Medicare and Cancer Patients

Cancer can be a daunting diagnosis, but knowing your Medicare coverage for Cancer options can help ease the burden. In this article, we will provide a detailed overview of Medicare coverage for cancer patients and answer frequently asked questions.

Does Medicare pay for cancer treatment?

Yes, cancer treatment is covered under Medicare in the United States. Medicare Part B covers certain cancer treatments, including chemotherapy and radiation therapy, as well as some medications used in cancer treatment. However, coverage may vary depending on the specific treatment and the individual’s Medicare plan. If you have a Medicare supplement plan F with United Healthcare or Aetna, it is covered completely. It’s important to check with your healthcare provider and Medicare plan to understand your coverage options and any associated costs.

Medicare Part B Coverage for Cancer

Medicare Part A covers inpatient hospital care, hospice care, skilled nursing facility care, and home health care. If you are diagnosed with cancer and require inpatient hospital care, Medicare Part A will cover the costs of your hospital stay, including room and board, nursing care, and meals. If you need hospice care, Medicare Part A will cover your care related to your terminal illness.

Medicare Part B Coverage for Cancer

Medicare Part B covers medically necessary services and preventive care, including doctor’s visits, outpatient hospital care, and diagnostic tests. If you have cancer, Medicare Part B will cover chemotherapy, radiation therapy, and other treatments necessary for your cancer care.

Medicare Part C Coverage for Cancer

Medicare Advantage plans (Part C) are offered by private insurance companies and provide all of the benefits of Medicare Parts A and B, and sometimes Part D. If you have cancer, Medicare Advantage plans may offer additional benefits, such as coverage for dental or vision care.

Medicare Part D Coverage for Cancer

Medicare Part D covers prescription drugs. If you have cancer and require prescription drugs, Medicare Part D can help cover the cost of your medications.

FAQ About Medicare Coverage for Cancer

Does Medicare cover cancer screenings?

Yes, Medicare Part B covers cancer screenings, such as mammograms, colonoscopies, and prostate cancer screenings.

Does medicare cover cancer radiation treatments?

Yes, Medicare does cover cancer radiation treatments. Radiation therapy is a common treatment for cancer, and Medicare Part B covers radiation therapy services, including the use of radiation equipment and supplies. The coverage may vary depending on the specific type of radiation therapy and the individual’s Medicare plan. It’s important to consult with your healthcare provider and Medicare plan to understand your coverage options and any associated costs.

What if I require experimental cancer treatment while on Medicare?

Medicare may cover some experimental cancer treatments if they are considered medically necessary and meet certain criteria.

What if I can’t afford cancer treatment while on Medicare?

If you have limited income and resources, you may qualify for Medicare’s Extra Help program, which can help cover the costs of your prescription drugs.

Does Medicare cover cancer treatment after age 70?

Yes, Medicare covers cancer treatment for individuals over the age of 70. In fact, Medicare is a health insurance program primarily designed for individuals over the age of 65, and it covers many types of cancer treatment, including chemotherapy, radiation therapy, and other necessary services.

Medicare provides comprehensive coverage for cancer care, including hospital stays, doctor’s visits, and prescription drugs. Knowing your coverage options can help alleviate the financial burden of cancer care. If you have any questions or concerns about your Medicare coverage for cancer, speak to an agent at Medicare 365 or a Medicare representative.

Does Medicare cover cancer meds?

Yes, Medicare does cover some cancer medications. Medicare Part B covers certain medications used in cancer treatment, including those administered in a doctor’s office or outpatient setting, such as chemotherapy drugs. Medicare Part D also covers prescription drugs, including some cancer medications that are taken at home. However, coverage may vary depending on the specific medication and the individual’s Medicare plan.

Here is the transcript to the video above:

I’m going to go over the best plan if you were to have a stroke, a heart attack, or any of these other major diseases. But first, my name is Brian Monahan.

I’ve been working with people going onto Medicare and people on Medicare for the past 15 years. I’m licensed in 46 states, and I help people with Medicare from A, signing up and getting their Medicare and B card to Z, completing their Medigap plan, Medicare Advantage, prescription drug plan and vision, dental and hearing plans.

