Do i need cancer insurance if i have medicare

Cancer insurance is a supplemental insurance policy that can help you cover more costs than what you can have from health insurance alone. While optional, it can relieve a substantial financial burden in a way no health insurance policy can.

Why Get Cancer Insurance?

Cancer is physically, mentally, emotionally, and financially devastating. It is a diagnosis no one wants to get, but something that half of men and a third of women will receive at some point in their lives. When you’re diagnosed, life as you once knew it becomes compromised.

Individuals with cancer are more than twice as likely to file bankruptcy than others. Treatment costs average a whopping $150,000, and health insurance can only go so far. This is also not to mention that cancer interferes with your ability to earn income. You may have to temporarily stop working while you receive treatments, adding onto the debt while leaving you no choice but to watch the bills pile up.

Cancer insurance relieves this financial burden. This is a way to mitigate those expenses so you can focus on your recovery instead of the expenses.

How Does Cancer Insurance Work?

How your cancer insurance policy works depends on which one you choose. Types of cancer insurance include:

• Expense incurred – covers a percentage of covered expenses listed on the policy (up to policy limits)
• Indemnity – functions like expense incurred, except it covers listed expenses up to a certain dollar amount
• First diagnosis – pays lump-sum once you are diagnosed with cancer

These plans cover treatment-related costs like screenings and surgeries, as well as non-medical expenses such as child care and lost wages. If you opt for first diagnosis cancer insurance, you can use the lump sum disbursed to you for anything. Filing claims is a quick process, too – you can do it online directly after a diagnosis.

Cancer insurance is still useful when you are not actively battling cancer. Some plans allow for yearly screenings to detect cancer early, further sparing you from high treatment costs. Other plans may give you benefits in case of cancer returning. 

Is Cancer Insurance Right For Me?

Cancer insurance is optional, and there is a chance you may not need it. Not having cancer insurance is not as detrimental as being without health insurance. However, there’s no way to predict whether you will get cancer at some point in the future. It can happen to anyone, and its effects are earth-shattering.

It’s worth considering for anyone – especially those who have a family history of cancer. It is also worthwhile for those who have insufficient health insurance coverage.

Cancer may not be preventable, but with cancer insurance, you can prevent the financially devastating effects.

Be Prepared Today

At Senior Health Solutions, we want to help you be prepared for whatever life throws your way. We’ll get you the best plan for the lowest price. Call us today at (636) 244-4415 for more information.

In this section, you will find information about the coverage of cancer treatment, including tumor testing, under:

• Medicare
• Medicaid
• Fertility preservation
   

Medicare

Your costs depend on several factors, like whether your health care provider accepts Medicare assignment, the type of facility, other insurance you may have, and the location where you get your services. You have a right to know how much your out-of-pocket costs will be. Your doctor's office and treating medical facility should work with you to help you understand and plan for the cost of your care. 

Medicare Prescription Drug Plans (Part D) or Medicare Advantage Plans with Part D cover most prescription medications and some chemotherapy treatments and drugs. If Part B doesn’t cover a cancer drug, the Part D plan may cover it. It’s important to check with your plan to make sure your drugs are on the formulary (list of covered drugs) and to check the tier in which the drug is listed. This affects out-of-pocket costs.

Tumor Testing

Tumor biomarker testing looks for certain genomic abnormalities in cancer cells. A tumor test may be done to determine if the cancer is more susceptible to specific treatments or how aggressive the cancer is and whether it’s likely to recur. 

Medicare covers biomarker testing when the patient has:

1. Recurrent, relapsed, refractory, metastatic, or advanced stage III or IV cancer; and
2. Either not been previously tested using the same NGS test for the same primary diagnosis of cancer, or repeat testing using the same NGS test only when a new primary cancer diagnosis is made by the treating physician; and,
3. Decided to seek further cancer treatment (e.g., chemotherapy)

The diagnostic laboratory test using NGS must have:

1. FDA approval or clearance as a companion in vitro diagnostic; and an
2. FDA-approved or -cleared indication for use in that patient’s cancer; and,
3. Results provided to the treating physician for management of the patient using a report template to specify treatment options

Biomarker tests that lack an FDA-approved companion therapy may be covered at the discretion of the regional Medicare Administrative Contractors (MACs). Patients still must meet the criteria defined in bullets A, B and C above.

