Medicare and Cancer: A Guide for Cancer Patients
Receiving a cancer diagnosis can be an overwhelming experience. If you or someone you love has been diagnosed, you're probably worried about health and well-being in addition to the high cost of cancer treatment. Fortunately, Medicare covers many of the expenses accrued during your treatment.
The cost of cancer supplies and treatment under Medicare
If you only have Original Medicare (Part A & Part B), then Medicare will cover 80% of costs (once you’ve met your deductibles). Especially if you’ve been diagnosed with cancer, 20% of all your medical costs can add up. 90% of Medicare beneficiaries enroll in supplemental Medicare plans to reduce their healthcare expenses.
Depending on your supplemental Medicare insurance, some of your costs may be significantly lower. Medicare Supplement (Medigap) plans will reduce or eliminate the 20% of costs of covered services that Original Medicare doesn’t pay. Medicare Advantage plans will limit your out-of-pocket expenses and sometimes provide coverage for additional services. Each Medigap and Medicare Advantage plan varies, and you can work with a Medicare agent to understand or change your plan to best meet your needs.
Medicare coverage for cancer supplies
Depending on the treatment plan you and your doctor choose, there are specific supplies and treatments you’ll need. Medicare Part B covers most supplies you’ll need during or after treatment. You'll need to get your supplies from a doctor or medical equipment company that accepts Medicare to get full coverage. If you have a Medicare Advantage plan, make sure to ask your provider if they take your specific plan. The following are standard cancer supplies that Medicare covers.
Breast Prostheses
Many women with breast cancer will undergo a mastectomy (a surgical procedure that removes one or both breasts). You can get external or internal breast prostheses if you require or choose to have a mastectomy. External breast prostheses, including post-surgical bras, are covered by Medicare Part B. If you choose to have internal breast prostheses surgically implanted, you may be covered by either Part A or Part B.
Ostomy Supplies
A Colostomy, Ileostomy, or Urinary Ostomy may be part of your treatment for Colon Cancer or other cancers that affect the digestive or urinary systems. Medicare Part B will cover ostomy supplies deemed medically necessary and ordered by your doctor from a company that accepts Medicare.
Durable medical equipment (DME)
Often during the course of treatment, cancer patients require medical equipment to help with treatment or recovery. Durable medical equipment includes supplies like:
Walkers
Wheelchairs
Nebulizer machines
Nutrition equipment, like feeding pumps
Hospital beds
Oxygen equipment and accessories
For these supplies to be covered, they must be ordered by your doctor—and your doctor and the equipment company need to be enrolled and in good standing with Medicare.
Depending on the type of equipment you need, Medicare may require you to rent or buy the equipment. Medicare covers 80% of the cost of rented equipment for 13 months. Many times after 13 months, you automatically take ownership. Medicare may require that you purchase equipment that is not very expensive. You will only pay the 20% coinsurance on these items if you’ve met your Part B deductible.
Medicare drug coverage for cancer treatments
Depending on the type of treatment you receive, and the location where you receive it, your cancer treatment may be covered by Original Medicare or Part D. You must be enrolled in a Part D (prescription drug) plan to obtain coverage for medications and treatments not covered by Original Medicare.
Chemotherapy
Medicare covers chemotherapy for cancer patients. How much you pay depends on your specific coverage.
There are limits to the number of treatments that Medicare will cover. Your doctor may want you to have more treatments than are covered by Medicare. If this is the case, you may be responsible for 100% of the cost of the additional treatments. Be sure to ask questions and find out what is covered before you get the treatment to avoid surprise medical bills.
Radiation
Medicare Part A covers inpatient radiation treatment. Medicare Part B covers outpatient radiation treatments.
Oral and Topical Medications
Medicare Part D covers most cancer medications that are taken at home. While most people think of chemotherapy as being administered by an IV, some chemotherapy drugs can be taken by mouth or applied topically. Topical chemotherapy medications are a common treatment or follow-up treatment for skin cancer. Other chemotherapy drugs can be taken by mouth or dissolved under the tongue.
Like other medications you pick up at your pharmacy, you must be enrolled in a Medicare Part D plan that covers the prescription drugs you need to receive coverage. Remember that even with your Part D plan, you may be responsible for a copay or a coinsurance charge.
Preventative services for Medicare beneficiaries
Early cancer detection can improve your chance of successful cancer treatment. Medicare Part B covers many preventative screening services, including cancer screenings. Most cancer screenings are simple outpatient scans or exams that can improve your chances of catching cancer earlier. Many screenings are covered at no cost to you, including:
Pap smears and HPV testing for women
Breast exams and mammograms
Bone density testing
Colon cancer screening, including fecal tests, colonoscopies, and flexible sigmoidoscopies
Lung cancer screening with low-dose CT scans
Prostate screening by digital rectal exam and PSA blood testing
Cancer supplies not covered by Medicare
Medicare covers most supplies and services needed for cancer treatment, but a few are not covered. While feeding pumps and equipment are covered, medical food and nutritional supplements are generally not.
If you have questions about how you're covered under Medicare, schedule time to discuss the details with one of Chapter’s Medicare Advisors. We’ll help you understand how your current Medicare coverage works and help you enroll in a plan with better coverage if there’s an opportunity.