Medicare and Cancer Coverage
- Open enrollment for Medicare runs until December 7.
- Medicare is primarily for those 65 and older.
- While cancer may qualify some for Medicare at a younger age, you must first be on disability for two years.
- Navigating the Medicare system can be challenging, but there are professionals who can help.
The answer isn’t simple. While Medicare can provide important coverage for costly cancer treatment in some cases, it’s also a system that’s complicated and often overwhelming — and that’s on top of the other fears and concerns that come with a cancer diagnosis.
Read More“This system is difficult. It’s a bit of a disaster. It’s no wonder cancer patients are suffering from financial toxicity at really really high rates.”
Failing to understand the program and its deadlines can be costly, and predatory practices abound. That’s why oncology social workers like Christina Bach say it’s so important for cancer patients to ask for assistance when they need it.
“Not enough people are asking for help, then they’re like, ‘Why am I getting these bills?’” Bach told SurvivorNet. “Medicare is super complicated, and there are parts within parts and supplemental plans to consider.”
Here, we break down some of the Medicare basics as well as where to go for help when you’re considering Medicare coverage.
Who Qualifies for Medicare?
Medicare was established in 1965 to provide health insurance coverage to people 65 and older. In 1972, it was expanded to cover some people under 65 who have long-term disabilities, which may include cancer. In some cases, cancer may qualify you for Medicare regardless of your age. The catch is that you have to be on disability for two years before you qualify for Medicare if you’re under 65.
“There’s no rushing it, no making it faster,” Bach says, though she notes that there are exceptions for people with kidney disease or ALS.
So what to do if you haven’t been on disability that long but need health insurance? Bach says many patients under 65 stay on a Cobra plan until they’re eligible, but Cobra plans can be extremely expensive. Some opt for health insurance plans under the Affordable Care Act in the meantime.
An Overview of Medicare
If you are eligible for Medicare, it’s important to understand its various components. In general, there are four parts to Medicare. The two primary ones are Part A and Part B.
Part A covers things related to hospitals. That includes inpatient hospital care, care at skilled nursing facilities, hospice, lab tests, surgery and home health care. It may also cover the cost of some clinical research studies while you’re a patient in a hospital.
Part B medical insurance covers things like doctor visits and outpatient care. It also covers medical equipment, home health care and some preventative services. Some cancer treatments such as chemotherapy are also covered by Part B.
Medicare Parts A and B don’t cover all your costs, however. In fact, for what they do cover, they only pay for 80 percent of the cost, and you’re responsible for the remaining amount; which can end up leaving you with a hefty bill if you are going through cancer treatments. Also, things like dental care, eye exams and long-term care aren’t covered at all. In some cases, you may have to also pay coinsurance and/or deductibles.
There are two other parts of Medicare to consider as well:
Part C, also known as Medicare Advantage Plans are offered by private companies. They bundle Parts, A, B and D into one managed plan that is run by a third-party insurance company. They also often cover things that Part A and B don’t, such as vision, hearing, gym memberships and dental coverage. Note that the open enrollment for these plans is different and runs from January 1 – March 31 each year.
“I tell my cancer patients to be very careful about Medicare C plans. They’re pretty predatory”
Part D is a prescription drug coverage program. Plans covers some, though not all drugs, and may provide coverage for cancer treatment drugs not covered by Part B.
So which one or ones do you choose? That’s not an easy question to answer according to Bach. In general, she warns that Part C plans are rife with predatory practices, so you must proceed with caution when signing up for one.
“I tell my cancer patients to be very careful about Medicare C plans,” she tells SurvivorNet. “They’re pretty predatory. They promise a gym, dental and vision and all sorts of extra benefits, and they do that. But they don’t tell people that they operate just like part A and B and you still have to pay 20 percent of your costs until you meet your out-of-pocket spending limit. And that resets every year—it’s not just one and done. The fine print is there is always cost sharing with these plans, just like with traditional Medicare.”
Medicare Supplemental Insurance
There are also Medicare Supplement Insurance policies, known as Medigap plans to consider. They’re sold by private companies and may cover some of the costs of deductibles and copayments. Rules for enrollment and coverage may vary by state. For example, in some states companies are required to sell Medigap policies if you’re under 65 and in some states they’re not. Bach says it’s extremely important to pay attention to when you purchase these plans. If you buy them during your initial enrollment eligibility, then they can’t look at pre-existing conditions. If you do so after that time, they can, and you may be disqualified or charged exorbitant rates because of cancer or other conditions.
- Enrolling in various Medicare programs at the appropriate time is important too. Bach says there are really special rules about when you can enroll in the various parts. Late enrollments come with penalties that you must pay for the rest of your life, which are based on the number of months you could have had coverage but didn’t. This section on Joining a health or drug plan breaks down more of the specifics for individual situations and deadlines you need to know.
If it all sounds like a lot, that’s because it is. Bach says it’s overwhelming at best.
“This system is difficult,” she says. “It’s a bit of a disaster. It’s no wonder cancer patients are suffering from financial toxicity at really really high rates. COVID-19 has exacerbated it too.”
That’s why she suggests that cancer patients seek help navigating the Medicare system. She says to start with your local cancer treatment center to see if they have financial counselors available. You can also contact a national organization for help, such as the Cancer Support Helpline who can put you in touch with a financial navigation specialist.
To learn more about the various parts of Medicare and how they work together, visit the OncoLink Health Insurance Webinar Series. You can also review “Medicare and You,” which is updated annually and available for free as well as “Medicare Coverage of Cancer Treatment Services,” provided by the Centers for Medicare and Medicaid Services.