Cancer coverage for Medicare
Cancer Protection Plan
What is a cancer protection plan? Do I need one if I already have insurance? Or Medicare?
Let’s review what a cancer protection plan is and how it works. Then you can decide for yourself if it makes sense to apply for coverage.
A cancer protection plan pays you a lump sum benefit upon being diagnosed with cancer. You are paid directly and receive the entire benefit upfront. Then you decide how you want to use that money.
- Pay medical bills
- Travel costs for treatment such as
- Airline flights to Mayo Clinic of MD Andersen
- Hotel bills
- Loss of income
- Anything else you prefer
I already have insurance, why do I need additional coverage?
So you already have insurance which is definitely a good thing. But does your insurance cover 100% of your health care costs?
Most people’s insurance plans do not. There are things like deductibles which you have to pay before the insurance company pays anything. And after you reach that deductible you probably still have some responsibility called co-insurance. Many plans are 80/20 which means you have to pay 20% of the bill until you reach your maximum out of pocket.
Do you have money set aside to pay that amount if you were diagnosed with cancer?
If you can’t say yes then applying for a cancer protection plan may be a good idea.
How does Medicare cover cancer?
Medicare covers cancer in a variety of ways so it depends on what type of plan you have. It also varies depending on what type of treatment you are receiving.
Traditional Chemo
Medicare Advantage
Medicare Advantage plans often require you to pay 20% of the bill for things like traditional chemotherapy. And chemotherapy typically costs more than $12,000 per month.
20% of a $12,000 bill means you owe $2,400 for 1 month of chemo treatment. You see you will quickly reach your maximum out of pocket which is close to $6,700 per year on many Advantage plans.
Original Medicare + Medicare supplement
Chemotherapy is covered under Medicare Part B. That means after reaching your deductible for the calendar year Original Medicare would pay for 80% of the medical bill for chemo treatment. A Medicare supplement could be used to cover the other 20% of traditional chemo.
But Medicare does have limits on how often you can get treated for things such as chemotherapy. If your doctor recommends that you go more often then Medicare may not cover those extra treatments at all. Here is some info from Medicare.gov about how cancer may be covered.
Here is a brief paragraph from that page that shows why you may want a cancer protection plan even if you have a Medicare supplement.
“Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.”
Oral Chemotherapy
In recent years, oral chemo medications have become more popular. They allow you flexibility in your schedule so you can get treatment on your own time.
But these medications are very expensive.
And they are covered under Medicare Part D instead of Medicare Part B. That means they will NOT be covered by your Medicare supplement. And if you have an Advantage plan, they do NOT go toward your maximum out of pocket.
Here is a list of some of the more commonly prescribed oral chemo medications. Most of these would be considered a tier 5 medication on Part D plans which means you would typically owe around 25% of the bill.
| Medication | Monthly Retail Cost | 25% Coinsurance |
| Revlimid | $21,051.00 | $5,262.75 |
| Jakafi | $14,108.00 | $3,527.00 |
| Ibrance | $12,388.00 | $3,097.00 |
| Odomzo | $11,810.00 | $2,952.50 |
| Zytiga | $11,376.00 | $2,844.00 |
| Matulane | $10,232.00 | $2,558.00 |
| Sutent | $5,368.00 | $1,342.00 |
| Hexalen | $1,669.00 | $417.25 |
| Femara | $742.00 | $185.50 |
Non-Traditional Medicine
Perhaps you don’t like the treatment plan outlined by your doctor. Have you ever known someone that has been through something like that?
I have.
They were frustrated enough dealing with a cancer diagnosis. But add on top of that the frustration of not getting the help you feel you need.
So people turn to non-traditional or alternative cancer treatments.
But alternative cancer treatments are often not covered at all by Original Medicare or Medicare Advantage plans. Which leaves you to pay for the entire bill all on your own.
This could be a situation where others have turned to Go Fund Me sites to help cover the costs.
But a cancer protection plan would pay you a lump sum benefit upon diagnosis that you can use however you choose. That way you aren’t trying to figure out how to pay your medical bills while also having to fight cancer.
Cancer Protection Plan
As you can see, almost all health insurance plans have some gaps where an additional cancer protection plan could help you fill. And according to the Association of American Cancer Institutes, 53% of all cancer related costs are non-medical or indirect costs.
So regardless of how you get your Medicare coverage, you may have some gaps that a cancer protection plan could help cover.
Lump sum benefits are typically between $5,000 and $75,000. Call me so we can review your situation and see what benefit makes sense based off your current coverage.
Mike Lovell
608-571-4461
Mike@askMedicareMike.com
If you’d like more information please contact me directly or complete this form.