If you have been diagnosed with cancer, you probably know that treatment costs are high. This is why it is important to carefully consider your options under Medicare.
Original Medicare
Medicare coverage is divided into parts. Part A covers inpatient care (hospitalization). Part B covers outpatient care, such as doctor visits and lab work. Part D is purchased separately and covers the costs of prescription drugs. Both Parts A and B have annual deductibles to be met before Medicare coverage kicks in. Once the deductible is met, Medicare pays for 80% of your outpatient care. There is no cap on your out-of-pocket costs with Original Medicare Parts A and B.
Medicare Advantage Plans
These health plans, which fall under Medicare Part C, provide an alternative to Original Medicare. They are Medicare-approved plans, offered by private insurance companies, that cover Parts A and B, and in many cases, Part D. These plans cover the same services as Original Medicare, and most have an HMO or PPO provider network. You are likely to have a copayment when you see a specialist, but there is no deductible to meet. Some Medicare Advantage plans offer dental and vision benefits, and some provide free gym memberships. These plans have out-of-pocket limits, which vary from one insurer to another.
Although Medicare Advantage plans have definite advantages over Original Medicare, they may also have certain disadvantages for individuals who have been diagnosed with cancer. For example:
- Advantage plans may require step therapy for Part B medications. This means you may be required to try a less expensive drug first before the plan will cover a more expensive drug, even if the cheaper drug is less effective.
- You may need prior authorization for certain procedures.
- With some Medicare Advantage HMO plans, you need a referral from your primary care physician (PCP) before seeing a specialist.
- The co-pays for some cancer services under Medicare Advantage plans can run up to 20% of the treatment cost. You must continue making co-payments until you reach the out-of-pocket maximum under the plan, which could be as high as $6,700 for in-network services.
Medigap Plans
A Medigap policy is supplemental insurance for people on Original Medicare. Many people purchase this coverage to bridge the gap not covered by Medicare. Medigap plans cannot be used to cover Medicare Part B premiums, but they can help cover the deductible of $1,484 (as of 2021) that you must meet before Medicare starts covering hospitalization. They can also help cover the 20% you are required to pay for outpatient care, including costly diagnostics, such as MRIs. As there is no out-of-pocket limit with Original Medicare, supplemental insurance is essential for people with serious health conditions, such as cancer.
Medigap plans are secondary insurance to Original Medicare. First, Medicare pays its portion of the bill, then the Medigap plan pays its portion. One distinct advantage of a Medigap plan with Original Medicare is the freedom to choose your own doctors and hospitals from all available Medicare providers anywhere in the country. You will not need a referral to see a specialist.
After a cancer diagnosis, speak with our friendly agent. We can help you choose the best Medicare options for your situation.