Receiving a cancer diagnosis can be life changing, and treatment may be costly. In 2018, over 1.7 million new cases of cancer was diagnosed in the United States, according to the National Institutes of Health (NIH). The good news is that cancer mortality is much lower than cancer incidence (new cases of cancer). That means that some lives are saved through cancer treatment.
CANCER TREATMENT
There is no “one” approach to treat cancer. Cancer treatment is the result of the work of several doctors who need to come up with highly individualized treatment plan, because approaches differ from person to person and from types of cancer, their stage and threat to normal life functions. A comprehensive cancer treatment plan will include one or more of the following courses of treatment:
- SURGERY
- CHEMOTHERAPY
- HORMONE THERAPY
- IMMUNOTHERAPY
- RADIATION
- GENETIC THERAPY
Surgery for cancer treatment may involve cutting out a tumor, surrounding healthy tissue, and nearby lymph nodes. Surgery works best for solid tumors that are contained in one area. Surgery cannot be used for blood cancer nor for cancers that have spread over the body. The cost of cancer treatment involving surgery includes costs for the surgeon, anesthesiologist, pathologist, operating room fees, equipment and medicines. Often surgery is combined with other cancer treatments.
Chemotherapy involves chemicals given orally or intravenously to kill cancer cells and stop cancer from spreading. Medicare generally covers chemotherapy cancer treatment if you’re a cancer patient in a hospital, outpatient clinic, or doctor’s office and cost may differ on ways how the chemotherapy medications are administered.
Hormone therapy uses synthetic hormone and hormone blockers to target cancers that use hormones to grow. The cost vary from treatment to treatment.
Immunotherapy helps your immune system fight cancer. Immunotherapy includes medications that cause an immune response which kills cancer cells. Immunotherapy also includes treatment vaccines which boost the immune system’s response to cancer cells. Medicare may cover immunotherapy cancer treatment if it determined to be medically necessary.
Radiation in high doses can kill cancer cells and shrink tumors, according to NIH. Radiation cancer treatment damages the DNA of cancer cells, making them unable to divide and killing them. External beam radiation therapy treats a specific part of your body. Internal radiation therapy could be a local treatment or systemic therapy, traveling in the blood to tissues throughout the body. Medicare Part A generally covers radiation cancer treatment for hospital inpatients. Medicare Part B covers radiation therapy for outpatients of patients in freestanding clinics. Medicare Advantage plans also generally cover radiation.
Genetic therapy is newest type of approach that typically deliver a virus to a cancer cell that will target and help destroy it.
MEDICARE COVERAGE OF CANCER TREATMENTS
Depending on the specific type of cancer a person has, Medicare covers some treatments from parts A and B, but in general, every part of Medicare covers some aspect of cancer treatment.
Medicare Part A may cover:
- inpatinet chemoterapy
- inpatient hospital stay for surgery
- blood transfusions
- hospice care
- skilled nursing facility care after a 3-day hospital stay
- home healthcare (physical and occupational therapy)
- surgically implanted breasts prostheses after a masectomy (if surgery takes place in inpatient hospital)
- some costs of clinical research in hospital settings
Medicare Part B may cover a variety of outpatient cancer services and treatments. It may cover:
- outpatient chemotherapy
- some oral chemotherapy
- radiation therapy at an outpatient center
- outpatient surgery
- durable medical equipment (walker or supplemental oxygen)
- equipment for external nutritional support at home (feeding tubes and pumps)
- tests to diagnose and evaluate cancer treatment (CT scans and screenings)
- some costs of medical research as an outpatient
- external breasts prostheses after a masectomy
- breasts implants after a masectomy, when the surgery takes place on an outpatient basis
- doctor`s office visits
Medicare Part C plans give you all of the guaranteed Part A and B benefits through private insurance coverage. Although Medicare Advantage plans usually aren’t the best choice for cancer patients because most plans’ benefits aren’t as good as Medicare plus a Medicare Supplement policy. Part C requires from you to go to specific doctors within specific network, they require paying coinsurance until meeting out-of-pocket maximum and you cannot add Medicare Supplement plan to your Part C plan. But on the other hand, Medicare Advantage plans may also bundle Part D into their coverage to cover the cost of prescription medications.
Medicare Part D may cover some oral chemotherapy drugs, anti-nausea medications, pain medications, and other medications your doctor prescribes as a part of your cancer treatment.
MEDICARE COVERAGE EXCLUSION FOR CANCER TREATMENT
Medicare does not cover any service, treatment, or medication that is not medically necessary. There are also limitations on coverage. For example, Medicare does not cover costs associated with:
- room and bord at assisted living facility
- services that help people with activities of daily living (such as bathing)
- adult daycare
- medical food or nutritional supplement
- long-term nursing home care
Since Medicare does not cover all possible treatments, people should check with a doctor to ensure that their coverage includes the recommended treatment. If Medicare does not cover a recommended treatment, a doctor may be able to suggest an alternative treatment that Medicare does cover. Medicare does not cover all related expenses. For example, if a person loses their hair due to cancer treatment, Medicare will not cover the cost of a wig, as it is not medically necessary. However, Medicare will cover surgically implanted breast prostheses after a mastectomy.
CONCLUSION
Cancer treatment can be very costly. The different parts of Medicare cover cancer treatments, medications, and some types of cancer screening. However, a person will still be responsible for some of the cost. People’s total out-of-pocket expenses will vary. Before beginning any treatment, it’s important to be sure your doctor accepts assignment. People should talk with a doctor about all recommended treatments, screenings, and medications to make sure that Medicare will cover some of the associated costs. If Medicare does not cover a recommended treatment, a doctor may be able to recommend a different treatment option.