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Medicare 101

Cancer And Medicare

Christian Worstell by Christian Worstell    |    Published Oct 03, 2019    |    Reviewed by John Krahnert

Growing older presents an increased risk for a number of health complications, including cancer. In fact, getting older is the leading risk factor for cancer. The median age for a cancer diagnosis is 66 years and one quarter of new cancer cases are in people age 65-74. With such a threat to older population, it seems appropriate that Medicare provides coverage for many types of cancer in a variety of ways. 

Below are some of the ways Medicare helps the fight against cancer.

Cancer Screenings

Early detection is key for nearly all types of cancer. Some reports indicate that the survival rate among people with eight of the most common types of cancers is three times higher when the disease is detected early. 

Cancer can be present in the body long before any symptoms arise, and a screening can help identify people who unknowingly have the disease. Medicare covers screenings for:

1. Breast cancer
Medicare Part B covers a mammogram for women 40 and over once every 12 months or when deemed medically necessary. Women ages 35-39 can have one baseline mammogram covered. Medicare covers screening mammograms completely.

Mammograms that are considered diagnostic require a 20 percent coinsurance payment of the Medicare-approved cost once your Part B deductible is met.

2. Cervical and vaginal cancer
Medicare Part B covers a Pap test and pelvic exam in full once every 24 months for all women and once every 12 months for high-risk women or those of childbearing age (20-35 years old) that have had an abnormal Pap test within the past 36 months.

A women may be considered high risk for cervical cancer if she:

  • Has human papilloma virus (HPV)
  • Smokes
  • Has a weakened immune system
  • Is overweight
  • Has had three or more full-term pregnancies
  • Has a prolonged history of taking oral contraceptives 

3. Prostate cancer
Men over the age of 50 can get a digital rectal exam and a prostate specific antigen (PSA) test once every 12 months. You’ll pay 20 percent of the Medicare-approved amount for the rectal exam while the PSA test is covered in full. 

4. Lung cancer
Part B of Medicare covers a lung cancer screening in full once per year for people who are:

  • Between the ages of 55 and 77.
  • Not showing any current signs or symptoms of lung cancer.
  • Either a current smoker, have quit smoking within the last 15 years or who have an extensive history of smoking. 
  • Referred by their physician or practitioner. 

5. Colorectal cancer

Medicare Part B provides coverage for a number of screening tests for colorectal cancer, including:

  • Barium enema screening – Covered once every 48 months for those over 50 and once every 24 months for high-risk people. You’ll pay 20 percent of the Medicare-approved amount and may face a copayment if done in a hospital outpatient setting.
  • Colonoscopy – Covered once every 120 months for everyone, once every 48 months after a previous flexible sigmoidoscopy and once every 24 months if you’re at high risk for the disease. You may have to pay a copayment if a biopsy or removal of a lesion or growth is performed.
  • Fecal occult blood test – Covered every 12 months for those 50 and over who are given a referral.
  • Multi-target stool DNA test – Covered once every 36 months for those who meet certain conditions.
  • Flexible sigmoidoscopy – Covered once every 48 months for those over 50 and once every 120 months following a colonoscopy. You may have to pay a copayment if a biopsy or removal of a lesion or growth is performed.

Chemotherapy

Chemotherapy involves the use of chemical drugs to kill off cancerous cells in the body and has been used in the fight against cancer since the 1950s. 

Both Part A and Part B of Medicare provide coverage for chemotherapy. Part A covers chemotherapy in a hospital inpatient setting while Part B provides coverage for hospital outpatients and patients in a doctor’s office or clinic. 

Chemotherapy covered under Part A requires a copayment while Part B coverage requires 20 percent of the Medicare-approved amount.

Drugs

There are hundreds of drugs used to treat cancer and many of those can be administered orally. Medicare Part B provides coverage for some drugs that can be taken orally if the same drug is also available in an injectable form. 

Covered drugs require patients to pay 20 percent of the Medicare-approved amount when received at a doctor’s office or pharmacy. Drugs received in a hospital outpatient setting come with a copayment. 

In addition, Medicare Part D plans may provide varying levels of coverage for certain cancer treatment drugs.

Radiation Therapy

Radiation therapy involves the use of high-energy radiation to kill cancer cells and tumors. Radiation therapy performed in a hospital inpatient setting is covered by Medicare Part A with a coinsurance requirement. Outpatient radiation therapy is covered by Medicare Part B with a required copayment. At a freestanding clinic, patients pay 20 percent of the Medicare-approved amount.

Medicare Supplement Insurance and Cancer

Because Medicare’s coverage of cancer often requires copayments, coinsurance and Part A and Part B deductibles to be satisfied, cancer patients can benefit even further with the help of a Medicare Supplement Insurance plan

These plans are designed to help pay for some of the out-of-pocket expenses associated with Original Medicare. These plans can make the fight against cancer all the more affordable for Original Medicare beneficiaries. Speak with a licensed agent at 855-650-1292 to find Medicare Supplement Insurance Plans in your area.

Learn More

To learn more about Medicare and the types of services it covers, read through our guide What Does Original Medicare Cover?

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