A diagnosis of cancer first brings concern about the disease itself. But then comes the worry about the high cost of all aspects of its treatment.
Medicare covers medically necessary cancer treatment through the program's different "parts." But coverage in many cases can be partial, leaving you with the burden of out-of-pocket costs. These could be deductibles (how much you have to spend before the plan starts paying), copayments (a fixed fee you pay for each doctor visit, drug or service) or coinsurance (the percentage of costs you pay after meeting your deductible).
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). However, because it does not include prescription drug coverage, you will probably want to buy a standalone Medicare Part D (prescription drug) policy.
It is essential to check if you are receiving services as an inpatient or outpatient, as that can affect if and how you are covered. (For example, you can be in a hospital as an outpatient, under "observation" status, and not as an inpatient.)
Part A will cover your inpatient cancer treatments if you are hospitalized. Also, skilled nursing facility care and home health care if you meet their requirements, plus hospice. But you will still be responsible for Part A's deductibles, copays and coinsurance.
Part B will cover many cancer-related preventive, diagnostic and treatment expenses received as an outpatient. And again, deductibles, copays and coinsurance may apply. Many intravenous chemotherapy drugs, some oral chemo drugs, immunotherapy infusions, radiation treatments, outpatient surgeries and some clinical research study costs may be covered. Check carefully as these treatments can be costly.
Part D will cover the medication you need to treat your cancer, based on your drug plan's formulary (or drug list). Besides most prescription drugs, plans cover some chemotherapy treatments and drugs not covered by Part B. Comparing the cost of your prescribed medications through various Part D plans before signing up is vital. Plans classify medicines into tiers, so find one where your drugs are in the lowest-possible tier to lower your costs.
In general, Part D may cover chemotherapy drugs taken by mouth, anti-nausea and other drugs (such as pain medications) used during your cancer treatments.
If your prescriptions change, you may want to change your Part D drug plan during the next enrollment period. You may find a plan with better pricing for your overall medication needs.
Medicare Part C
With Medicare Advantage (Part C) plans, private insurers must cover everything the government's Original Medicare (Part A and Part B) covers. These plans usually also cover your Part D prescription drug needs. However, insurers are free to have different rules and costs, including limiting services to the plan's network of doctors and specialists.
A cancer diagnosis makes finding a Medical Advantage plan that covers the greatest number of prescriptions and your preferred doctors and hospitals particularly important. You are free to change your Part C plan each year.
Five ways to save on cancer-related costs.
Supplemental insurance. With Original Medicare (Part A and Part B), doctors' visits, medications, hospital stays and surgeries can become very costly. But you can purchase a Medicare Supplement plan that covers all or most of the Medicare-approved out-of-pocket expenses Original Medicare doesn't cover.
Takeaway action step: Check the Medicare.gov website for available Medigap plans.
Generics. Generic versions of branded medications can save you 50% to 75% and be equally effective. In addition, drug plans list generic medicines among the lower tiers of formularies, so your out-of-pocket costs are lower.
Takeaway action step: Ask your doctor to recommend generic products to meet your cancer-treatment needs.
Online pharmacies. Medicare Part D and Medicare Advantage plans work with online pharmacies and retail chains, but online pharmacies tend to be cheaper.
Takeaway action step: Compare the cost of your medication's online pharmacy pricing with that in local retailers.
Pharmacy assistance programs. With the high cost of cancer-treatment drugs, their manufacturers often help patients afford their products. These programs might lower your out-of-pocket cost-sharing, but your purchases may not count towards your plan's annual deductible.
Takeaway action step: Especially for a brand-name product, contact the pharmaceutical manufacturer to see if they are willing to help you with the cost.
Extra Help. The Extra Help program helps with out-of-pocket costs for prescription drugs if you have limited resources. It might cover premiums, copays and coinsurance, for example.
Takeaway action step: Call 1-800-MEDICARE to check on available help, then ask your Medicare plan provider if that is the best approach for you.