How much does it cost to treat cancer? Can I afford treatment? What if I can’t pay? What is Medicare ABN? Living and dying with cancer. Does a cancer diagnosis have to mean a death sentence? Where can I get help paying for my treatment?
Table of Contents
Does Medicare cover the cost to treat cancer?
The good news is, routine cancer treatment is covered by Medicare. Some cancer treatments can be very expensive . . . $5,000 to $10,000 per treatment.
If the procedure to treat cancer is administered in a doctor’s office or clinic, the good news is, that is a Medicare Part B expense. But only if your treatment is a Medicare covered expense . . . .
Martha and the Medicare ABN
Martha is a 3 year cancer survivor . . . of sorts. Two bouts with cancer in three years and now the cancer has returned.
Most of the routine medications had been tried, leading to only a temporary remission. But now her oncologist wanted to try something new. The problem was, this medication was not on the approved list for ovarian cancer.
“I’m most optimistic about this new one. It works in women who haven’t had any treatment, but prior studies have shown it works on women who have already received treatment. I would recommend we try it; if it doesn’t work, we do have other standard options available.”
“Sounds good,” she said.
“Great!” I stepped out of the room to inform our practice nurse of my plan.
She listened as I told her of my plan and after I stopped talking, asked calmly: “You realize that it’s not approved in ovarian cancer, right?”
“Yes, I realize that,” I said. “What’s your point?” I asked, with more than a little irritation in my voice.
“Well,” our nurse continued, “it’s a pretty expensive drug and she has Medicare. So if you want to give it, she has to be aware that there’s a pretty good chance it won’t be covered, and she will have to sign an ABN.”
If your doctor mentions the ABN form (Advance Beneficiary Notification), do not dismiss it. In simple terms, this is what it means.
If Medicare denies payment for the procedure you are 100% liable for the cost of care.
Medicare supplement plans won’t pay either.
What is the Medicare ABN form?
“an ABN should be issued when the clinician (or his institution, in this case) believes Medicare may not pay for it or may not consider it as medically reasonable or necessary for the patient, despite any prior record that Medicare had covered it in the past. The ABN is meant to protect the institution from nonpayment by getting the patient to accept the financial liability that comes with Medicare nonpayment. Essentially, it guarantees someone will pay for the treatment — even if it means the entire bill rests with the patient.”
If the patient refuses to sign the form, the provider is within their right to refuse treatment.
Paying to treat cancer
What happens if Medicare won’t cover your cancer treatment? What then?
Some cancer policies will step in and pay a lump sum direct to you on first diagnosis, even before your treatment begins. Of course these policies must be in place before you are diagnosed with cancer.
There are other cancer treatment resources for Georgia Medicare beneficiaries.