In this video, I want to give you the raw data to show you what could possibly happen if you got not only cancer, but one of the other major diseases that could be financially devastating. So let’s take a look at the numbers. So if we look at a Medigap plan G and a Medigap Plan N, versus a Medicare Advantage Plan, when it comes to cancer treatment, this is pretty much easily dissected by going through what covers cancer and where does this coverage come from.

So the first thing that I want to mention is, if you look at this Medicare card to the left of the screen, everyone is going to have to pay for this card. And on average, they’re going to pay $164 and 90 cents. You’re going to pay this to the government. But the next decision that you’re going to have to make is, do I want a Medicare supplement plan, also known as a Medigap plan, or do I want to go the other route and get a Medicare Advantage Plan?

Well, the one thing that could help you make this decision is for these major diseases like cancer and so forth, is that Medicare Part B, and let me scroll up a little bit. This is coming directly from if you can see at the top left, the URL. Medicare Part B is what is used for chemotherapy treatments. I’ll read this in case you can’t see it.

Many chemotherapy drugs that are administered through your vein in an outpatient clinic or doctor’s office are covered by Part B. Now, this would be also doctor’s visits, some oral chemotherapy treatments, radiation treatments in an outpatient clinic, diagnostic tests like CAT scans and X-rays, durable medical equipment, nutrition, all sorts of things.

So let’s jump back and see what these plans actually cover. So if you are to get on a Medigap plan G or a Medigap plan N, the premium on average is going to be about $140 for a plan G per month, or $100 for a Plan N. And I’ll get into what these cover. So keep in mind you’re going to pay the $164.90 no matter what, and then if you get a Plan G, it’s going to be around $140 if you’re 65 years old, or around $100 if you’re 65 for the Plan N.

Now the Advantage Plan, their premium is going to be zero. That’s because the government is given subsidies to the Advantage Plans. But here’s the difference. Number one, if you are to stay in the hospital, with the gap plans, it’s going to cost you zero. With the Medicare Advantage Plans, it will cost you $195 a day, something like that, or it could be $300 a day, $350 a day.

But the real thing with cancer and things like strokes and so forth, is going to be the CAT scans, number one. So if you look at it with Plan G and Plan N. The Plan G, no matter what, the only thing you’re going to pay for when it comes to outpatient, which would be going to the doctors, going to the specialists, going to MRIs, CAT scans and so forth, would be $226 a deductible for the year. For Plan Annual, you’ll pay the same deductible and it will be $20 each time you go to an outpatient specialist or a doctor and so forth.

Now, with the Advantage Plans, if you had to get a CAT scan, which most likely an MRI and so forth, these are the things that you do when you have cancer or if you have anything like a stroke or heart attack, this is going to cost you between $195 to $300. So you can see how fast it adds up when you have a Medicare Advantage as opposed to those gap plans.

Now I wrote down a couple things. If I was to do a split chart, and I should have done it on the screen so that you can see it, but I did it on paper and I’ll just read it to you. So some of the biggest things. For Plan G and N, they cover the chemotherapy, which I went over. The payment for chemotherapy on a lot of these Medicare Advantage Plans… Let me just click on it here, is going to be, and this is in-network. If you look at Part B drugs, chemotherapy, 20% of what the cost is. That’s what it’s going to cost you.

Now, if your maximum out of pocket for a Medicare Advantage Plan is somewhere between 5,000 and $10,000 as I have on the chart, this is going to be an enormous amount of money out of pocket. So before I go any further, I just want to let you know, the answer to the question is, the plan G and the Plan N are going to be your best options for cancer, stroke, heart attack, any of these things. Not your Medicare Advantage Plans as far as I’m concerned.

Another thing that is big with this, if you look at the skilled nursing, you will get 100 days with a gap plan for zero cost, and with the Medicare Advantage, you’ll get 20 days zero. But here’s another thing, with the Medigap plan, the only thing that you have to ask is, does this facility take Medicare, which most of them do because this is a big money maker for the facility. But a lot of these facilities do not take the Medicare Advantage Plans. So they give you 20 days, which is 80 days less than the Medigap plan G and N, plus you might not be accepted at the facility.

