Does Medicare Cover My Cancer Treatment?

Does Medicare cover my cancer screening and treatment? How about chemotherapy? How much will I have to pay for my cancer treatment? Does Medicare cover the rest? How can I get help paying my medical bills?

From a purely financial perspective, most people with original Medicare and a supplement (Medigap) plan will not have to worry about how they will pay for the cost of cancer treatment. Most Medigap plans cover 100% of your hospital inpatient (Medicare Part A) expenses and the bulk of your outpatient care.

That’s not the case with Medicare Advantage.

Your out of pocket costs for cancer treatment with an Advantage plan can run several hundred or even thousands of dollars each year. If your treatment includes chemotherapy, you are generally responsible for 20% of the cost. Your plan picks up the balance.

If you are turning 65 and going on Medicare, this may be your only chance to pick a Medigap plan. Choose wisely.

Medicare shop and compare

Your information is NEVER sold. We are happy to discuss options by phone and will give you an

instant quote for the absolute lowest Medigap rate in your area. There is never any pressure to buy.

Post summary.

  • How common is cancer?
  • Will Medicare pay for treatment from ANY doctor?
  • How much will I pay for chemo?
  • Is cancer screening covered by Medicare?
  • Medicare Advantage or original Medicare and a supplement plan? Which is better?

 

Coverage for Cancer Treatment

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.cancer treatment

Original Medicare covers about 80% of your cost of care. Most Medigap plans will pick up the remainder. You can pick your own doctor(s), hospital and treatment center and a referral is never required.

Not all cancers require or even respond to chemotherapy, but there are some things you should know about the cost of chemo.

Medicare does not pay for most prescription drugs but it does cover chemotherapy. Roughly 80% of cancer patients receive chemotherapy in their doctors office or other outpatient setting.

Original Medicare pays for 80% of the cost of chemotherapy. Medigap plans F, G and N pick up the remaining 20%.

If you have a Medicare Advantage plan you pay the 20% out of pocket.

The average price of cancer drugs for a year is estimated to exceed $100,000.

Even if you have health insurance, your out-of-pocket expenses may be as much as $25,000 to $30,000 a year – Mayo Clinic

Your share of these expensive medications is reduced to almost nothing with original Medicare and a supplement plan.

The American Cancer Society estimates the average out of pocket cost for cancer treatment ranges from $3500 to $4800, depending on the type of cancer you have.

 

Medicare and Cancer Screening

Medicare does cover many routine screenings for cancer. “Free” cancer screenings with Medicare include:

  • Cervical and vaginal cancers
  • Colorectal cancer
  • Prostate cancer

Other types of cancer screening are covered under Medicare Part B and may require a small charge or copay depending on the type of plan you have.

Notes from the American Cancer Society

Medicare coverage for breast cancer screening

One screening mammogram every 12 months is fully covered for all women with Medicare age 40 and older. You can get one baseline mammogram between ages 35 and 39, too. Medicare also covers newer digital mammograms.

cancer screeningMedicare coverage for cervical cancer testing

Medicare covers one Pap test and pelvic exam every 24 months if you are at average risk for cervical cancer. If you’re at high risk for cervical or vaginal cancer or are of childbearing age and have had an abnormal Pap test in the last 3 years, the tests are covered every 12 months.

You pay nothing for the Pap lab test or for collecting the Pap test and the pelvic exam, as long as your doctor accepts assignment from Medicare. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.

Medicare coverage for colorectal cancer testing

Medicare covers colorectal screening tests in people 50 and older to help find colon or rectal cancer and/or pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Coverage for these tests depends on the person’s risk for colorectal cancer, when they had their last test, and whether something is found that needs to be removed during the test.

Medicare coverage for prostate cancer testing

For men over age 50 with Medicare, one digital rectal exam (DRE) and one prostate-specific antigen (PSA) blood test are covered every 12 months. This coverage starts the day after your 50th birthday.

Medicare coverage for lung cancer testing

Medicare covers lung cancer screening with a low dose CT scan once per year if you have Medicare, are 55-77 years old, have a tobacco smoking history of at least 30 pack years*, and you either continue to smoke or you have quit smoking within the last 15 years.

 

Need Help Paying Medical Bills?

There are several resources that can help cover the gaps when it comes to paying medical bills.

This list is by no means complete. If you know of a resource that should be added, please let us know.

Cancer Treatment, the Final Word

I enrolled in Medicare in September, 2015. Cancer is a word I know too well. My mothers twin sister and older sister died of cancer. My wife’s father and mother died because of cancer. All 5 of my father-in-laws siblings died of cancer. Two of my mother-in-laws siblings died of cancer.

I have seen what cancer can do to the human body and the misery that accompanies this dread illness. If you are diagnosed with cancer, the last thing on your mind should not be “How will I pay for my treatment?”

Currently my health is good. That has been true for most of my life. No chronic illness, not even high blood pressure or cholesterol.

But having spent the last 40 years in the health insurance business I know how quickly things can change. When my health changes I want to control the direction of my care. Insurance carriers are not going to give me a list of doctors and tell me this year I can only use these, and next year the list may change.cancer

I am in original Medicare plus Medigap plan N.

You may not know it, but the Mayo Clinic does not participate in any Medicare Advantage plans.

M D Anderson is another cancer treatment facility that does not accept Medicare Advantage plans.

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.

You may never receive a cancer diagnosis. I hope you don’t. But one thing I can tell you with certainty is this. Original Medicare and a supplement plan provides assurance the funds will be there to pay for almost all of your care.

We have rates on over 170 different Medigap plans in Georgia. We will quote you a rate over the phone and tell you who has the lowest rate.

More than that, there is no charge for our advice. No pressure. No “up-selling”.

You can also shop and compare online Medigap quotes instantly.

Medicare shop and compare

One other thing.

You don’t need a separate cancer insurance plan or a hospital plan. You can sleep well at night knowing the cost of your cancer treatment is covered in full.

Also see:

How Much Does it Cost to Treat Cancer

Cancer Treatment Resources

The Secret Life of Medicare Advantage Plans

 

 

 

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