According to the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, nearly 40% of people will eventually be diagnosed with some form of cancer at some time in their life. Considering that increased age is a common risk factor for many cancers, it’s easy to believe that the 65 – 74 age range had the most cancer diagnoses from 2007 to 2011.
Since seniors experience the most cancer diagnoses, Medicare is responsible for insuring many cancer patients. Because of this, Medicare has made sure to provide substantial coverage for cancer treatment.
Medicare Part A Cancer Coverage
Each part of Medicare is in charge of a different portion of your care. Medicare Part A covers your inpatient stays at hospitals, skilled nursing facilities, and other places. Part A also covers other care, such as hospice care and some home health services.
For cancer patients who have an inpatient stay at a hospital for cancer treatment, Part A will cover their first 60 days in the hospital at 100%. The patient will owe their Part A deductible for these 60 days, which as of 2019 is $1,364.
If the hospital stay lasts longer than 60 days, the patient will also be responsible for the Part A daily copay. If the stay is anywhere between 61 days and 90 days, the daily copay is $341. If the stay exceeds 90 days, the copay increases to $682. The maximum amount of consecutive days that Part A will cover is 150. After 150 consecutive days in the hospital, you pay for 100% of your stay.
The Part A deductible and copays usually increase from year to year. Therefore, these numbers may be different in 2020.
Part A also covers skilled nursing facility (SNF) stays after a 3-day stay in the hospital if your doctor recommends you finish your recovery there. Your first 20 days at the SNF is also covered at 100% under the Part A deductible. If your doctor recommends you finish your recovery at home, then Part A may help cover short-term home health care.
Medicare Part B Cancer Coverage
While Part A covers your inpatient stays, Part B covers your inpatient and outpatient medical services such as doctor visits, MRIs, CTs, lab work, chemotherapy, radiation, surgery, therapy, and other supplies.
For example, if you went to the doctor for an exam or lab work, Part B pays. However, if you had an inpatient stay in the hospital, Part A and Part B would pay. Part A would cover your stay, while Part B covered your medical services while in the hospital, such as lab work, surgery, and doctor visits.
Part B’s deductible is annual, unlike Part A’s deductible, which is charged for each new benefit period (60 days). As of 2019, Part B’s deductible is $185 per year. After you meet that, Part B will cover 80% of your services, while you cover 20%.
For instance, if you go to the doctor and are charged $300, you will pay $185, Part B will cover 80% of the remainder of the bill, which would be $92, and you’d pay $23, making your total out of pocket $208.
Then, for the rest of the year, Part B would cost 80% of the allowable charges for Medicare-approved services. Keep in mind that there is no cap on how much you can spend on Medicare-covered services, so you should consider a Medicare plan to help protect you from catastrophic health care expenses.
Chemotherapy Coverage with a Medicare Plan
Chemotherapy is a medical service covered under Part B at 80%. If your chemotherapy bill is $10,000, Part B will pay $8,000, and you pay $2,000.
However, as many cancer patients know, chemotherapy is not cheap and is usually needed for several months. A $2,000 bill every month can add up fast. That’s where Medicare plans like Medigap and Medicare Advantage come into play.
Medigap plans cover the out of pocket charges under Medicare Part A and Part B, such as deductibles and coinsurance. If you enrolled in a Medigap Plan G, your Part A deductible, Part B coinsurance, and Part B excess charges would be covered at 100%. You’d only be responsible for your $185 Part B deductible.
Medicare Advantage plans may also lower your out-of-pocket costs. These plans usually have a low monthly premium with copays or coinsurance when you access care. Medicare Advantage plans have an annual out of pocket cap. As of 2019, that out of pocket maximum is $6,700 per year..
Medicare Part D Cancer Coverage
Medicare Part D handles prescription drug coverage. Your oral cancer medications can be found on Part D plan’s drug formularies. However, Part D plans aren’t required to cover all cancer drugs. Therefore, it’s important that you find a plan that covers your most important cancer drugs.
Medicare plans and costs can change from year to year. However, we aren’t expecting any coverage changes for cancer treatment in 2020. One thing to look out for is Medicare Advantage plans that will soon offer more in-home health care benefits. This added benefit could help many cancer patients in the future.