You or a loved one is diagnosed with cancer. After the initial shock and grief comes the question, “What’s this going to cost?” Fortunately, for those on Medicare, the coverage is good. Medicare Part A covers hospitalizations, and Part B covers doctors, outpatient facilities, and some cancer medications. Medicare Part D covers cancer medications too. So, which part covers what?
Part A covers services given in a hospital, such as surgeries, radiation treatment, and chemotherapy. Part A may also help pay for rehabilitation in a skilled nursing facility after cancer treatment. Hospice care is provided through Part A.
Part B covers most cancer treatment services, including chemotherapy drugs administered intravenously in a doctor’s office. It also may pay for medications taken orally if the drug is accessible in an injectable form or breaks down into the same active ingredient found in the injectable form.
Part B also covers oral anti-nausea medications used as part of an anticancer chemotherapeutic regimen. These drugs must be given immediately before, at, or within 48-hours of chemotherapy, and must be used as a full therapeutic replacement for intravenous anti-nausea medications.
Part D covers oral cancer medications, both chemotherapy and anti-nausea. Part D cancer drugs are those typically not covered under Part B. Part D also includes other prescription medications used during cancer treatment, such as pain medications.
Immunotherapy uses vaccines and medications to stimulate white blood cells, along with organs and tissues of the lymph system, to help the immune system fight cancer cells. Medicare may cover immunotherapy cancer treatment if it is determined to be medically necessary. Depending upon the drugs, this could fall under either Part B or Part D.
As stated earlier, most cancer treatment services fall under Part B. This is good news for those with Medicare supplements. Plan F policyholders pay nothing for Medicare covered cancer services. Plan G policyholders pay nothing after the Part B annual deductible (currently $203) is met. Supplement owners will need to pay for Part D drugs, the amount varying between plans.
Advantage plan policyholders are responsible for their plan’s payment structure of co-pays and coinsurance. All advantage plans I am aware of, have a 20% coinsurance charge for chemotherapy. It is during cancer treatment that those on Advantage plans are most likely to reach their plan’s annual out-of-pocket maximum amount.
A good way of offsetting the potential cost of cancer treatments while on an Advantage plan, is to purchase additional hospitalization and/or cancer coverage. This coverage is less than the price of a Medicare supplement and is not subject to the annual cost increases seen in Medicare supplements. We have hospitalization, critical illness, and cancer policies available. Let us know if you are interested. These supplemental policies do require underwriting, so don’t wait for a diagnosis before applying.
Keep in mind, Medicare has a list of services they cover. You can find this list at www.medicare.gov/coverage.Sometimes providers may recommend services Medicare does not cover. If that happens, you will have to pay for those services. Be sure to ask your doctor why these uncovered services are being recommended and how much you may be asked to pay.
