{"id":53929,"date":"2022-09-16T23:52:08","date_gmt":"2022-09-17T03:52:08","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=53929"},"modified":"2024-10-02T11:41:41","modified_gmt":"2024-10-02T15:41:41","slug":"does-medicare-cover-cancer-treatment","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-cancer-treatment\/","title":{"rendered":"Does Medicare cover cancer treatment?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">More than <\/span><a href=\"https:\/\/healthpayerintelligence.com\/news\/beneficiaries-with-cancer-spend-less-out-of-pocket-in-medicare-advantage\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">20 million Medicare beneficiaries<\/span><\/a><span style=\"font-weight: 400;\"> are cancer patients or survivors, and in 2017, <\/span><a href=\"https:\/\/avalere.com\/insights\/one-in-5-medicare-beneficiaries-taking-a-part-d-cancer-therapy-reached-catastrophic-level-in-2017\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">1.2 million Medicare beneficiaries<\/span><\/a><span style=\"font-weight: 400;\"> filled a prescription for a cancer drug. The different parts of Medicare work to provide cancer coverage in a variety of settings and for different treatment modalities.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Medicare cancer coverage<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare Part A covers the care you receive in a hospital inpatient setting. If you\u2019re being treated at an outpatient facility or health care provider&#8217;s office, coverage will fall under Medicare Part B. <\/span><span style=\"font-weight: 400;\">Part B covers 80% of services and treatments received at an outpatient facility, such as diagnostic imaging, outpatient surgery, <a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-chemotherapy\/\">chemotherapy<\/a>, radiation, and injectable medications.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are several ways to receive your Medicare insurance, and you should evaluate your options for coverage and price. For some people with cancer, Original Medicare plus a Medicare Part D Plan may be a good option. You may also want to consider secondary coverage with a Medigap plan. Additionally, you may want to consider a <\/span><a href=\"https:\/\/www.medicare.gov\/sign-upchange-plans\/types-of-medicare-health-plans\/special-needs-plans-snp\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Special Needs Plan<\/span><\/a><span style=\"font-weight: 400;\"> designed specifically for people with cancer.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you choose to enroll in a Medicare Advantage plan (Part C) instead, you\u2019ll more than likely reach your maximum out-of-pocket (MOOP) limit for cancer treatment due to cost-sharing. If you meet your MOOP, you will no longer owe cost-sharing for covered Part A and Part B services, and those services will be paid for by Medicare.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">What\u2019s covered<\/span><\/h3>\n<p><b>Part A covers:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Inpatient hospital stays, including cancer treatments you get while you\u2019re an inpatient in the hospital\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Skilled nursing facility care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Home health care (like rehabilitation services for physical therapy, speech-language pathology therapy, occupational therapy, or skilled nursing care)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Any blood transfusions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some costs of clinical research studies while you\u2019re an inpatient in the hospital<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Surgically implanted breast prostheses after a mastectomy, if the surgery takes place in an inpatient setting<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hospice care<\/span><\/li>\n<\/ul>\n<p><b>Part B covers:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Healthcare provider visits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Many chemotherapies and cancer drugs are administered through your vein in an outpatient clinic or a healthcare provider\u2019s office<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some oral chemotherapy treatments<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Immunotherapy treatments<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Radiation treatments in an outpatient clinic<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diagnostic tests (like X-rays and CT scans)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Durable medical equipment (DME) (like wheelchairs and walkers)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Enteral nutrition equipment (feeding pump) as DME that your healthcare provider prescribes for use in your home<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Outpatient surgeries<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Breast prostheses (external breast prostheses, including a post-surgical bra) after a mastectomy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Mental health services, including services that you usually get outside a hospital (like in a clinic, healthcare provider\u2019s office, or therapist\u2019s office) and services you get in a hospital\u2019s outpatient department<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nutritional counseling if you have diabetes or kidney disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certain preventive and screening services like Pap tests and colorectal cancer screenings<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some costs of clinical research studies while you\u2019re an outpatient<\/span><\/li>\n<\/ul>\n<p><b>Part C covers:<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Part C is also known as Medicare Advantage. With a Medicare Advantage plan, your benefits are regulated by the federal government. This means that the Medicare Advantage plan must cover the same services Part A and Part B cover. The difference is that the private health insurance company can have different rules and costs. This means the plan may cover the same services as Part A and Part B, but the out-of-pocket costs, such as premiums, deductibles, coinsurance, and copayments, are not standardized.\u00a0<\/span><\/p>\n<p><b>Part D covers<\/b><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription drugs for chemotherapy only if taken by mouth<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Anti-nausea drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Other prescription drugs used in the course of your cancer treatment, like pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medication<\/span><\/li>\n<\/ul>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/medication-management-for-cancer-patients-and-caretakers\/\"><b>Medication management for cancer patients and caretakers<\/b><\/a><\/p>\n<h3><span style=\"font-weight: 400;\">What\u2019s not covered<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare does cover the majority of cancer screenings and treatments. If your cancer screening or treatment is denied by Medicare, \u200b\u200byou have the right to appeal any decision made by Medicare if you disagree with it. You can also appeal if Medicare stops paying for any cancer screenings or treatments that you still need.