Did you know more than 4,500 people are diagnosed with cancer every day? A cancer diagnosis is scary and can cost beneficiaries thousands of dollars when they don’t have the right coverage. As an agent, it’s crucial you understand the role of Original Medicare, Part D, and Medicare Supplement plans so you can ensure your beneficiary has the best possible cancer coverage.
Original Medicare and Cancer Coverage
Cancer coverage can vary depending on where the beneficiary is receiving treatment and their type of cancer. The most common treatments include surgery, radiation therapy, chemotherapy, and immunotherapy. Inpatient treatments are covered under Part A and outpatient treatments under Part B.
Cancer Screenings
Medicare covers the following screenings as a preventive service under Part B as long as the doctor accepts Medicare:
- Annual mammograms for women over 40
- Cervical and vaginal cancer screenings every two years (annually for high-risk beneficiaries)
- Colorectal cancer screening, including a colonoscopy, every 10 years for people over 50
- Annual lung cancer screenings for current or past smokers (age 55-77) with a doctor’s order
- Annual prostate cancer screening for men over 50
Chemotherapy
Chemotherapy can be administered orally through pills, capsules, and liquids, or can be given intravenously (injected in a vein or muscle). Original Medicare typically covers each treatment option in a hospital, outpatient clinic, or doctor office setting.
Part A will cover injection treatments when they are given in a hospital and beneficiaries will be responsible for their Part A deductible. Part B will cover outpatient injection treatments, and beneficiaries will be responsible for 20% of the costs unless they have a Medicare Supplement plan. A Part D plan can help cover chemotherapy-related drugs that need to be taken at home.
Immunotherapy and Radiation Treatments
Immunotherapy and radiation treatments are covered under Original Medicare (Part A for inpatient treatments and Part B for outpatient). A Medicare Supplement plan can help beneficiaries cut costs for remaining treatment expenses.
Cancer Drugs
Part B typically covers 80% of injection drug treatments and anti-nausea drugs. It may also cover prescriptions if a doctor could have injected them, but prescribed a pill instead. The pill must be taken within 48 hours of treatment to qualify. Without a Medicare Supplement plan, beneficiaries are responsible for 20% of those costs.
Part D plans may cover drugs that Part B does not. This includes anti-nausea medications in pill form, injections that a beneficiary injects themselves, and any drugs that are used to prevent cancer from reoccurring. Beneficiaries will typically pay coinsurance or a copy, but the costs are drastically lower than the original retail price of the drug.
Best Cancer Coverage Options
Medicare Advantage plans are generally not the best option for beneficiaries looking for cancer coverage. Instead, you should inform beneficiaries of Part D and Medicare Supplement plans. Medicare Supplement Plan F and G are the most popular. Starting January 1, 2020, Plan F will no longer be available. If a beneficiary is interested in Plan F, they need to enroll before this date. Plan G is very similar to Plan F. The only difference is that Plan G does not offer coverage for the Part B deductible. Both plan options help cover Part A coinsurance and hospital costs, Part B coinsurance and copayments, blood work copays up to 3 pints, hospice coinsurance and copayments, skilled nursing facility coinsurance, Part A deductible, Part B excess charges, and 80% of international emergency travel.
Part D plans are also a great option because, as we discussed, they can cover drugs beyond Original Medicare. If a Medicare Supplement plan does not include drugs, beneficiaries can also enroll in a Part D plan. Plus, if a beneficiary is free of cancer and has not had symptoms in the past, they may be eligible for a cancer insurance plan. A lump sum cancer plan is the most popular and allows beneficiaries to pay a small monthly payment that can be used down the road during treatment.
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