I get calls all the time telling me people were not accepted at a certain facility. They want to move from a Medicare Advantage to a gap plan and at that point, if they’ve had a stroke or they now have cancer, most of them are unable to switched, if not all of them. So this is a big thing when it comes to cancer in these different diseases. So I wrote that down the facility.

So that is the biggest thing. When it comes to cancer, you have to look at, number one, how much is the cost going to be? And this will tell you right on, and I’ll try and leave this PDF down at the bottom. If you’re inpatient, the hospital, this is going to be the cancer inpatient if you stay overnight, that’s going to be covered there at zero cost to you if you have a Medigap Plan G or a Plan N. If you look at the hospital here.

If you’re inpatient with an Advantage Plan, you’re going to be paying out of pocket and you have to be accepted at that facility. They don’t just take anyone at these facilities. The question that you have to ask is, do you take Medicare? If the answer is yes, they will take any Plan G or Plan N. Doesn’t matter what company. Advantage Plans are very different. You have to say, “I’m on this specific company and I have this specific plan.” And most of the time you’ll call that company and say, “Which hospital or doctor can I go with?” Or you’ll do it online. So that’s number one.

Number two, the part B, as I went over, this covers everything. Part B is so important for so many different reasons. But when it comes to chemotherapy drugs, this is what it covers. And as I said, plan G will cover everything that Medicare part A and B do not cover as far as inpatient and outpatient is concerned, except for a $226 deductible, which means you can go get your chemotherapy outpatient drugs.

It will cover everything but that $226, and then you will be done. You can go to any facility that accepts Medicare, and with the Plan N, you’ll pay that $226 and then you’ll pay up to $20 each time you go where they administer these drugs. This goes if you have radiation, if you have X-rays, CAT scans, all of those things.

So this is a big decision for a lot of people. Of course, nobody thinks they’re going to get cancer. I can tell you this, if we move from cancer onto a stroke, the biggest thing for strokes is going to be the skilled nursing facility. I see this over and over again, and the one thing of course I did not put up, how many people have a stroke each year? I think it’s around a million people in this country, United States, that have a stroke each year. It’s somewhere around a million people a year.

Nobody thinks it’s going to be them, but when it is, believe me, you are going to want to have one of these Medigap plans, even if it’s the high deductible G plan, you’ll pay more out of pocket. You’ll pay less in premiums, but more out of pocket for that high deductible. But you will not want to be on a Medicare Advantage Plan if you have a stroke.

I get hundreds and hundreds of calls about this each year. I am licensed in 46 states. People call me from all over the country and tell me their story and where they want to go, and I have to look it up for them and so forth. And most of the time, when they’re on the Advantage Plan, it’s because they have a problem getting into certain facilities that they want to get into and they’re just not able to do it. If they were on the Plan G and/or high deductible G, they could get into those facilities.

So how do they entice people to get on these Advantage Plans if the coverage for the gap plans are so much better for things like cancer and heart attacks and strokes and so forth? Well, they give you vision, dental and hearing for free. They give you a gym membership for free, and they give you a flex card for free, which means they’ll give you $40.

I spoke to someone who said they’re giving $75 each quarter to go into your Walgreens or CVS or wherever, pharmacy, even Walmart, and pick out items and spend that $75, with that $40. This could be band-aids, toothpaste. They have lists of items that you get for free, vitamins and so forth. Is that worth the medical coverage? That’s what you have to decide.

I always tell people when they call me, if they want a Medicare Advantage Plan and it’s a good Medicare Advantage Plan in their area, I will say, “Hey, let’s put you on that plan.” I have actually turned down people that want Medicare Advantage Plans that are bad plans. I do not do that. I stay away from them, but there are good Medicare Advantage Plans.

But I always tell people, if you do not want a Medicare Advantage Plan, the least that you can do is get on a high deductible plan as you see here. The average cost is $40. A lot of times if you’re $65, it could be $30 a month. But if these major things happened, like cancer, heart attack, stroke, et cetera, you will be happy that you’re on one of these three plans, G, N or high deductible G.

Posted on May 2023