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Oncologists near you who accept Medicare<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The Centers for Medicare &amp; Medicaid Services has a fantastic tool that allows you to <\/span><a href=\"https:\/\/www.medicare.gov\/care-compare\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">search for healthcare providers and hospitals near you<\/span><\/a><span style=\"font-weight: 400;\"> that accept Medicare. This, of course, includes oncologists. All you have to do is enter your location, select healthcare provider and clinicians or hospitals, then in the keywords area, enter oncology and select from the drop-down menu.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How much does cancer treatment cost with Medicare?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare does not cover the full cost of cancer treatments. As with all coverage, there are out-of-pocket costs that vary depending on the facility, person\u2019s income, stage of cancer, and treatment location. <\/span><span style=\"font-weight: 400;\">A study showed that back in 2017, the average out-of-pocket costs for Medicare beneficiaries ranged between <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5441971\/\"><span style=\"font-weight: 400;\">$5,976 and $8,115<\/span><\/a><span style=\"font-weight: 400;\"> after a cancer diagnosis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare Part A covers inpatient expenses with a set deductible and coinsurance cost for each benefit period. <\/span><span style=\"font-weight: 400;\">A benefit period begins the day that you are admitted to a hospital or skilled nursing facility and ends after you have stopped receiving inpatient care for 60 consecutive days.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare Part B covers outpatient cancer-related expenses (like radiation and chemotherapy), and has a set deductible and coinsurance percentage that you are required to pay<\/span><\/p>\n<p><span style=\"font-weight: 400;\">With a Medicare Advantage plan, you can expect to reach the MOOP limit when receiving cancer treatments. Medicare Advantage also may require prior authorization, while Original Medicare does not. Some Part C plans may set the MOOP at a lower level, so it is important to consider when choosing a Part C plan.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The cost of prescription medications under a Medicare Part D plan will vary. It\u2019s always best practice to look closely at the prescription drug plan formulary to ensure all your cancer medications will be covered.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Other ways to save on cancer treatment<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Cancer treatments may be expensive, but there are ways to save. Your healthcare provider may be able to help you with financial assistance or align you with organizations that help patients with the cost of cancer treatments. Learn how else you can save on cancer treatments.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">1. Medicare Extra Help<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If you&#8217;re considered low-income or dual-eligible for both Medicare and Medicaid, then it&#8217;s possible that all your out-of-pocket costs for cancer medications could be covered with help from the <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> program under Part D.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This federal initiative reduces your out-of-pocket costs by eliminating prescription premiums as well as deductibles while also reducing copays, depending on what level of assistance you qualify for.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">2. SingleCare coupons<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicare and other medical insurance plans don&#8217;t cover the full cost of cancer medications. But there is a way for you to get those necessary prescriptions at a lower cost. <a href=\"https:\/\/www.singlecare.com\/blog\/can-i-use-singlecare-and-medicare\/\">SingleCare<\/a> offers <\/span><span style=\"font-weight: 400;\">free coupons<\/span><span style=\"font-weight: 400;\"> that can save patients as much as 80% on their medications\u2014even if they&#8217;re covered by Medicare or another type of healthcare coverage plan.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">3. Medicaid<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Medicaid is a financial assistance program that helps provide affordable health coverage. If eligible for Medicaid, you may be able to receive health insurance for little to no cost. The Medicaid <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">eligibility requirements<\/span><\/a><span style=\"font-weight: 400;\"> vary from state to state, and coverage can be used in conjunction with your Medicare coverage.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">4. Manufacturer rebates &amp; coupons<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Depending on your prescribed cancer medication, coupons may be available through the drug manufacturer.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">5. Patient assistance programs<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Some manufacturers do offer a patient assistance program. Your best option is to research online if the manufacturer offers this type of program.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">6. Free samples at your doctor&#8217;s office<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">To save money on your prescriptions, ask for free samples at your healthcare provider&#8217;s office. Drug company representatives may leave samples at healthcare provider offices. However, this is not a long-term solution.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>More than 20 million Medicare beneficiaries are cancer patients or survivors, and in 2017, 1.2 million Medicare beneficiaries filled a prescription for a cancer drug. The different parts of Medicare work to provide cancer coverage in a variety of settings and for different treatment modalities. Medicare cancer coverage Medicare Part A covers the care you [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":53930,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[794,608,15],"coauthors":[20918],"class_list":["post-53929","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-cancer","tag-health-insurance","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Medicare coverage of cancer treatment<\/title>\n<meta name=\"description\" content=\"Medicare covers many aspects of cancer care, like preventive screenings, inpatient and outpatient care, chemotherapy, and radiation. 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