While cancer medicine and treatments are advancing every year, the disease is still a harsh reality for many Americans. In fact, approximately 39.5% of men and women will be diagnosed with cancer in their lifetime¹. Receiving a cancer diagnosis is devastating enough, but when it comes to the actual cost of treatment, confusion and uncertainty can be thrown into the mix. 

The Bare Basics

Original Medicare pays for 80% of covered services, leaving your copay at 20% after you hit your annual deductible of $198 in 2021. While Medicare Advantage plans cover the same services as Original Medicare, the amount you pay may be different based on your plan. There is a more detailed breakdown of these services below. 

Cancer Related Expenses –

• Medicare Part A covers:
  • Cancer Treatment
  • Blood work
  • Diagnostic testing you receive in the Hospital
  • Inpatient surgeries 

• Medicare Part B covers:
  • Visits to your General Practitioner
  • Visits with your oncologist or other specialists
  • Outpatient surgery
  • Medical equipment such as walkers, wheelchairs, and feeding pumps

• Medicare Part C (Medicare Advantage)
  • Medicare Advantage (MA) plans are administered through private insurance companies who cover the same services as Original medicare and usually combine Parts A, B, and D.
  • Some MA plans have higher premiums, but their coverage options and copay prices are more suitable for the client’s situation. 

• Medicare Part D
  • Part D covers the prescription drugs associated with your cancer treatment. This may include
    • Pain medications, 
    • Oral chemotherapy drugs
    • Other medications prescribed by your doctor.
  • Medicare Part D is not automatically included in your Medicare or Medicare Advantage plan. However, Part D can be added to Original Medicare and may already be included in Medicare Advantage, but plans can vary. 

• Medicare Supplement Plans (Medigap)
  • Similar to Medicare Advantage, Medigap policies are administered through private insurance companies and help cover your share of cancer treatment costs.
  • You pay an additional premium for these plans, and in exchange they may help reduce your copays, coinsurance, and deductible amounts. 

So what do I pay?

According to a 2017 Study, average annual out-of-pocket cancer treatment costs ranged from $2,116 to $8,115. There are many factors in how much you pay for cancer treatment including type of cancer, how advanced it is, and the treatment type prescribed by your doctor. Picking the right coverage plan could save you thousands, so understanding your options is important

Important Tip:

Before you start cancer treatment, ask your doctor if they “Accept Assignment”. If a doctor accepts assignment, then they consider Medicare’s contribution and your copay as full payment for the treatment. 

However, some doctors who have opted out of Medicare may bill more than what Medicare covers, leaving you to pay what’s left in addition to your copay. It’s important to do your research while picking a treatment plan, and asking the doctor if they “Accept Assignment” could greatly affect how much you pay for treatment.  

Let SBS Help!

An Insurance Broker like SBS can show you plan options from over 50 different insurance companies and walk with you step by step through the often confusing pathway of Medicare. We’ve been serving the community for over 40 years and are experts in cancer coverage options. It’s our privilege to share our knowledge and expertise with you. 

If you’re diagnosed with cancer, the last thing you want to worry about is how much you’re paying for treatment. So let us focus on your coverage, while you focus on your family, your treatment, and your recovery. 
1 https://www.cancer.gov/about-cancer/understanding/statistics