Some Medicare plans cover expenses of medication and implants, while others cover the cost of treatment and hospital stay.
The out-of-pocket expenses vary between these different insurance plans.
It is highly advisable to consult with your doctor regarding recommended screenings, treatments, and medications.
This way you can ensure that your chosen Medicare plan covers the maximum amount of the total cancer treatment costs.