If you or someone you know has cancer, you may be wondering about Medicare cancer coverage. Medicare Advantage plans offer an alternative to Original Medicare that works better for the finances and care needs of some. Read on to learn about how Medicare Advantage can cover life-saving services and treatments.
When It Comes to Cancer, What Does Medicare Advantage Cover?
Medicare Advantage, also known as Medicare Part C, replaces coverage for Medicare parts A, B, and sometimes D. According to the Centers for Medicare & Medicaid Services, all Medicare Advantage plans must provide the same services as Original Medicare, including:
- Inpatient hospital stays such as inpatient cancer treatments
- Outpatient radiation treatment
- Outpatient chemotherapy medications
- Some oral chemotherapy treatments
- Hospice care
- Some cancer screenings
Because chemotherapy is covered under Medicare Part D, a Medicare Advantage plan with Part D included will cover chemotherapy treatments.
“When chemo and radiation are administered, the most a Medicare Advantage plan can charge in coinsurance is 20 percent. While the coinsurance can vary from plan to plan, almost all pay to charge the max of 20 percent. There are some that charge less, but those are rare,” Christopher Duncan, founder and independent broker at Trusted Benefits Direct, tells WebMD Connect to Care.
Medicare Advantage plans must provide the same coverage as Original Medicare. The Centers for Medicare & Medicaid Services notes that, for breast cancer patients, this coverage includes:
- Surgically-implanted breast prostheses after a mastectomy
- Post-mastectomy external breast prostheses, including a post-surgical bra
Medicare Advantage Plans come in different forms, including Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. The best type of plan for you will depend on the availability of specific plans in your region as well as your preferences.
“If a Medicare beneficiary is more concerned with the selection of doctors and facilities to use, then a Medicare Advantage PPO will most likely be more suitable. With a PPO plan, the coinsurance, copays and deductibles are likely to be higher than the HMO plans,” Duncan says.
Medicare Advantage HMO plans have a restrictive network. Aside from emergency care, you would have to see the doctors, hospitals and providers within your chosen HMO network.
“The restrictive network also usually comes with much lower deductibles, copays and coinsurance. If the cancer patient is enrolled in a Medicare Advantage plan, then there is likely to be a per-day copay,” Duncan says.
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