Among men, prostate cancer is one of the leading causes of death. According to the Centers for Disease Control and Prevention, prostate cancer is the second most common cancer in the U.S. among men. These statistics can strike fear in many, but one worry you don’t need is no prostate cancer coverage under Medicare.
Luckily, there are many cancer-related services and treatments Medicare covers. Many of these will be outpatient services covered under Medicare Part B. No, you may not be covered 100%, but there is additional coverage you can have with your Medicare benefits to help lower your expenses.
Now, let’s go over what your coverage would look like if you were diagnosed with prostate cancer. Below, we will provide more information on Part B and how it covers cancer.
Will Medicare cover me if I get prostate cancer?
Medicare Part A and Part B will provide coverage for you if you get prostate cancer.
Under Medicare Part A, you will receive coverage for prostate cancer treatment during an inpatient hospital stay. Part A would also cover you if you needed a skilled nursing facility after an inpatient stay for prostate cancer surgery.
What does Part B cover?
Part B handles outpatient services like outpatient surgeries, chemotherapy, radiation, and lab work. Certain cancer screenings are also covered 100% by Medicare Part B.
Prostate Cancer and Part D
Cancer medications are known to be quite expensive. Thankfully, many of the drugs you might need to fight prostate cancer are covered by Medicare Part D. The types of medications that will fall under Part D are typically ones you pick up at the pharmacy and ones you take by mouth or inject yourself.
How much can I expect to pay?
Medicare can cover a good portion of your care when undergoing cancer treatment, but it won’t foot all your medical bills. Here’s a little breakdown to help give you an idea of the money that could be coming out of your pocket:
For Part A, beneficiaries are responsible for the Part A deductible before they can have coverage for their inpatient hospital stay ($1600 in 2023). A key thing to remember about the Part A deductible is that it is per benefit period, which comes every 60 days you have not been in the hospital. If you have prostate cancer and only have Medicare Parts A and B, you could face the deductible multiple times a year, depending on your cancer journey, diagnosis, and treatment plan.
Part B has a monthly premium that everyone must pay. Most people pay the standard amount ($164.90 in 2023), but if your income is higher, you could have to pay more for your Part B premiums.
Before Part B begins to cover your outpatient services, you must also meet the yearly deductible. For 2023, it is $226. Once the deductible is met, Part B covers 80% of your Medicare Part B services and treatments. However, this means you will be responsible for the remaining 20% with no cap on how much that can become.
Additional Coverage and Cost
Since everything isn’t paid for 100% with just Medicare Parts A and B, you have two options to help with your cost-sharing. You can look into either a Medigap or Medicare Advantage plan. These plans can help reduce your prostate cancer-related expenses so that you can have one less thing to worry about as you try to get through your cancer treatments.
Will my Medigap plan help pay if I get prostate cancer?
Medigap plans (also known as Medicare Supplements) help provide additional coverage for your Medicare services, including cancer treatment.
Medigap plans help pay for the Part A deductible, coinsurance, hospital costs, and more. However, how much your monthly premium will cost is based on multiple factors, such as your gender, age, zip code, and tobacco use. These factors mean the cost of a plan will be different for everyone, but they can be very reasonable for the coverage you get.
As we said before, these plan pays secondary to Medicare and helps cover the remaining 20% after Medicare Part B pays its 80%. When Medicare pays, so will your Medigap plan.
How does Medicare Advantage cover prostate cancer?
If you enroll in an Advantage plan, there is coverage for you in the event you are diagnosed with prostate cancer. Medicare Advantage plans offer beneficiaries an alternative option through private insurance carriers. When you have this type of plan, your Medicare Part A and B benefits come from your Advantage plan. Many Medicare Advantage plans include a built-in Part D drug plan.
Each Advantage plan covers medical services and treatments differently. Your plan will have a Summary of Benefits detailing how your services are covered and what your out-of-pocket costs will amount to.
An important thing to note are that these plans must offer you the same benefits as Medicare Parts A and B.
Although Advantage plans provide coverage differently than Medicare Supplements, both options offer assistance with your Medicare-related costs and help put a cap on your out-of-pocket spending.
There is coverage for you
A cancer diagnosis is a hard enough thing to process on its own. You don’t need to add the stress of wondering how your Medicare will cover you on top of it. Though your journey can be long and hard, be sure you know that if you have Medicare, there is coverage for you.