Cancer is one of the most invasive and deadly conditions of all time. One of every two men and one of every three women will get cancer. The American Cancer Society reports over 4,500 people to receive a cancer diagnosis daily. Fortunately, more people are living through and beating cancer. Medicare covers cancer treatment and procedures.
Medicare coverage for cancer treatments and screenings?
There are several cancer treatments available. Medicare will cover cancer treatments that have been proven to treat cancer. There is access to experimental cancer treatments. Generally, Medicare won’t cover experimental treatments.
Cancer treatments include surgery, chemotherapy, radiation therapy, immunotherapy, hormone treatment, stem cell transplant, bone marrow transplant, and targeted therapy.
Cancer screenings
Medicare covers cancer screenings under Medicare Part B. Different screenings are used to detect cancer. The most prevalent cancers affecting Medicare beneficiaries are lung, prostate, and cervical.
Medicare coverage for lung cancer screenings
Part B covers an annual lung cancer screening with low-dose computed tomography for those who meet certain criteria.
- Aged 50-77
- No signs or symptoms of lung cancer
- Either a current smoker or non-smoker for less than 15 years
- Tobacco usages history of a pack of cigarettes a day on average
- Your doctor recommends the screenings
Medicare coverage for cervical and vaginal cancer screenings
Part B pays for Pap tests and pelvic exams to detect cervical and vaginal cancers. The pelvic exam also includes a clinical breast exam to look for any signs of breast cancer.
Generally, Medicare covers these screenings once in a 24-month period; however, for individuals at high risk for cervical or vaginal cancer or those aged between child-bearing years and with an abnormal Pap test in the past 36 months are eligible for screenings once in a 12-month period.
Furthermore, Medicare Part B will cover Human Papillomavirus (HPV) tests (as part of a Pap test) every 5 years for those aged between 30-65 without any HPV symptoms.
The following screenings are covered at 100% if your healthcare provider accepts Medicare assignment.
- Lab Pap test
- Lab HPV with Pap test
- Pap test specimen collection
- Pelvic and breast exams
Medicare coverage for prostate screenings
Medicare Part B covers digital rectal exams and prostate specific antigen (PSA) blood tests once every 12 months for men aged 50 and above. Covered prostate cancer screenings include digital rectal exams and PSA blood tests.
Cancer treatments
Medicare coverage for cancer surgery
Surgery is a standard cancer treatment. It involves surgically removing the cancerous tissues to eliminate cancer and stop the spread. Depending on the location of the procedure, Medicare covers it as an inpatient or outpatient procedure.
Medicare coverage chemotherapy
Chemotherapy is a cancer treatment that uses anti-cancer drugs as a standardized chemotherapy regimen. This treatment may cure cancer, prolong life, or reduce symptoms. Chemotherapy is performed as either an inpatient or an outpatient service.
There are newer prescription drug versions of chemotherapy available also. If you receive a chemotherapy pill, it’ll be covered by Medicare Part D.
Medicare coverage for radiation therapy
Radiation therapy or radiotherapy is a therapy using ionizing radiation. Radiation therapy is provided as a cancer treatment to control or kill malignant cells.
A linear accelerator delivers this type of therapy. Medicare covers radiation therapy and will be provided as an inpatient or outpatient treatment.
Medicare coverage for cancer immunotherapy
Immunotherapy is a cancer treatment that helps your immune system fight cancer. Immunotherapy is a biological therapy that uses substances from living organisms to treat cancer.
Your immune system detects and destroys abnormal cells and prevents the growth of many cancers. Immunotherapy is generally covered under Medicare Part B.
Medicare coverage for hormone therapy
Hormonal or endocrine therapy is a cancer treatment that may slow or stop the spread of cancer. It blocks the body’s ability to produce these particular hormones or changes how hormone receptors behave in the body.
Hormone therapy is available via pills, injections, or surgery. Hormone therapy surgeries remove hormone-producing organs, namely the ovaries in women and the testicles in men. It’s used alongside other cancer treatments.
Original Medicare does not cover hormone therapy treatment for cancer. Some Medicare Advantage or Part D drug plans may cover hormone replacement therapy drugs. You should check the plan’s drug formulary to see if the necessary hormone replacement drug is covered.
Medicare coverage for stem cell transplants
Stem cell transplants restore blood-forming stem cells in people who have lost theirs due to chemotherapy or radiation therapy used to treat certain cancers:
- Blood-forming stem cells are important because they grow into different blood cells.
