Medicare and Cancer Coverage

Unfortunately, Cancer is something many of us will face directly or indirectly at some point during our lifetime.  According to the American Cancer Society, approximately 1.9 million new Cancer cases were diagnosed in the United States in 2023.

Does Medicare cover Cancer? Yes, it does.  Depending on your choice for coverage when you enrolled in Medicare, you most likely receive your benefits from original Medicare OR a Medicare Advantage plan.

  • Original Medicare (Medicare Part A and Medicare Part B):
    Medicare Part A will cover you for inpatient hospital stays, and Medicare Part B will cover your other medical services for your treatments.
  • Medicare Advantage (Medicare Part C) plans must offer the same coverage you receive from Original Medicare. Depending on the Part C plan you have, you could be responsible for the plan’s maximum out-of-pocket amount during the year.
  • Many Cancer medications will be covered by Medicare Part B. There are some medications that are covered by your Medicare Part D.

Medicare and Cancer Benefits

Examples of your coverage with Medicare:

  • Inpatient hospital cancer care
  • Surgery
  • Visits to your oncologist and other medical providers
  • Second opinion
  • Chemotherapy and/or Radiation
  • Medications for nausea and other possible side effects
  • Skilled nursing
  • Home health services
  • Durable medical equipment
  • Physical therapy
  • Short-term nursing home care
  • Hospice

Original Medicare Coverage

If your coverage is original Medicare, then you are receiving your benefits through Medicare Part A and Medicare Part B.  More than likely you also have a Medicare supplement (Medigap) plan as a secondary to your original Medicare.

Medicare Part A will cover the Cancer treatments you receive during an inpatient hospital stay. Part A has a deductible that is your financial responsibility. The Part A deductible is $1,632. Your Medicare supplement (Medigap) plan will cover that deductible payment for you. So, your inpatient stay should be $0!

Medicare Part A covers skilled nursing care if needed after your inpatient hospital stay. Your first 20 days in a skilled nursing facility are covered 100% by Medicare. If you need to stay past day 20, days 21 through 100 would possibly be ZERO out of pocket as well. This will depend on which Medicare supplement plan you purchased.

Medicare Part B covers chemotherapy and/or radiation that you receive at a medical clinic (outpatient). Certain Cancer screenings are covered at 100% under your preventive care benefits.

Financially you are responsible for the Part B deductible.  After the deductible is met, Medicare will then cover 80% of the cost of your outpatient services. The other 20% is your responsibility.  There is NO cap on the 20%.

The GOOD NEWS – Your Medicare supplement will pay the 20% for you!

No one wants to hear the word “Cancer”!  If that does happen, Original Medicare with a Medicare supplement limits your medical costs to almost ZERO!  Medigap Plans, such as Plan F, Plan G, and Plan N, will pay the 20% that Medicare doesn’t.

Consider this Example……

Sue has original Medicare and is undergoing chemotherapy treatments for Cancer. Her treatments will be covered 80% by Medicare Part B.  After treatments, Sue has surgery and is in the hospital for several days due to complications.

If Sue has Medicare supplement Plan F as a secondary to her Medicare, her Plan F policy will pay her deductible and the other 20%.  Sue will owe NOTHING!

If Sue has Medicare supplement Plan G as a secondary to her Medicare, her Plan G policy will pay all but the Part B deductible.  The Part B deductible is currently $240. Sue’s financial responsibility will be $240 for a calendar year.  After that her cost is ZERO!

Medicare Advantage Coverage

Medicare Advantage (Part C) plans cover the same Part A and B services as Original Medicare. However, your benefits and your financial responsibility for your medical services will be different.

If you enroll in a Medicare Advantage plan, then original Medicare is no longer your primary payer.  The Medicare Advantage plan is your primary.

Advantage plans have a network of providers. Your care will be provided to you within the network to get the lowest copays. There may be situations where the oncologist or hospital you wish to see may not be in the network.

With Medicare Advantage, you will have copays for treatment. Your cost under your Medicare Advantage plan may require payment up to 20% coinsurance.

Out-of-Pocket Maximums – All Medicare Advantage plans have Out of Pocket Maximums for enrollees.  Your cost-share for chemotherapy and radiation will depend on the plan.

You will pay this until you reach the plan’s Out-of-Pocket Maximum. That maximum can be as high as $6,300 per calendar year in the network and $10,000 for out-of-network per calendar year.

Consider this Example……..

Sue is undergoing radiation treatment.  Her Medicare Advantage plan requires her to pay 20% coinsurance for her treatments. Her plan also has a $50 copay for specialist visits.

Sue has oncologist visits every other week.  Each specialist visit will require a $50 copay and she will pay the 20% cost for her treatments until she reaches $6,300 out of her own pocket. Then the plan covers 100% of your medical costs.

Important to Remember……….

If you enroll in a Medicare Advantage plan, be sure that you understand possible costs for medical services. You will still receive the care you need under a Medicare Advantage plan.  Your care will be through medical providers who participate in the plan’s network.

If you are receiving your medical care through a Medicare Advantage plan, we would strongly recommend purchasing a cancer policy to help pay for out-of-pocket costs if you develop Cancer.