Does Medicare Cover Cancer Treatment? | Medicare Plan Finder

Does Medicare Cover Cancer Treatment?

Troy Frink Fitness & Health, Medicare Leave a Comment

Cancer is the second-most common cause of death in the US, right behind heart disease. A cancer diagnosis comes with a lot of uncertainty. You might be unsure of how to tell your friends and family, or you might not know how you’ll pay for treatment. After all, cancer treatment can be expensive. The average cost for cancer treatment is about $150,000, according to the American Association of Retired Persons (AARP).

The good news is that Medicare does cover cancer treatment, prescriptions, and screenings and might even cover genetic testing, depending on your plan

Medicare Cancer Coverage: What you Need to Know

Cancer treatment usually involves a combination of treatments that can include chemotherapy, radiation, and surgery. Medicare plans can cover a lot of the costs associated with these treatment options.

What Cancer Treatment Does Medicare Cover?

In order for your treatment to be covered, your doctor must accept Medicare. Outpatient care (including intravenous chemotherapy, certain screenings, and outpatient radiation) falls under Part B. You may have to pay a copayment, coinsurance and a deductible for each service.

Cancer treatment under Part A (hospital insurance) covers inpatient surgeries and hospital stays. Part A will also cover limited skilled nursing care and home health care services.
Medicare Part D plans cover cancer drugs like oral chemotherapy medications, anti-nausea drugs, and painkillers. Many people will buy Medicare Supplement Plans (Medigap) plans to cover any dollar amount that Medicare does not cover.

Medicare Cancer Screening

Catching cancer in its early stages can make a huge difference in your treatment’s success.  That’s why Medicare offers coverage for preventive screenings for most cancers, including but not limited to:

Catching cancer in its early stages can make a huge difference in your treatment’s success.  That’s why Medicare offers coverage for preventive screenings for most cancers, including but not limited to:

  • Breast cancer: Medicare will cover one annual mammogram, and one clinical breast exam (CBE) every two years for all women 40 and older who have an average risk of developing breast cancer. Women who are at a high risk of developing breast cancer can receive one CBE every year.
  • Cervical cancer: Medicare pays for one pelvic exam and Pap test every two years. If you have a high risk of cancer, Medicare covers those tests once yearly.
  • Colorectal cancer: Medicare covers certain colorectal cancer screenings looking for pre-cancer polyps for people 50 and older.
  • Prostate cancer: Medicare covers one digital rectal exam (DRE) and one prostate-specific antigen (PSA) for men 50 and older. Medicare will cover 80 percent of the DRE, and 100 percent of the PSA.
  • Lung cancer: If you’re a smoker or have a long history of tobacco use, Medicare will cover low-dose CT scans for lung cancer.

Medicare Genetic Testing

Some people are at a higher genetic risk for cancer than others, meaning that they have specific gene mutations. Medicare will cover BRCA1 and BRCA2 genetic testing to find those mutations if you have a personal history of cancer. Depending on where you live, that coverage extends to multigene testing if the initial test indicates multiple mutations.

Medicare Special Enrollment Period and How to Qualify for Medicare Cancer Coverage

A cancer diagnosis means you qualify for the Medicare Special Enrollment Period (SEP). The SEP allows you to enroll in or change your plan as your treatment or other needs change. Most people have to wait for the Annual Enrollment Period (AEP), which is from October 15 to December 7, to change coverage, but you can take advantage of the SEP.

Medicare Chronic Special Needs Plan (C-SNP)

If you are diagnosed with cancer, you may be eligible for a Chronic Special Needs Plan (C-SNP). C-SNPs are a form of Medicare Advantage designed specifically for those with certain chronic illnesses and conditions.

They go above and beyond the coverage that Original Medicare provides. For example, C-SNPs provide coverage for prescription drugs. Your C-SNP will involve a network of providers that will communicate with each other about your treatment plan.

When to Enroll

You can enroll in coverage as soon as you receive your cancer diagnosis, but you must get confirmation from your doctor that you have cancer. While you are allowed to enroll in a C-SNP before your doctor verifies the diagnosis, your doctor must verify the diagnosis before you can keep the coverage.

We Can Help You Get Covered

A cancer diagnosis can be overwhelming, but the right medical coverage can help give you the chance to get the quality care you need. If you have cancer and need to enroll in a C-SNP, we will assist you with finding the best insurance plan for you. Call us at 833-438-3676 or contact us here today.

Leave a Reply

Your email address will not be published. Required fields are marked *