Medicare Advantage Cancer Coverage
Medicare Advantage Cancer Coverage: How does it really work?
It’s scary to think about but many people question how their Medicare coverage works if they are diagnosed with cancer.
If you have a Medicare Advantage plan, here’s what you need to know
Some cancer services under Medicare Advantage require you to pay up to 20% of the cost of your treatment. And you have to pay this until you reach the plan’s out of pocket maximum. That maximum can be as high as $6,700 per calendar year within the network. Or even higher out of network.
It’s important to know that limit resets every January 1st too. So if you reach your maximum out of pocket in December, you still reset to $0 January 1st.
Which means you need to be prepared to reach your maximum out of pocket twice if something serious like a cancer diagnosis occurs. This is why Medicare Advantage plans may not actually be cheaper than a Medicare supplement.
80% of people in a Medicare Advantage plan are in a plan that requires prior authorization for some services including Part B drugs like chemotherapy, hospital and skilled nursing facility stays, lab tests, home health and medical equipment.
So before you even start treatment, you may need to get approval from your insurance company that they will cover your treatments.
Prescription Drug Plans & Cancer
Cancer drugs may be covered under Part D:
- Prescription drugs for chemotherapy only if taken by mouth
- Anti-Nausea drugs
- Other prescription drugs used in the course of your cancer treatment, like pain medication
But many plans have certain medications listed as requiring step therapy.
Step therapy happens when a company requires you to try a less expensive medication first. Then if it doesn’t work as well you can “step up” to the next medication until you eventually reach the one your doctor recommended.
This can happen even if your doctor recommends a more effective medication.
For cancer patients, this can mean delays in using the best treatments to treat their cancer, side effects and treatments.
What does Medicare say?
“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.”
Medicare also has a booklet with more detailed info about facing a cancer diagnosis while on Medicare.
What can you do?
Cancer sucks!
But a cancer protection plan is a great option for people on Medicare. Especially for people on a Medicare Advantage plan. For less than a dollar a day, you can buy extra coverage to help pay your medical bills.
You can use it for prescription medications like oral chemo. Or for paying traditional treatment options like in Medicare Advantage.
That way you don’t have to find a way to pay your medical bills while also fighting cancer.
There are many different options available for you. Please contact me directly for help so I can make it easy for you.
Mike Lovell
855-712-7316
Mike@askMedicareMike.com