How do cancer patients get treatment under Medicare? | BCBSKS

If you are on Medicare, you might wonder whether cancer treatment is covered. After all, cancer is responsible for more than 600,000 deaths in the United States each year, including about 5,000 per year in Kansas. Cancer is more survivable than ever, but prevention, early detection, and modern treatments can significantly impact survival. If you’re facing cancer treatment while on Medicare, here is what you need to know.

Does Medicare cover cancer treatment?

Medicare is available to people ages 65 and over, as well as those with specific disabilities. This government-sponsored health insurance covers many basic healthcare costs. However, coverage is divided into four parts, only two (Parts A and B) are included in original Medicare.

Medicare Part A is hospitalization insurance, covering medically necessary hospital stays, hospice, and other services. It’s accessible to everyone who worked and paid Medicare taxes starting at age 65 (or sooner, with specific disabilities).

Medicare Part B is for day-to-day medical services. When you become eligible for Part A, you can also enroll in Part B. There is a small monthly premium and a low deductible. This insurance covers everything from preventive screenings to imaging tests, provided they are medically necessary.

Together, Medicare Parts A and B cover many of the costs of cancer treatment. These include screenings for some types of cancer, inpatient cancer treatments, CT scans, and other tests, and some chemotherapy drugs. However, coverage can be incomplete, depending on your unique needs. In addition, you will need to pay coinsurance costs of 20 percent with no annual cap on out-of-pocket spending. This can be pricey, as the total cost of cancer treatment often runs into hundreds of thousands of dollars.

Medicare Part C, also known as Medicare Advantage, and Medicare Part D (prescription drug coverage) can help fill in the gaps. These products purchased through private insurance companies such as Blue Cross and Blue Shield of Kansas provide additional coverage to ensure complete wraparound protection for your health. Many Part C plans also include prescription drug coverage, so you may not need to purchase this separately. These plans typically cover more cancer treatments and drugs than original Medicare while setting annual caps on out-of-pocket costs.

Is there an age cut-off for cancer treatment coverage under Medicare?

There is no age cut-off for cancer treatment under any of the four parts of Medicare. You will receive the same treatment benefits as anyone else with the same coverage, regardless of your age.

Is coverage different for different cancers?

In general, no. All Medicare recipients get the same cancer benefits as anyone else with the same coverage parts, regardless of their type of cancer. However, cancer is not a one-size-fits-all disease. Original Medicare does not cover certain types of cancer treatments, such as at-home injections or certain pills to keep cancer from recurring, which may be more suitable for one type of cancer or one individual case. Medicare Part C (Advantage) plans, especially those that include prescription drug coverage, tend to cover more treatment options.

In addition, original Medicare covers some preventive cancer screenings, including mammograms and colonoscopies. But it may not cover all screenings your doctor would like to perform. Medicare Advantage plans generally cover a more thorough list of screening tests.

What kinds of cancer treatments are covered by Medicare?

Original Medicare covers standard medical treatments for cancer, such as chemotherapy and radiation therapy. It also covers inpatient and outpatient surgeries, doctor visits, hospice care, and other related services. However, it does not necessarily cover all medications and therapies that your doctor may want to prescribe.

Factors that may impact your coverage

The most significant factor that impacts cancer coverage under original Medicare is the specific treatment protocol you and your doctor choose. While original Medicare coverage is pretty comprehensive, you must know what’s covered when choosing a treatment plan. And since there is no limit on out-of-pocket costs, you must be aware of treatment costs. Medicare Advantage plans can plug many of the holes in original Medicare coverage, including limiting your out-of-pocket costs.

What items are covered for early detection and prevention?

Original Medicare covers screening tests for specific types of cancer depending on your age, gender, and medical history. These are covered 100 percent, with nothing due out of pocket.

