Medicare And Cancer - Understanding What’s Covered

By: Meredith Miller
Published: Tuesday, February 12 2019
Last Updated: 3 years ago

When you grow older and retire, the last thing you want to think about is your health. However, in 2009, over 50% of all cancer occurrences were diagnosed in adults 65 years and older according to the American Journal of Preventive Medicine. The journal also stated that number is due to grow to 70% by the year 2030.

Perhaps one of the greatest fears today is being diagnosed with cancer, and nobody likes to think it could happen to them. What we’re here to discuss is what happen if it does. Do you know what your treatment options are?

Medical technology and healthcare have come a long way since the early days of cancer treatment, but that doesn’t mean it’s gotten any more affordable. Another major concern for cancer patients stems from the financial burden they are about to incur along the road ahead. When you’re on a fixed income, which most American seniors are, you begin to wonder whether or not your cancer treatments will be covered by Medicare, and that’s what we’re here to help you with.

Is Cancer Covered by Medicare?

AARP estimates that the average cost for cancer treatment is around $150,000. This huge price tag makes many cancer patients uncomfortable with seeking out treatment. The good news is that Medicare cancer coverage is real. While Medicare for cancer patients is very specific about what it will and will not cover, elderly patients on Medicare can rest a bit more comfortable knowing that many of their cancer treatment bills will be covered by the Medicare coverage.

Medicare Part A Cancer Coverage

Medicare Part A insurance is also known as your hospital coverage. That is honestly the easiest way to remember which part of your Medicare coverage pays for which bill. In regards to cancer, Medicare Part A covers medically-necessary cancer-related services and treatments. These treatments include things like:

  • Blood testing
  • Blood transfusions
  • In-patient stays
  • Any treatments received while an inpatient at a hospital
  • Hospice costs

One fact that surprises many women is that Medicare Part A will actually cover the cost of a surgically-implanted breast prosthesis. If a woman needs to have a mastectomy due to cancer, and the surgery takes place while the woman is an inpatient at a hospital, Medicare will cover the cost of a prosthesis.

Medicare Part B Cancer Coverage

Medicare Part B is the part of Medicare that works as your medical insurance. This is the insurance that is billed whenever you have a checkup at your primary care physician’s office. Basically, any outpatient expenses you may have for any medical situation are billed to Medicare Part B. When it comes to talking about cancer, Medicare Part B can be used for cancer screening and some treatment.

Medicare Part B covers preventative screening, including paying for 1 mammogram every year and a pelvic exam every 24 months for women who are at risk of cervical cancer. Men who are over the age of 50 can receive a prostate cancer screening once a year as well. When it comes to Medicare cancer coverage, part B Is responsible for providing benefits for tests that are used to diagnose cancer, this includes diagnostic text such as X-rays and CT scans.

Does Part B Medicare cover cancer treatments? When it comes to treatment options, Part B Medicare cancer coverage includes payment for a variety of different outpatient treatments including radiation, surgery, and vein, or orally administered chemotherapy. Part B may also cover some costs that are associated with clinical research studies as well. Heartbeat also covers medical equipment, such as Walkers and wheelchairs or an intravenous pump if your doctor prescribes it for you to use at home.

How Much You’ll Pay Out-Of-Pocket

While you can rely on Medicare coverage, you’ll also be required to pay some out-of-pocket costs for cancer treatment. The leftover cost after Medicare for cancer patients has kicked in varies depending on the type of cancer you have and the type of treatment and medications your doctor deems necessary to fight your disease.

There will always be a deductible that you’re required to pay if you’re only using Medicare coverage. The deductible varies depending on a variety of things but it’s safe to assume that, with only Medicare coverage, you will wind up paying at least a few thousand dollars out-of-pocket per year.

Reducing Your Medicare Coverage Costs

If you’re wondering if there’s any way to reduce the cost of cancer through Medicare, there is. First, consider investing in a supplemental insurance plan, also known as Medigap coverage. Supplemental plans can help reduce your out-of-pocket costs by thousands of dollars a year.

Another option is enrolling in a Medicare Advantage plan to help cut costs and save money. Known as Part C, this type of plan is a good option for a patient who is searching for how to make Medicare for cancer patients more affordable as it drastically lowers the deductible and amount due out-of-pocket.

Medicare Prescription Drug Costs for Cancer Patients

One of the biggest costs that Medicare cancer payments have to deal with is prescription drug costs. While some prescription drugs are covered under Medicare, others may not be. Regardless, your best bet is to explore Medicare Part D plans, which are specifically designed to help you cover the costs associated with your medication and prescription drugs. It is possible to have your doctor prescribe drugs that are lower in cost to help you save money, so make sure that you speak with your physician if you’re worried about prescription drug costs.

Are You Covered After 70?

Yes, Medicare does cover cancer treatment costs for beneficiaries of all ages, and that includes patients over 70 and 76 years old. There may, however, be more of a deductible required. When it comes to Medicare for cancer patients it’s best to speak with your physician and billing expert, to learn what you can, and can’t, trust Medicare to cover.