Lynch syndrome

Testing for Lynch syndrome in people diagnosed with cancer begins with tumor testing. Medicare covers two different types of tumor tests to look for evidence of Lynch syndrome:

• Microsatellite Instability (MSI)
• Immunohistochemistry (IHC)

Patients with tumor test results that suggest Lynch syndrome may be referred for genetic testing for an inherited mutation.

In a family with a known Lynch syndrome mutation (MLH1, MSH2, MSH6, PMS2, or EPCAM), Medicare covers genetic testing only for individuals with:

• Signs and symptoms of Lynch-associated cancer, and
• A blood relative with a known Lynch syndrome mutation

Read your plan materials or call your plan for more information about your coverage and benefits. Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get cost information.
 

Medicaid

Medicaid benefits for cancer treatment vary by state but care is generally similar to that of people with basic private health insurance. Every state’s Medicaid program is required to cover certain services including inpatient and outpatient hospital services, and laboratory and x-ray services. Medicaid covers non-emergency medical transportation in most states, which is helpful if you are too sick to drive yourself to your health care providers or if you don’t have reliable transportation.

Medicaid also provides retroactive eligibility—covering the costs of medical care that took place during the 3 months before finalizing the eligibility process for people who would have been eligible during those months. If you are newly diagnosed with cancer or if your income is being depleted to cover medical expenses, retroactive eligibility can be crucial in helping you get treatment instead of delaying or avoiding treatment altogether.

Under existing law, state Medicaid programs must cover all of the drugs for a manufacturer that has a Medicaid rebate agreement. This requirement ensures relatively broad access to medications and therapies for cancer patients with Medicaid. 

Tumor Testing

Tumor biomarker testing looks for certain genomic abnormalities in cancer cells. A tumor test may be done to determine if the cancer is more susceptible to specific treatments or how aggressive the cancer is and whether it’s likely to recur. Access to this type of testing for Medicaid recipients varies by state but it is generally more limited than what is available with private insurance or Medicare.

Lynch syndrome

Testing for Lynch syndrome in people diagnosed with cancer begins with tumor profiling. While coverage varies by state, Medicaid typically covers two different types of tumor tests to look for evidence of Lynch syndrome:

• Microsatellite Instability (MSI)
• Immunohistochemistry (IHC)

Patients with tumor test results that suggest Lynch syndrome may be referred for genetic testing for an inherited mutation.

The majority of state Medicaid programs cover genetic testing for individuals with a blood relative who carries a Lynch syndrome mutation (MLH1, MSH2, MSH6, PMS2, or EPCAM).

If you are age 65 or older with a disability and a very limited income, you could be eligible to receive both Medicare and Medicaid benefits. Medicaid may cover what Medicare does not.

Contact your state Medicaid office to learn more about the cancer diagnosis and treatment benefits in your state.
 

Fertility Preservation

Although infertility may be caused by cancer treatment or surgery, health insurers do not typically cover fertility preservation or related treatments. Several states have fertility preservation coverage laws that require private individual and group health plans to cover certain fertility services for women and men who will experience “iatrogenic infertility” (infertility caused directly or indirectly by surgery, chemotherapy, radiation or other medical treatment), but most do not apply to individuals with Medicare or Medicaid. 

If you do not have insurance coverage for fertility preservation, you should ask about discounts. Many clinics will provide significant cost reductions for patients who need fertility preservation and related procedures. In addition, some hospitals and adolescent & young adult (AYA) programs have charitable funds available to help offset sperm banking and other fertility preservation costs.

There are also grants and discounts available through established financial assistance programs.

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