  • Mammogram: One baseline screening for women ages 35-39, and then every 12 months starting at age 40.
  • Colonoscopy: Every ten years for those at average risk for colon cancer or every 24 months for those at high risk.
  • Fecal occult blood test: Every 12 months starting at age 50.
  • Multi-target stool DNA lab test: Every three years for those aged 50 to 85 at average risk for colon cancer with no current symptoms of colon disease.
  • Pap test and pelvic exam: Every 24 months for women at average risk for cervical or vaginal cancer. Every 12 months for those at high risk and childbearing-age women with an abnormal Pap test in the past three years.
  • Prostate-specific antigen test: Once a year for men starting at age 50.
  • Low-dose computed tomography (LDCT) lung cancer screening: Every 12 months for smokers or former smokers ages 50 to 77.

Medicare Part C plans generally cover screenings for additional types of cancer and certain preventive therapies that lower the risk for cancer.

Does Medicare cover immunotherapy for cancer?

Immunotherapy is often covered under Medicare Part A or Part B, depending on how it’s delivered. Medicare Advantage plans may also include coverage for immunotherapy.

Does Medicare cover dermatology cancer screening?

Original Medicare does not cover routine skin cancer screenings in those with no symptoms, and it will typically cover diagnostic screening in patients with suspicious skin changes. Many Medicare Part C plans add coverage for routine dermatology and other cancer screenings.

Does Medicare cover wigs for cancer patients?

Original Medicare does not cover wigs for those undergoing cancer treatment. However, many Medicare Advantage plans do offer this coverage. A high-quality wig can play an important quality of life role for those battling cancer, making it worthwhile to choose a plan that covers them.

Cancer prevention tips

Cancer is caused by many factors, from genetics to lifestyle factors to simple bad luck. Therefore, it would be impossible to prevent all cases. However, you can take some basic steps to reduce your risk for many types of cancer.

  • Don’t smoke. Tobacco use increases your risk for lung cancer and many different types of cancer. Chewing tobacco and other intake methods are not safer alternatives.
  • Improve your diet. Lowering your intake of unhealthy fats, alcohol, and processed foods while increasing your intake of fruits and vegetables, fiber, and healthy fats can reduce your risk for cancer, including colon cancer.
  • Get physically fit. Maintaining a healthy weight while keeping your body moving can help prevent all sorts of diseases, including many cancers.
  • Protect your skin.Skin cancer runs the gamut from minor to deadly, and protecting your skin from the sun is the best way to prevent it. Use a broad-spectrum sunscreen with an SPF of 30 or greater. Wear long sleeves and long pants when shade is hard to find. Whenever possible, stay indoors between 10 a.m. and 4 p.m., when the sun’s rays are the strongest.
  • Get your vaccines. The link between human papillomavirus (HPV) and cervical cancer is well-documented. But other infections may also increase your risk for cancer. In particular, hepatitis infections can raise your risk for liver cancer. Get all of your vaccines according to your doctor’s recommendations. Many vaccinations require multiple doses at specific intervals, so be sure not to miss any doses in a series.
  • Implement safer practices. HPV, HIV, and other diseases can be transmitted through sex. Different types of hepatitis, as well as HIV, can be transmitted through needle sharing. These conditions can raise your risk of various types of cancer. To lower the risks, practice safer sex, including limiting your number of partners and using condoms. Do not share needles with anyone.
  • Have an annual physical. Cancer, like all diseases, is far easier to treat when caught early. Have an annual wellness visit and get any screenings that your doctor recommends. Please talk with your doctor about self-screening, which can help you catch many suspicious developments at their earliest stages.

Talk to a fellow Kansan about Medicare coverage for cancer

Cancer is a scary disease, though modern interventions have made cancer more survivable than ever before. The last thing you need when facing a cancer diagnosis is to worry about how you will pay for treatment. To learn more about how a Medicare Part C (Medicare Advantage) plan can help plug the gaps in original Medicare coverage, call BCBSKS today at 866-627-6705.

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