On occasion, this blog allows guest experts to submit a post on a complicated topic. This week, I am delighted to have a post on how Medicare will cover the prevention, diagnosis and treatment of cancer. The post also goes into detail on the differences in your coverage if you have a Medigap or Medicare Advantage plan.
This post on Medicare and cancer benefits was written by Danielle Kunkle, the co-founder of Boomer Benefits, an
insurance agency specializing in Medicare-related insurance products in 47 states. Her contact information is included at the end of this article.
Medicare and Cancer Benefits
If you have
cancer or a family history of cancer, you may have concerns about how Medicare
will cover treatment of cancer. Treatment for cancer can be expensive, but
Medicare will be an enormous help with diagnosing and treating this health
condition.
Medicare
provides a wide range of cancer services from preventive care all the way to
surgery and chemotherapy. Understanding Medicare’s coverage of cancer treatment
starts with first understanding the parts of Medicare.
Original Medicare Parts A and B
Part A is
your hospital insurance. It will pay for hospitalization, skilled nursing,
blood, home health care and hospice.
Part B is
your outpatient insurance. It covers doctor visits, lab-work, durable medical
equipment, surgeries, ambulance and many other medical services. In relation to
cancer, Part B will also pay for chemotherapy, radiation, second opinions
before surgery, drugs administered in a clinical or hospital setting, and
physical therapy or rehab care.
Medicare
Part B also provides mental health care to deal emotionally with your diagnosis
and preventive care screenings, such as mammograms, cervical screenings, prostate
exams and colonoscopies.
Medicare Part D Drug Coverage
Part D is
for your retail prescription drugs. Although Part D is optional, it is really
very important when it comes to cancer care. This is because some cancer
medications and anti-nausea medications are now in an oral form which you pick
up yourself at a pharmacy. You will want good coverage for these potentially
expensive medications.
Your Part D
pharmacy card will provide drugs to you at a copay level instead of you paying
full price. Most importantly, all Part D plans provide catastrophic coverage.
After your spending reaches a certain annual limit, the insurance company then
must pay 95% of the cost of your medications for the rest of the year.
Common Questions Regarding Medicare
and Cancer
Here are
some of the most common cancer questions we receive in relation to Medicare’s
coverage of cancer treatment.
Is Immunotherapy covered by Medicare?
Immunotherapy
is a form of treatment which helps the body’s immune system fight cancer. Medicare
Part B provides coverage for most intravenous medications which are considered reasonable
and necessary. Check with your doctor before beginning treatment.
What will be my cost for cancer
treatment under Medicare?
You are
responsible to pay for your hospital and outpatient deductibles, which are set
by Medicare each year. You are also responsible to pay 20% of the cost of your
Part B services. There are Medigap plans available which pay after Medicare
pays its share. The one with the most comprehensive coverage is Plan F, which
will cover 100% of your cost-sharing responsibility.
Medicare
beneficiaries can enroll in any Medigap plan without health questions during
the first 6 months after their Part B effective date. There are no pre-existing
condition exclusions or waiting periods if you apply during this Medigap open enrollment period.
If a Medigap
plan is not in your budget, another alternative is Medicare Advantage. Also
called Part C, Medicare Advantage plans are private plans which pay instead of
Medicare. These plans usually have a network of doctors from whom you will get
your care. Some plans require you to choose a primary care doctor who can then
refer you to your oncologist and other specialists.
Medicare
Advantage plans often have lower premiums than Medigap, but you will pay copays
for your various treatments as you go along. As long as you apply during a
valid election period and live in the plan’s service area, most people with
Original Medicare can get approved for a Medicare Advantage plan. There is only
one health question about end-stage renal disease which could prevent you from
being covered under a Medicare Advantage plan.
Which cancer doctors can I see while
on Medicare?
Medicare has
over 800,000 providers. Many cancer treatment centers and specialists
participate in Medicare. Visit Medicare’s website to find a list of
participating providers.
How Do I Know if a Drug is Covered by
Part B or Part D?
Part B
typically covers drugs which are offered in intravenous form. However, if your
doctor prescribes an oral version of one of these medications or an anti-nausea
medication, Part B may cover it. Your doctor must give it to you within 48
hours of your cancer treatment.
If you take
a drug which only comes in oral form, your Medicare Part D drug plan will
likely cover it. Should you be prescribed a drug that is not on the formulary,
your doctor can file an exception with your drug plan to request coverage for
it.
Does Medicare cover second opinions?
Sometimes
cancer patients want a second opinion before a surgery. Medicare Part B does
cover this at 80%. Most Medigap plans will cover the other 20%. If you are
enrolled in a Medicare Advantage plan, check your plan’s summary of benefits to
determine what your copay will be for this doctor visit.
Author Bio
Danielle Kunkle is the co-founder of Boomer Benefits, an
insurance agency specializing in Medicare-related insurance products. They help
baby boomers new to Medicare learn about their benefits and coverage options
across 47 states. You can reach her at dkunklebb@gmail.com or 1-855-732-9055.
If you are interested in more information on common medical issues as you age, retirement planning, Social Security, Medicare, and more, please use the tabs or pull-down menu at the top of the page to find links to hundreds of additional helpful articles.
Watch for my book, Retirement Awareness: 10 Steps to a Comfortable Retirement, which will be released by Griffin Publishing in 2017.
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