Does Medicare Cover Chemotherapy?
While Medicare isn’t 100% coverage, it does help pay for many medically necessary services and items. Many Medicare-eligible individuals are concerned about the risks of cancer, and with that, the potential costs associated with it.
What Are the Risks of Cancer?
Cancer is the second most common cause of death following cardiovascular diseases (Yale Journal of Biology and Medicine).
According to the latest research from the American Cancer Society, 39 out of 100 men and 38 out of 100 women will develop cancer during their lifetime. Your individual risks increase substantially if you have a history of smoking, a family history of cancer, or genetic susceptibility.
Many people think their risk of cancer is mainly based on their family history. However, we now know that inherited genetic mutations play a major role in only 5-10% of all cancers (National Cancer Institute).
That means that around 90% of all cancers have nothing to do with your family history.
Because cancer is so prevalent, and the risk is very real, planning and understanding the costs is important. Is chemo covered by Medicare, and how much does Medicare pay for chemotherapy?
Is Chemotherapy Covered by Medicare?
Whether you’re inpatient or outpatient, Medicare will help cover the costs of chemotherapy.
Medicare Part A will help cover chemo if you’re a hospital inpatient.
If you’re a hospital outpatient or are in a doctor’s office or freestanding clinic, Medicare Part B would help cover chemotherapy.
If you don’t have supplemental coverage, the difference between Part A and Part B coverage does matter, because it will directly affect how much you pay.
Medicare Part A Chemotherapy Coverage
If you have cancer and are receiving chemo as a hospital inpatient, Medicare Part A will help pick up the costs.
Your responsibility will be a $1,408 deductible. After you pay that amount, Medicare Part A will do the heavy lifting and cover you.
If you have a Medicare Supplement, your responsibility would be $0.
Medicare Part B Chemotherapy Coverage
If you have cancer and are receiving chemo as an outpatient, Medicare Part B will help pick up the costs.
Your responsibilities will include the Part B deductible as well as 20% coinsurance. Currently, in 2020, the Part B deductible is $198.
If you have a Medicare Supplement Plan F, your costs will be $0. If you have a Medicare Supplement Plan G, your costs will be the Part B deductible, or $198 in 2020. Both Plan F and Plan G pay the 20% coinsurance.
The gray area is the 20% coinsurance. After all, how much does chemotherapy cost, and what would 20% of the total be?
How Much Does Medicare Pay for Chemotherapy?
We did some research for you and pinned down the Medicare-approved rate for chemotherapy.
Keep in mind that there are hundreds of medical billing codes that have to do with chemotherapy, so please understand that the code we’re referencing today may not be the same code your physician uses.
Using HCPCS code 96245, which is described as “Chemotherapy infusion method,” the facility prices ranges from $159-$240 with the average price being $191. The variation in price is simply based on where you live.
Chemotherapy is given in cycles that can last years, or generally as long as the chemo is tolerated and the disease does not grow. If the disease disappears, the chemo may continue for 1-2 months beyond the observation. A fairly common regimen is two bi-weekly chemotherapy sessions per month.
If we take the average price for a chemotherapy infusion, or $191, and assume that you are doing chemo for a full year (about 50 sessions), the total Medicare-approved amount for chemotherapy would be around $10,000.
Again, this is all based on factors that vary greatly, but in this example, you’d be responsible for about $2,000 if the chemo was given in an outpatient scenario. Additionally, you can see that Medicare would pay $8,000 for the chemotherapy infusions in this example.
How Much Does a Medicare Supplement Pay for Chemotherapy?
If you have a Medicare Supplement, you’d be responsible for none or very little of the chemotherapy costs.
With a Medicare Supplement Plan F, you would not be responsible for any chemotherapy costs. With a Medicare Supplement Plan G, you would only be responsible for the Medicare Part B deductible, which is $198 in 2020.
What About Other Cancer-Related Costs?
There are a lot of costs associated with cancer, and unfortunately, about 42% of them are indirect costs.
Translation: Medicare won’t pay for nearly half the costs associated with a cancer diagnosis.
We’re talking about things like transportation to and from specialty hospitals, hotels and lodging while there, loss of income if you were working, clothing and hair pieces, and even experimental medications and trial drugs that could save your life… Medicare won’t pay for them.
Many cancer patients travel out of state to receive higher quality care from specialized cancer centers. In fact, patients treated at one of a handful of specialized cancer centers had a 9% higher survival rate over 5 years compared to patients treated at community hospitals.
On top of that, the Sloan Kettering researchers found that patients treated at these hospitals had a 10% lower chance of dying in the first year than did patients who were treated at other facilities including community hospitals.
It’s in your best interest to travel, and that’s expensive! Common travel costs include:
- Rental car
- Bus or train fares
- Airplane fares
- Restaurants/Fast food
So, how can you plan for potential cancer costs even if you have Medicare and a Medicare Supplement?
Cancer Insurance Is Affordable and Easy to Apply For
Our most popular cancer insurance options are called lump sum plans. This simply means that when you’re diagnosed with cancer, you receive a check. You can use that check for anything you need. It’s as simple as that.
When you sign up for the plan, you decide what that check amount will be.
If you haven’t had cancer in the past 10 years, you can apply for a cancer insurance plan – it’s very easy to qualify!
You can obtain a cancer insurance plan up to age 89, and they’re very affordable, with a $10,000 lump sum benefit costing as little as $28 per month.
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