Medicare Cancer Coverage includes a range of services:
- Inpatient hospital care for cancer treatment
- Cancer-related surgeries
- Consultations with oncologists and other physicians
- Second opinion consultations
- Chemotherapy and radiation treatments
- Medications for chemotherapy and managing side effects like nausea
- Participation in clinical trials
- Skilled nursing and home health services
- Durable medical equipment
- Physical therapy and rehabilitation
- Short-term nursing home care
- Hospice or End of Life care
Your out-of-pocket expenses vary depending on whether services are under Part A or Part B. For instance, chemotherapy can be administered on an inpatient or outpatient basis. Most beneficiaries access benefits through Original Medicare or a Medicare Advantage plan, each with different cost-sharing arrangements. Let’s delve into potential costs for these coverage options.
Original Medicare Coverage of Cancer Treatment
For those enrolled in Original Medicare, including a Medicare supplement plan (Medigap), benefits are provided directly through Medicare Parts A, B, and D. You have the flexibility to consult any Medicare-accepting doctor or provider.
Medicare Part A Cancer Coverage
Medicare Part A covers most cancer treatments during hospitalization. Part A has a deductible that you must satisfy before your benefits begin. This deductible may be incurred multiple times depending on hospital stays in a year, but many Medigap plans can cover it. Additionally, Part A includes coverage for skilled nursing post-hospitalization for cancer surgery, with the first 20 days fully covered, and hospice benefits if required at a certified facility. Accessing benefits for those in a Medicare Advantage plan will be discussed below.
Medicare Part B Cancer Coverage
Under your preventive care benefits, Medicare Part B fully covers specific cancer screenings. Additionally, Part B extends coverage to chemotherapy or radiation administered at your doctor’s office or a standalone clinic. Following payment of the Part B deductible, Medicare shoulders 80% of the outpatient care expenses, leaving you responsible for the remaining 20%. For cancer treatments falling under Part B, this 20% co-payment applies without a spending cap.
Medicare Advantage Coverage for Cancer
Medicare Advantage plans offer coverage for the same services as Original Medicare Parts A and B. However, the method of accessing benefits and the associated costs differ. Typically, these plans operate within an HMO or PPO network of providers, where seeking care within the network ensures lower copays. It’s important to note that certain oncologists or hospitals may not be included in the plan’s network.
Under Medicare Advantage plans, you encounter cost-sharing or copays for services as you utilize them. For some cancer-related services, Medicare Advantage plans may require up to a 20% coinsurance from you, meaning you contribute a percentage of the treatment cost.
Main Points to Remember:
- Medicare Part A and Part B provide coverage for cancer treatment both in and out of medical facilities.
- Medicare Advantage plans assist in covering cancer treatment, but you might face a 20% coinsurance for chemotherapy until you reach your plan’s maximum out-of-pocket limit.
- Remember that cancer drugs may fall under Part D, potentially incurring significant costs.