The “C” word can be terrifying; however, support is available. Did you know that as a Medicare patient, you may be covered for numerous cancer health services and screenings? Click here to download a user-friendly guide to learn more about “Medicare Treatment Services.”
Practicing disease prevention and receiving early detection screenings is a meaningful way to stay healthy and can save your life. Abarca suggests talking to your doctor and healthcare provider during your yearly check-ups or whenever a change in your body occurs. Other sure ways to prevent cancer are avoiding tobacco use, eating healthy, being physically active, protecting yourself from the sun, getting vaccinated against certain diseases, practicing safe sex, and getting your regular yearly exams.
Types of screenings & coverage
Early detection of cancer is key and can save your life in the long run. Medicare may provide coverage for screenings for breast cancer, cervical cancer, prostate cancer, lung cancer, and colon cancer. It is important to note that your coverage may depend on whether or not you meet certain conditions, your type of coverage, your clinical history, and certain criteria.
Below, we’ve compiled a list to help you better understand what your Medicare coverage may cover when it comes to certain types of cancers.
Breast cancer
- Medicare covers a clinical breast exam, as well as two different types of mammograms (an X-ray of the breast which is the best way to detect breast cancer at an early stage).
- Every 12 months, you can be seen by your doctor for a mammogram at no extra cost if you are over 40 years of age.
- In the case of a diagnostic mammogram, the frequency will vary; however, Medicare covers 80% of the cost. You will only be responsible for 20% plus Part B deductible costs.
Cervical & vaginal cancer
- Every 2 years, Part B covers a Pap Test and pelvic exam; however, if you’re at high risk for cervical or vaginal cancer, Medicare covers these screening tests once every 12 months.
- Part B also covers Human Papillomavirus (HPV) tests (as part of a Pap test) once every 5 years if you’re aged 30-65 without HPV symptoms.
Prostate cancer
- Medicare covers PSA (Prostate-specific antigen blood tests) and DRE (Digital Rectal Exams) every 12 months for people over 50.
- If your doctor accepts Medicare, there are no fees for a PSA blood test.
- You will need to pay 20% of the Medicare-approved amount for a DRE, which covers the exam and services and the Part B deductible.
Lung cancer
Medicare Part B (Medical Insurance) covers lung cancer screenings with low-dose computed tomography once each year if you meet all of these updated conditions:
- You’re aged 50-77.
- You don’t have signs or symptoms of lung cancer (asymptomatic).
- You’re either a current smoker or have quit smoking within the last 15 years.
- You have a tobacco smoking history of at least 20 “pack years” (an average of one pack (20 cigarettes) per day for 20 years).
- You get an order from your doctor.
Colorectal cancer
- Medicare covers colonoscopies and other tests.
- You can get a colonoscopy every ten years or 24 months if you are a high-risk patient.
- If you are 50 years of age or older, you can get a fecal occult test yearly at no cost.
- If you are 50 or older and high-risk, you can have a screening for barium enema every 24 months.
- Every 48 months, you can get tested with flexible sigmoidoscopy or traditional colonoscopy.
Cancer treatment options covered by Medicare
Chemotherapy
- Medicare will cover chemotherapy when recommended for the treatment of cancer.
- Part A covers hospital inpatient, and Part B covers chemotherapy in an outpatient setting.
- For Chemo in an outpatient setting, Medicare covers 80% of the cost. You will only be responsible for 20% plus Part B deductible costs.
- For prescription drugs, Part D covers certain medicines such as anti-nausea, oral prescriptions, pain medications, and others.
Radiation therapy
- Part A and Part B can cover radiation therapy. Part A and the deductible cover radiation if you are an inpatient.
- Part B covers radiation as an outpatient. However, you will need to pay 20% of the amount.
Additional resources
You can lower your risks of getting one of these cancers with healthier habits. Meanwhile, here are some excellent resources to get you started on preventing cancer and finding help if you do find yourself with the disease.
- How to prevent cancer or find it early
- Excellence in Cancer Care
- Staying Health, Medicare’s preventative services
- Medicare Coverage of Cancer Treatment Services
Abarca stands committed to helping Medicare patients understand what their insurance covers If you have questions about whether Medicare covers a certain test, item, or service, access this link for an easy search tool for more information. If you still have doubts, reach out to your healthcare provider who can answer your questions including what your Medicare plan does and doesn’t cover.
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*This blog post was written by Kiersten Aymar, Assistant Vice President of Government Programs Services at Abarca Health.