- White blood cells are part of your immune system and help your body fight infection.
- Red blood cells carry oxygen throughout your body.
- Platelets help the blood clot.
All three types of blood cells are needed to remain healthy. Most stem cell replacement is considered experimental, and Medicare does not cover experimental treatment.
Medicare can cover FDA-approved stem cell cancer treatments.
Medicare coverage for bone marrow transplants
Bone marrow transplant is another name for stem cell transplant. There are two types of stem cell transplants covered by Medicare.
Autologous transplant stem cells come from your own body. For this type of stem cell treatment, doctors remove stem cells from your blood or bone marrow before beginning cancer treatment.
After chemotherapy, the stem cells are returned to your body. This restores your immune system and allows your body to fight infection and produce blood cells.
Allogeneic transplant stem cells come from another person. The patient receives the donor’s stem cells following chemotherapy or radiation therapy.
Medicare coverage for targeted therapy
Targeted therapy targets proteins that control how cancer cells grow, divide and spread. The most common target therapies are small-molecule drugs and monoclonal antibodies, the latter also being a treatment for COVID. Small-molecule drugs use drugs that are small enough to enter cells.
Monoclonal antibodies or therapeutic antibodies are proteins produced in the lab. They attach to locations on cancer cells. Monoclonal antibodies can mark cancer cells so the immune system can identify them and make destroying them easier.
Additionally, monoclonal antibodies can directly stop cancer cells from growing, causing them to self-destruct or carry toxins to cancer cells.
Medicare covers targeted therapy for FDA-approved treatments.
Medicare coverage for breast cancer?
While there are many different forms of cancer, breast cancer in women (and sometimes even in men) is one of the most common kinds. Three out of every ten women who develop cancer yearly will have breast cancer.
The good news in this fight is that both parts of Medicare cover it. Part A will deal with any hospital visits or long-term care about defeating this disease. Part B will be the aspect of Medicare that deals with treatment and visits to a doctor.
Either way, Medicare covers breast cancer, including the long list of medicines used to combat it.
How much do cancer treatments cost on Medicare?
The treatment and location determine your Medicare costs. Most cancer treatments occur as inpatient or outpatient.
Inpatient procedures occur in the hospital, and Medicare Part A covers those services. On Medicare Part A, you can expect to pay your Part A deductible, and any coinsurance or copays depending on the length of your inpatient stay.
Outpatient procedures happen at an outpatient facility or doctor’s office. Medicare Part B covers these services. You can expect to pay your Part B deductible and 20% of the cost.
If your provider doesn’t accept Medicare assignments, you can pay an additional 15% on top of the 20%.
Suppose your treatment includes prescription drugs from the pharmacy. In that case, Medicare Part D will cover the prescriptions. Check your plan’s formulary to determine coverage for medicine. You’ll be responsible for any deductibles, copays, or coinsurance as your plan outlines.
Do Medigap plans cover cancer treatments and screenings?
Medicare Supplement plans fill the gaps in Parts A and B of Medicare. Depending on your plan letter, you’ll have little to no money out of pocket for Medicare-approved cancer treatments covered by Medicare parts A or B.
Medicare Supplement plans don’t cover drug coverage. For Medicare-approved cancer prescription drugs, you’d refer to your drug plan.
Do Medicare Advantage plans cover cancer treatments and screenings?
If you enroll in a Medicare Advantage plan, expect to pay the plan’s copays or coinsurance for covered cancer treatments.
In many cases, you should expect to hit your maximum out-of-pocket in a Medicare Advantage plan. Most Medicare Advantage plans include drug coverage.
You will pay the plan’s deductible, copays, or coinsurance. Check your plan to ensure coverage of a specific drug.
How are prescription drugs for cancer covered?
Medicare Advantage or a Part D prescription plan will cover you.
Check with your plan’s formulary to ensure coverage for your prescription. You can expect to pay the plan’s copay, coinsurance, or deductibles as applicable.
How to Get Medicare Coverage for Cancer
If you’re facing an unexpected battle with cancer, or you’re the loved one or caretaker of someone, you aren’t alone. We can assist you in figuring out your options for health coverage so that you can concentrate on dealing with cancer.
We have a team of licensed agents at your disposal to help find the best coverage for your individual needs. Fill out our online request form, or give us a call. We’ll be more than happy to connect you with the information you need and answer your questions.
Related Content
