Does Medicare Cover Cancer Treatment and Screenings? - Hella Health (2023)

Comprehensive Medicare coverage is essential for eligible individuals diagnosed with cancer. Without the right coverage, cancer patients can become financially burdened by the high costs of cancer treatment.

Do cancer patients qualify for Medicare?

Cancer patients qualify for Medicare as long as the individual meets the standard eligibility. Medicare coverage for cancer patients is considered essential for the average senior over 65 to not become financially burdened by cancer treatment costs.

Can I get Medicare early if I have cancer?

A cancer diagnosis alone does not qualify an individual for Medicare before the standard eligibility age of 65. Medicare for cancer patients under 65 requires the individual to meet one of the following criteria:

● Received SSI (Supplemental Security Income) for at least 24 months;

● Diagnosed with End-Stage Renal Disease;

● Diagnosed with ALS (also known as Lou Gehrig’s Disease).

Does Medicare cover cancer screenings?

While Medicare does cover cancer screenings, there are differences in the frequency of the coverage that depends on the type of cancer, urgency, and the individual’s age. Some cancer screenings that are recommended for ages younger than 65, such as a prostate screening for men at the age of 50, would only be covered by Medicare if the individual has active coverage.

Medicare lung cancer screening

Lung cancer is well-known but especially aggressive cancer most commonly diagnosed in lifelong smokers. If you’re between the ages of 50 and 77, Medicare Part B will cover a lung cancer screening once a year if all the qualifying conditions are met:

● Active smoker or quit smoking within the past 15 years;

● Does not currently have any symptoms of lung cancer;

● Have a written order for the screening from a doctor;

● Smoked a pack of cigarettes per day for 20 years at some point in your lifetime.

If all these conditions are met, a Low-Dose Computed Tomography (LDCT) lung cancer screening will be covered by Medicare. These lung cancer screenings are highly recommended because early detection can improve survival chances and overall prognosis.

Medicare breast cancer screening coverage

Another cancer that’s represented by the iconic pink ribbon is breast cancer. This cancer is most commonly developed in women and detecting it early with a breast cancer screening, also known as a mammogram, can significantly increase its already high survival rate.

Medicare will cover the costs of a breast cancer screening once per year for women aged 40 and over. If additional testing is ordered by a doctor within the same year, Part B will provide its standard post-deductible coverage of 80% of the cost. The patient is then responsible for the remaining 20% of the cost unless covered by supplemental Medicare Advantage or Medigap plan.

Does Medicare cover skin cancer screening and treatment?

Skin cancer — which includes basal cell carcinoma, squamous cell carcinoma, and melanoma—is one of the most common forms of cancer throughout the US.

Surprisingly, Medicare does not cover preventative skin cancer screenings, but it does cover medical visits requiring further evaluation for diagnosing skin cancer. For example, Medicare will not cover a preventative screening from a dermatologist of PCP — However, if a mole or portion of the skin needs to be looked at further, they will cover the PCP’s referral to a dermatologist.

Treatment for skin cancer is covered by both Medicare Part A and Part B. Part A coverage will be utilized for blood work and any in-hospital treatment while Part B is billed for outpatient services like doctor visits and radiology. According to HealthMatch, skin cancer treatment costs can vary drastically from a stage I diagnosis to stage IV. Early detection treatment methods include cryotherapy—the freezing of early skin cancer — while later-stage diagnosis treatment can include costly chemotherapy if cancer has spread beyond the skin and internally within the body.

Does Medicare cover prostate cancer treatment?

According to the CDC, prostate cancer is leading cancer in men worldwide when excluding non-melanoma skin cancer. Even though early detection screenings for prostate cancer are covered by Medicare at the earlier age of 50, the average diagnosis age is 66 which individuals should be already receiving Medicare coverage.

Since prostate cancer is one of the leading causes of death in men, treatment is vital to improving prognosis and survival chances. Similar to other cancers mentioned previously, treatment for prostate cancer will be covered under both Medicare Part A and Part B.

A Medicare Advantage plan is highly recommended to supplement financial coverage for prostate cancer treatment. This additional coverage will quickly outweigh the monthly premiums of the Medicare Advantage plan. Chemotherapy for prostate cancer averagely costs $1,000-$12,000/month, and 20% of that cost will be the patient’s responsibility after being billed to Medicare Part B. Since chemotherapy is likely only one portion of the treatment plan, the comparison of a Medicare Advantage plan under a $100/month premium and the 20% patient responsibility of unsupplemented Part B speaks for itself.

