Medicare and Cancer

People do not like to consider the possibility, but anyone, at any time, is capable of being diagnosed with cancer. You might be wondering, "why get a cancer plan if you don’t have cancer or a history of this disease in your family?". The statistics for the likelihood of being diagnosed with cancer is quite frightening.

  • Nearly 1 out of 3 people in the U.S. will have cancer.
  • 87% of all cancers are diagnosed in people older than 50 years.
  • Every 2 minutes a child is diagnosed with cancer.
  • 41% of men and 38% of women will be diagnosed during their lifetime.

With these numbers, it is evident that cancer insurance is essential for protecting you or your family from the unexpected high out-of-pocket costs. The NCI reported that Americans pay $157 billion a year in fighting cancer. For anyone that is faced with this diagnosis, they are going to need a cancer plan. If in fact you do get diagnosed with cancer, a lump sum will be paid direct to you or whom you select, no matter other health insurance coverage. For example, a cancer policy with Aetna will pay 100% of the chosen benefit amount – anywhere from $5,000 - $75,000. This money can be used for any type of expense.

You might be wondering, what if the cancer ever comes back? You can get a “Recurrence Benefit”, which is payable as long as medical advice or treatment hasn’t been received for at the minimum two years since last diagnosis. This benefit pays a percentage of the benefit amount. Please see below for percentage details.

Aetna Cancer Plan Re-occurrence

It is important to look at what Medicare covers for cancer patients. As you may know, Medicare only covers 80% of the cost and you are left with the remaining 20%. 

Part A – Hospital Insurance

  • Staying in the hospital for things like cancer treatment (inpatient).
  • Following a 3-day hospital stay, skilled nursing facility care.
  • Home health care.
  • Blood.
  • Hospice.
  • Certain clinical research study costs while an inpatient in the hospital.

Part B – Medical Insurance

  • Doctor appointments.
  • Drugs for chemotherapy through veins in outpatient clinic or doctor’s office.
  • Oral chemo-treatments.
  • Radiation treatments (outpatient).
  • Diagnostic tests like CT scans and X-rays.
  • Medical equipment like walkers, wheelchairs, etc.
  • Surgeries (outpatient).
  • Mental health services (outpatient).
  • Counseling for diabetes or kidney disease.
  • Certain preventive and screening services.
  • Eternal nutrition equipment (feeding pump).
  • Certain clinical research study costs while an outpatient.
  • Breast prostheses after mastectomy (outpatient setting).
  • In specific cases, a second opinion for a procedure that is not urgent, and a third if the first and second are different.

Things that Medicare does not cover:

  • Long-term nursing home care.
  • Medical food or nutrition supplements.
  • Room and other expenses in assisted living facilities.
  • Adult daily care.

You can also expect to pay things like copayments, coinsurance, or deductibles per each service. Depending on various factors, Medicare might have maximum payment amounts on services and will not provide coverage. Be sure to ask your doctor what Medicare will and will not pay for. 

All though we cannot predict the future, we can protect ourselves from the unexpected. If you would like to talk with someone about insuring yourself from the high costs of cancer, be sure to call MWG Senior Services at (877) 759-5760 or email senior.services@morganwhite.com. Our team of advisors are ready to answer any questions you might have about cancer plans!