Cancer Costs and Medicare Coverage Options

Most cancer diagnoses occur in adults who are older than 44 years of age, and over 15 million people in the US are cancer survivors. If you have had cancer in the past, your chance of receiving a future cancer diagnosis is increased.

Obesity, smoking, and a family history of cancer also heighten the risk of developing cancer as you age. Since most people covered by Medicare incur “out-of-pocket” expenses, it is vital to understand these potential “out-of-pocket” expenses if you are dealing with a cancer diagnosis.

The following describes the three forms of cancer most common in middle-aged adults, along with related population-based statistics. Also described is Medicare coverage related to these forms of cancer, as well as four top-rated Florida hospitals and their locations.

Colon Cancer, Colonoscopies, and Medicare Coverage

In order to diagnose colon cancer at the earliest possible stage in people at average risk, undergoing periodic colonoscopy exams starting at age 50 is recommended by the US Preventive Services Task Force. Anyone with a higher-than-average risk should receive a baseline colonoscopy at a younger age.

Notably, the American Cancer Society (ACS) predicts that – among men aged 45 and older – 74,020 new diagnoses of colon cancer will be diagnosed in 2019 (plus 63,140 among women). Besides the traditional colonoscopy exam, three other colon cancer screening tests described by the Centers for Disease Control are:

• Stool sample tests (such as the Guaiac-Based Fecal Occult Blood Test [gFOBT]);
• Flexible sigmoidoscopy;
• CT colonography (Virtual Colonoscopy)

Original Medicare covers screening colonoscopies once every 24 months if you are at high risk for colon cancer (per the Centers for Medicare and Medicaid Services [CMS]). If no cancerous polyp is found, 100 percent of your cost is covered.

However, you may be charged for a portion of the cost if a cancerous polyp is found and excised. Purchasing Medicare supplemental insurance (termed Medigap) may ensure that the full cost of your colonoscopy screening exam will be covered regardless of whether a cancerous polyp is excised.

Breast Cancer, Genetics, and Medicare

The total number of new breast cancer cases in 2019 in women age 45 and older is predicted to be 241,940 by the ACS (and 26,660 in women younger than age 45). Women who have the HER-2 genetic mutation are at far higher risk for breast cancer, and this mutation is also linked to a greater risk for rapid cancer progression and death.

According to the Mayo Clinic, HER-2 positive breast cancers are less sensitive to hormone therapy of any kind. Original Medicare will cover HER-2 genetic testing in people who have had breast cancer under specific conditions (per the American Society of Clinical Oncology).

Lung Cancer and Advances in Treatment

Among men aged 45 and older, 115,130 are expected to receive a lung cancer diagnosis by the ACS (as well as 110,150 women aged 45 and older). The American Lung Association notes that the five-year survival rate is 56 percent in cases when the cancer is localized to solely the lungs – and the survival rate is lower than for breast, colon, and prostate cancers.

However, a new type of “cutting-edge” chemotherapy has been developed that can utilize a patient’s own immune system cells to attack the cancer cells (termed immunotherapy) which is increasing later-stage survival rates.

One problem for Medicare-enrolled lung cancer patients is that the cost of any cancer treatment considered “experimental” is not covered by Medicare (and immunotherapy typically costs at least $100,000 per dose). Enrolling in a clinical trial is a way that a cancer patient may be able to receive immunotherapy treatment at no cost, but it usually requires meeting specific enrollment parameters.

Four Top-Rated Hospitals in Florida Among the numerous hospitals in Florida, US News and World Report ranked the following as the top four hospitals in the state:

• Mayo Clinic (Jacksonville, Florida).
• Tampa General Hospital (Tampa, Florida).
• UF Health Shands Hospital (Gainesville, Florida).
• Cleveland Clinic Florida (Weston, Florida).

Besides assisting you to learn more about Original Medicare coverage options, scheduling a consultation with UrHealth Benefits can enable you to gain a better understanding of both Medicare Advantage and Medigap plans.

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