Does Medicare cover genetic testing for cancer?

Since the mid-1990s, genetic testing for cancer has truly been a breakthrough for early detection. Geneticists can review an individual’s family history and genes to determine if they are at a higher risk for specific gene mutations that can cause the development of cancer.

Medicare does not cover genetic testing unless it’s recommended by a doctor. Doctors might recommend genetic testing if a patient could have inherited higher risks for certain medical conditions or the results will help guide a treatment plan. In this case, the genetic test would be covered by Medicare Part B.

There are multiple different types of genetic testing that doctors or geneticists would recommend to benefit a cancer treatment plan:

● Pharmacogenomics (PGx) testing will help determine if enzymes that digest medications are effective within the body.

● Next Generation Sequencing (NGS) is a test that searches many of a person’s genes at once to better guide cancer treatment

● Molecular Diagnostic Testing (MDT) searches the genetic makeup of a person’s cells to look for warning signs of a specific disease, such as the BRCA 1 and BRCA 2 genes that increase breast cancer risk

While some of these genetic tests can be purchased over the counter from testing organizations, it’s wise to consult with a medical professional beforehand. Their expertise will help determine if there is any benefit to be gained from the testing.

Does Medicare cover cancer drugs?

When it comes to Medicare and cancer treatment, there is a lot of medical expertise and prescribed medications that form a treatment plan. It’s important to understand how these different medications are billed to your Medicare plans and the possible costs that could be the patient’s responsibility.

Original Medicare does not cover prescription medications unless they are administered at an in-patient or out-patient facility. Patients who need prescription coverage from retail or mail-order pharmacies should enroll in additional Part D Medicare coverage.

Without Part D coverage, the out-of-pocket costs for cancer drugs can be overwhelming from the high price tags. Cancer patients that are considering Part D coverage should schedule time with their treating doctor to review different formularies in order to ensure the right medications are being covered.

Does Medicare cover immunotherapy for cancer?

Another common treatment method for cancer patients is immunotherapy. This method uses pharmaceutical medication to adjust how a person’s immune system responds to the disease.

Thankfully, Medicare does cover immunotherapy and the Medicare Parts that are billed depending on where the medication is administered. Lots of immunotherapy drugs are very expensive, so planning ahead with the right Medicare coverage is essential for some cancer patients.

However, it’s not uncommon for immunotherapy drugs to require a doctor’s authorization before Medicare or supplemental coverage plans accept assignment. There are even cases where a doctor may use an immunotherapy drug for treatment outside of its standard use, like when Keytruda is used in a Mesothelioma treatment plan. In situations like this, the doctor may have to speak with Medicare to explain the treatment plan before the medication is covered.

Best Medicare plans for cancer patients

After everything reviewed previously, it’s clear to see why Medicare for cancer patients is so important. Picking the right Medicare Advantage, Prescription Drug or Medicare Supplement plan can help curb a majority of the stressful out-of-pocket costs a cancer patient could accumulate throughout treatment.

One of the best Medicare Supplement plans for cancer patients Is Plan G. This plan is very beneficial because of its excellent Part B coverage. After the $226 deductible for 2023 has been met, Plan G covers all of the out-of-pocket costs a patient would have from Part B. This is especially beneficial for cancer patients because most IV medications like chemotherapy and immunotherapy are administered at outpatient facilities.

Also, choosing Part D coverage for prescription medication is a wise choice. While a patient will have lots of their treatment administered at outpatient facilities, it’s common to have multiple prescription medications to take at home. Part D coverage, which is not included in Original Medicare, will help cover the costs of medication dispensed by pharmacies.

FAQs

Does Medicare cover wigs for cancer patients?

If a cancer patient is undergoing chemotherapy treatment, they will begin to lose hair all over their body. Wigs help preserve a sense of normalcy during the difficult time of battling cancer.

Unfortunately, wigs are not covered by Medicare as they are not deemed medically necessary.

Does Medicare pay for cancer treatment after age 75?

Medicare does cover cancer treatment after the age of 75 and currently does not have any age limit for coverage. However, different age groups may receive more or less coverage for things like cancer testing, but health services are covered no matter what.

While understanding what is and isn’t available to you may be confusing, moreover daunting, there are plenty of resources available to help you through this process. Take the time to look at the basics, and understand your own coverage plans as you work through this unexpected and unprecedented experience. Sometimes, a few extra resources can go a long way in helping you and your loved ones plan.