Medicare and Cancer Coverage
Danielle K Roberts, Guest Writer
One main risk factor for most cancers is advancing age. Because of this, most cancer diagnoses occur among the senior population. According to the Centers for Disease Control and Prevention, in 2016, the 65 – 69 age group had the most cancer diagnoses of all age groups.
Because cancer occurs so frequently among Medicare patients, Medicare provides substantial coverage for cancer treatment and care. There are different parts of Medicare to know about. Beneficiaries can obtain even more comprehensive coverage if they add a Medicare plan to their Part A and Part B coverage.
Part A and Part B Cancer Coverage
Part A and Part B, also referred to as Original Medicare, provide Medicare beneficiaries with both inpatient and outpatient medical services. Part A is the part we pay into while working, that’s why most people qualify for premium-free Part A. This part covers room and board during an inpatient stay in the hospital or skilled nursing facility (SNF).
Medicare Part B covers outpatient medical services, such as doctor visits in and out of the hospital, preventive care, durable medical equipment, and much more. To better understand how Part A and Part B work together, let’s look at an example.
Paul is diagnosed with cancer after he starts Medicare. His multiple doctor visits and procedures will be covered under Part B after he meets his annual deductible. The Part B annual deductible is $185 in 2019. Part B will cover 80% of his care, while Paul will pay for 20%.
If Paul needs to have surgery to treat his cancer, then he will likely require an inpatient stay in the hospital. Part A will cover his first 60 days in the hospital for a $1,364 deductible. This deductible covers his semi-private room, his meals, and 20 days in an SNF for recovery.
Medicare Part B will also cover any chemotherapy Paul receives. While Medicare beneficiaries access most of their drug benefits through Medicare Part D, any medications administered by medical professionals in a medical setting, like chemotherapy, are covered by Part B.
Cutting Costs with Medicare Plans
There are two main types of Medicare plans – Medigap and Medicare Advantage plans. Medigap plans, also called Medicare Supplements, help cover deductibles, copays, and coinsurance that Original Medicare holds the beneficiary responsible for.
For example, if Paul had a Medigap Plan G, the only expense he would have to pay in the example above would be the Part B deductible. That’s because Plan G covers the Part A deductible, the Part B coinsurance, and excess charges.
Medicare Advantage plans are offered at a lower monthly premium; you may even have access to a zero-premium plan. However, you will have to pay as you use your plan. For example, depending on which Medicare Advantage plan Paul had (there are about 3,000 available today), then his hospital stay may have a copay instead of the large Part A deductible.
What’s good about having a Medicare Advantage plan rather than just Original Medicare is that the beneficiary is protected from spending no more than $6,700 (2019) in any given year. With Original Medicare alone, there is no cap to how much you will spend on out-of-pocket expenses.
While Medigap plans pay after Medicare, Medicare Advantage plans pay instead of Original Medicare. When Medicare beneficiaries have a Medigap plan or Medicare Advantage plan, they still have to pay their Original Medicare premiums, like the $135.50/month Part B premium.
Medicare Updates for 2020
Medicare usually updates from year to year, whether it’s a change in prices, coverage, or both. For example, in 2018, the Part B premium was $134, then increased by $1.50 in 2019. Prices for 2020 have not yet been confirmed. Normally, the Centers for Medicare and Medicaid Services (CMS) will announce the pricing updates around November.
However, there are a few confirmed updates we are going to see in 2020. For instance, the Medicare Advantage Open Enrollment Period that runs from January 1st until March 31st. This period gives Medicare Advantage beneficiaries a chance to change or drop their current Medicare Advantage plan.
Another update that occurred this year is the therapy cap being eliminated. Now, Medicare beneficiaries who need physical, speech, or occupational therapy, can continue getting therapy for as long as medically necessary.
Danielle is a Medicare insurance expert, TCU journalism graduate, and former magazine editor who writes regularly for many online publications, including Forbes, where she is a member of the Finance Council.