Summary: What Cancer Costs Medicare Can and Cannot Cover
For many cancer
Medicare Part A – Hospital Insurance:
Insurance Hospital Stays
- Hospital Stay (room and food)
- Inpatient cancer treatments
- Cancer medications
- Some of the costs of in patient clinical research studies
- Breast prostheses after a mastectomy
Skilled Nursing Facility (following at least 3 days in the hospital)
Home Health Care
- Room and Food
- Rehabilitation Services
- Speech-language pathology therapy
- Physical Therapy
- Occupational Therapy
- Skilled Nursing Care
Hospice Care
Blood
Medicare Part B – Medical Insurance:
Part B focuses on outpatient medically-necessary cancer-related services and treatments. If you are in the hospital for “observation” then you also fall into Medicare Part B coverage. A summary of Part B coverages is below:
- Doctor’s visits
- Chemotherapy administered through a vein at an outpatient clinic or doctor’s office
- Many oral chemotherapy treatments
- Outpatient Radiation treatments
- X-rays and CT scans for diagnostic purposes
- Wheelchairs and walkers
- Some outpatient surgeries
- Mental Health Services – visits to a Clinic, doctor’s office, or therapist’s office, services provided in a hospital’s outpatient department.
- Nutritional counseling if you have diabetes or kidney disease.
- Certain preventive and screening services.
- Enteral nutrition equipment (feeding pump) as DME that your doctor prescribes for use in your home, and certain nutrients if you can’t absorb nutrition through your intestinal tract or you can’t take food by mouth.
- Some costs of clinical research studies while you’re an outpatient.
- Breast prostheses (external breast prostheses, including a post-surgical bra) after a mastectomy. Part B covers surgically implanted breast prostheses after a mastectomy if the surgery takes place in an outpatient setting.
- A second opinion for surgery that isn’t an emergency, and a third opinion if the first and second opinions are different.
Medicare does NOT cover:
- Room and board in assisted living facilities.
- Adult day care.
- Long-term nursing home care.
- Medical food or nutritional supplements (except enteral nutrition equipment).
- Services that help you with activities of daily living (like bathing and eating) that don’t require skilled care.
Medicare Part D Prescription Drug Coverage
For prescription coverage you must enroll in Medicare Part D, it is NOT automatic. Part D covers some chemotherapy treatments and most prescription medications. There may be out of pocket costs depending upon the medication and what tier it sits in. It is also very important to know which drugs fit into Plan B versus Plan D.
Another opportunity for coverage is to add a Medigap (Medicare Supplemental Insurance) policy. These policies are sold by private insurance companies. These supplemental policies can help cover costs that original Medicare does not cover.
There are other Medicare benefits for cancer patients that were not covered in this summary. For more details we suggest you visit www.medicare.gov.
[i] Medicare Coverage of Cancer Treatment Services, https://www.medicare.gov/Pubs/pdf/11931-Cancer-Treatment-Services.pdf