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Does Medicare Cover Cancer Costs?

Does Medicare Cover Cancer Costs?

Medicare offers really great health coverage, but sometimes, you’ll realize that Medicare doesn’t cover everything – so does Medicare cover cancer costs?

Here’s your quick answer: Medicare does help cover cancer costs that are medically necessary. But there’s the catch – the majority of cancer costs aren’t actually medical costs. We’ll get to that shortly, but first, here’s what Medicare will cover for cancer patients.

Does Medicare Cover Cancer Costs

What does Medicare Part A cover for cancer patients?

Here’s what Medicare Part A will cover for you if you have cancer.

Medicare Part A, your hospital insurance, will cover:

  • Inpatient hospital stays, including cancer treatments you get while in the hospital
  • Skilled nursing facility care (following a 3-day related hospital stay)
  • Home health care
  • Hospice care
  • Blood
  • Some costs of clinical research studies while you’re in the hospital
  • Surgically-implanted breast prostheses after a mastectomy if the surgery takes place in an inpatient setting.

If you don’t have a Medicare Supplement, keep in mind that you will still have to pay the following charges:

  • $1,340 deductible
  • Days 1-60: $0 coinsurance
  • Days 61-90: $329 coinsurance
  • Days 91+: $658 coinsurance per “lifetime reserve day,” which caps at 60 days
  • Beyond lifetime reserve days: You pay all costs

If you have a Medicare Supplement Plan F, G, or N, all of these costs would be covered.

What does Medicare Part B cover for cancer patients?

Here’s what Medicare Part B will cover for you if you have cancer.

Medicare Part B, your medical insurance, will cover:

  • Doctors’ visits
  • Many chemotherapy drugs that are administered through your vein in an outpatient clinic or a doctor’s office
  • Some oral chemotherapy treatments
  • Radiation treatments given in an outpatient clinic
  • Diagnostic tests like X-rays and CT scans
  • Durable medical equipment (DME) like wheelchairs and walkers
  • Outpatient surgeries
  • Certain preventive and screening services
  • Enteral nutrition equipment (feeding pump) as DME that your doctor prescribes for use in your home, and certain nutrients if you can’t absorb nutrition through your intestinal tract or you can’t take food by mouth
  • Some costs of clinical research studies while you’re an outpatient
  • Breast prostheses (external breast prostheses, including a post-surgical bra) after a mastectomy. Part B covers surgically implanted breast prostheses after a mastectomy if the surgery takes place in an outpatient setting.
  • In some cases, a second opinion for surgery that isn’t an emergency, and a third opinion if the first and second opinions are different

If you don’t have a Medicare Supplement, keep in mind that you will still have to pay the following charges:

  • $183 deductible
  • 20% coinsurance on everything after you meet your deductible

If you have a Medicare Supplement Plan F, G, or N, the coinsurance costs would be covered. However, with Plan N, you do have office visit and ER visit copays (ranging from ~$10-$50). And with Plan F, your Part B deductible is covered.

You can read more about the differences between Medigap Plan F, G, and N in this article.

Medicare cancer coverage over 70

What does Medicare Part C, or Medicare Advantage, cover for cancer patients?

In case you aren’t familiar with Medicare Advantage (also called Medicare Part C), it is an alternative to Original Medicare. You can read more about Medicare Advantage here.

If you do choose to have a Medicare Advantage plan for your health insurance, it’s important to know how your cancer costs will be covered.

According to the Centers for Medicare & Medicaid Services, Medicare Advantage plans are required to give you at least the same coverage as Original Medicare. However, there may be different rules and costs.

For example, services might cost more if your doctor isn’t in your network. It’s important to find out which doctors are in your network before having any services done or scheduling any appointments.

Medicare Advantage plans vary depending on which type you have, but you can certainly find out what your deductible, copayments, and coinsurance look like by asking your insurance agent.

What does Medicare Part D, or my prescription drug plan, cover for cancer patients?

Medicare Part D, your prescription drug coverage, covers most prescription medications and some chemotherapy treatments and drugs.

If Medicare Part B does not cover a certain cancer drug, your Part D plan might cover it. You can check your plan to make sure your drugs are on the plan’s list of covered drugs. Again, your insurance agent can help you figure out if your drugs are covered and how much your out-of-pocket costs will be.

In many cases, prescription drugs for chemotherapy only available to be taken by mouth are covered under your Medicare Part D drug plan.

Also, anti-nausea drugs are often covered under your Part D plan as well as other prescription drugs used in the course of your cancer treatment, such as pain medications.

Best medicare plans for cancer patients

Medicare Cancer Coverage: What Does Medicare Actually Pay For?

Earlier in this article, we mentioned that Medicare only covers medical costs. The sad truth is that only 38% of costs associated with cancer are medical.

The other 62% of cancer-related costs are not covered by Medicare at all.

You may be thinking – how could there be a cancer bill that isn’t medical?

Here’s a look at what those costs could be:

  • Travel expenses
  • Lodging
  • Loss of income
  • Experimental medications
  • Meals
  • Child care
  • Counseling
  • Clothing and hair pieces (wigs)

4 Real-Life Examples of Non-Medical Cancer Costs That Medicare Won’t Cover

Here are some common examples of situations where you’ll have to pay for expenses out of your own pocket due to cancer.

Example #1: When you get cancer, the treatments tend to cause loss of appetite. It’s normal to drop a significant amount of weight. That means you need all new clothing. And over time, it’s probable that you’ll put some of that weight back on – which means you need new clothes again.

Example #2: If you’re spending most of your time in a hospital – and keep in mind that cancer drains you both physically and mentally – you likely won’t be able to keep up with a full-time job. Where will income replacement come from?

Does Medicare Cover Cancer Treatment

Example #3: You have twice the chance of survival if you go to a research facility — so why wouldn’t you? The top cancer hospitals are in Houston, New York City, Rochester, and Boston. Who will pay for the airfare, the hotel stays, the meals, etc.? We’ve had clients travel to New York and Texas, and they were responsible for the flight and hotel bills that add up over time.

Example #4: Another example is a veterinarian who was diagnosed with cancer. He was advised to take an experimental drug. This drug had seen success with other cancer patients, and they expected it to increase his lifespan. The cost? $4,500 per month. Would you be able to afford this without some kind of critical illness insurance plan?

How to Pay for Cancer Treatments and Cancer Costs If You’re On Medicare

To sum things up, here’s what we know about Medicare and cancer treatment costs:

Medicare covers about 80% of medically-necessary cancer costs. Only 38% of costs associated with having cancer are considered medically-necessary.

Because of this, we’d advise you to consider two insurance solutions if you haven’t already:

1. You might consider a Medicare Supplement to help pick up your deductibles and that 20% coinsurance.

Keep in mind that a Medicare Supplement isn’t just to help cover cancer costs – it will pay for any medical costs that Medicare leaves behind.

2. A Critical Illness Insurance plan can give you a lump sum of money when you’re diagnosed with cancer.

What’s really nice about cancer insurance is that you can use that lump sum in any way you see fit – that means that if you need the money for hotel rooms, you can use it for hotel rooms. If you need it for groceries, you can use it for groceries.

You can read more about cancer insurance here.

Do you have any other questions about how Medicare covers cancer costs? Our team of Medicare specialists are always ready to help inform and educate you. Simply click the button below or start a chat (the red button on the bottom your screen) to ask us a question.

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