Cancer and Medicare – How Are You Covered?

Cancer is most prevalent in senior age groups. According to the Centers for Disease Control and Prevention (CDC), there were nearly 265,000 new cancer cases in 2016 in the United States within the age group of 65 to 69. Globally, seniors make up 60% of new cancer diagnoses.

Many of these new cancer patients have either just entered Medicare or have only been on Medicare for a few years. It’s reassuring to know that Medicare has comprehensive coverage for cancer care.

Medicare Part A Cancer Coverage

Medicare Part A provides coverage for in-patient facility stays. When you need to stay in a hospital or skilled nursing facility (SNF), Part A pays for your bed and meals.

Hospital Stays with Part A

Like all parts of Medicare, Part A has a deductible. What makes Part A’s deductible different from Part B is that the Part A deductible is per benefit period rather than per year. A benefit period starts the day you’re officially admitted to the hospital and ends once you have been discharged from the hospital for 60 consecutive days.

As of 2019, the Part A deductible is $1,364. This deductible covers your first 60 days in the hospital. If after 60 days you’re still in the hospital, you pay a daily copay of $341 for days 61 through 90 and $682 for days 91 through 150.

For example, if you are admitted to the hospital for surgery to remove your cancer, you will owe $1,364 plus any daily copays if you stay past 60 days.

Skilled Nursing Facility Stays with Part A

After your surgery, your doctor may recommend you finish your recovery in a skilled nursing facility. Your Part A deductible will also cover the first 20 days in an SNF. Medicare requires you have at least a three day stay in the hospital to qualify for a covered SNF stay.

If your recovery takes longer than 20 days, you pay a daily copay. From day 21 until day 100, your copay is $170.50 as of 2019.

Medicare Part B Cancer Coverage

Part B supplies cancer patients with the majority of their coverage. Part B will cover your outpatient medical services as well as medical services while in the hospital.

Medicare Part B will cover your doctor visits, lab work, imaging, surgery, chemotherapy, and durable medical equipment. When Part B accepts a claim, it will cover 80% of the claim after a $185 annual deductible (2019). In addition to the deductible, you pay a 20% coinsurance amount.

For example, if you get blood work done, an MRI, surgery, and a round of chemotherapy with a Medicare-approved bill of $20,000, then you will pay $185 plus nearly $4,000. You’ll also owe a Part A deductible.

Medicare Part D Cancer Coverage

While Part A and Part B are handled by Medicare itself, Part D is handled by a private insurance carrier. Each Part D plan has to be structured the same way and abide by the same rules, but each carrier decides which drugs to cover and cost-sharing structures.

All Part D plans must cover at least two medications in every drug class. This allows your doctor to have a couple of options when prescribing a medication that is covered by your plan. What you pay for each medication will depend on your plan, the tier of the drug, and what stage of your plan you are in.

You may wonder why Part B covers chemotherapy, even though technically, that is a drug. Part B covers drugs that are administered to you by a medical professional, while Part D covers drugs you administer yourself.

Additional Medicare Plans

You have the option to buy a Medicare plan to help cover your out-of-pocket expenses. You can choose between a Medigap plan or Medicare Advantage plan. Each type of plan has many options to choose from.

For instance, a Medigap Plan G covers all out-of-pocket expenses for Part A and Part B services except your $185 deductible. Therefore, with Plan G, you’d only be responsible for the deductible in the example mentioned earlier rather than several thousand dollars.

You should study each type of Medicare plan available in your area to figure out which one is most cost-effective for you and your cancer coverage.