The financial aspect of cancer can be debilitating for many Americans, so it is essential to utilize all your resources and find the right health insurance plan for you. So, let's explore one option: Medicare.
Medicare is a government funded health insurance plan designed for people 65 years of age or older, some younger people including children with certain disabilities, and those who have been receiving Social Security disability benefits (SSI or SSDI) for two years.
According to the American Cancer Society, elderly Americans make up more than half of all new cancer patients. They are, regardless of race or ethnicity, 10X more likely to get cancer than younger people. Also noted by the ACS is that lung cancer is detected in 1 of 6 new cancer patients and is the leading cause of death in the elderly, followed by breast cancer. Medicare is a trusted choice and covers almost all elderly or disabled individuals in America.
Now, you may be wondering how to apply for Medicare when you are suffering with cancer. This process can be very confusing and daunting, but staying informed is your best option. Here are the steps you can take to ensure the process goes smoothly and you have the fullest knowledge of your options.
1. First, get started on that application! The enrollment period begins 3 months before your 65th birthday and ends 3 months after so it is critical that you are prepared for this window of time. The U.S. Social Security Administration deals with Medicare enrollment and should be your main contact for any questions or concerns! You may choose to apply online or visit your local Social Security office.
Apply online here: https://www.ssa.gov/benefits/medicare/
2. Stay informed, know your options.
Medicare includes many parts that cover different services.
Part A
This part covers most of the inpatient and hospitalization expenses as well as nursing facility care, hospice care, and home health care. Usually, people will not have to pay any premiums for Part A but will have to for Parts B and D. Individuals with higher incomes will have to pay higher premiums.
Part B
This covers care that is medically necessary: Doctors visits, outpatient care, home health care, medical equipment, some services to prevent disease, and certain early detection screenings.
For more information on the various screenings offered please visit: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/medicare-coverage-for-cancer-prevention-and-early-detection.html
Mammograms: https://www.medicare.gov/coverage/mammograms
Lung Cancer Screenings: https://www.medicare.gov/coverage/lung-cancer-screenings
Chemotherapy: https://www.medicare.gov/coverage/chemotherapy
Breast prostheses: https://www.medicare.gov/coverage/breast-prostheses
Part C/Medicare Advantage
This is a part of the optional Medicare Advantage Plans that are offered by private companies. If one of these alternative plans are chosen, Part A and B will be covered and most include Part D as well. Some plans even offer additional coverage for vision, hearing, dental, lifestyle support services (transportation, home safety features, home meal delivery, etc.), and/or health and wellness programs. According to CancerCare, in 2019, there were an average of 24 Medicare Advantage Plans (depending on your resident state) and most have an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) providers.
Before signing up for any Advantage plans, be sure to consult more in depth information.
Part D
This is an optional part that covers prescription drugs. To enroll, choose one of the Medicare Prescription Drug Plans. You must have Parts A and B if you would like Part D too. If you are a part of one of the Advantage plans, check to see if Part D is included otherwise you may choose to enroll in a Prescription Plan.
For more information on Part D coverage please visit: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/part-d.html
Private Medigap Plans
These plans are sold by private companies and can help fill in the “gaps” of your original Medicare plan. They may help pay for some remaining costs such as Copayments, Coinsurance, and Deductibles. You must already have Parts A and B before you can purchase a Medigap plan.
Like the Advantage plan, Medigap has many rules and policies you may want to consult before enrolling. For more information please visit https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap or ask your current health insurance provider to find out what they can offer!
To find a Medigap Plan that works best for you please visit https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?lang=en&year=2021
The Oncology Care Model
Medicare has brought on a more patient-focused approach to oncology care, introducing the Oncology Care Model. The Model will help oncology practices bring better, more quality care for cancer patients with Original Medicare who are receiving chemotherapy or hormonal therapy. Currently there are more than 200 oncology practices and 13 private health plans that are a part of this Model. Your practice should have notified you if they are a part of this Model but if you are unsure, contact your practice or plan to get more information!
According to Medicare.gov, with the Oncology Care Model you can expect to receive:
“A plan of care personalized and tailored to your specific health needs.
Access to a health care provider who can answer your questions 24 hours a day, 7 days a week.
Health care focused on your needs—as defined by you and your support network.
Support in coordinating care with other health care professionals and community organizations to meet the full range of your health needs.
Access to support services (like financial help, social, and emotional support) to help you navigate your treatment journey.”
For more information please visit https://www.medicare.gov/manage-your-health/coordinating-your-care/a-patient-focused-approach-to-oncology-care.
****This already may seem like a load of information and you may have many questions, but don’t worry, we’ve got you covered. If you have any questions call 1-800-MEDICARE or visit https://www.medicare.gov/. You can also receive free help through the State Health Insurance Assistance Program, also known as SHIP. Visit https://www.shiptacenter.org/ or call 1-877-839-2675 for support!
3. Really think about which plan meets your needs. Don’t rush, plan ahead of time and gather as much information as possible to make the best decision. You’ve got this!
4. It is so important to review your Medicare choices every year as you need to renew coverage every year. Sometimes plans will discontinue a certain coverage or benefit and you will need to adjust your plans accordingly. Your health insurance provider will send you an “Annual Notice of Change” every September 30 to outline the changes made to your plan to begin the next year.
Medicare’s open enrollment period is from October 15-December 7. In this time, you can switch from the Original Medicare plan to an Advantage Plan or vice versa. You can also change Advantage plans and add/change a Part D prescription plan.
5. Finally, take ample time with the process. Navigating Medicare can be complicated and overwhelming but if you give yourself lots of time to plan and use your available resources to help you along the way, you will be able to make the best choice for yourself!
Some things to keep in mind if you have Medicare:
According to the American Cancer Society, before scheduling any kind of appointment or tests, double check that your doctor accepts Medicare as well as if he/she “accepts assignment”. These doctors are called participating doctors and will:
“Take the amount Medicare pays, along with your standard deductible and co-pay, as payment in full.
Usually wait for Medicare to pay for their share before asking for your payment.
Likely cost you less in “out-of-pocket” charges (the amount you must pay).
Send your claims to Medicare and not charge you for submitting the claim.
Not require you to pay a deductible and co-pay for many preventive services. (These are discussed below.)”
Non-participating doctors will often charge you more than what Medicare would cover and leave you paying out of pocket. Medicare will pay you back but only for part of the bill (for the services they cover). This means you will still have other extra costs to pay. Along with non-participating doctors, there are opt-out doctors. These doctors have opted out of Medicare and will not cover anything; you must pay everything out of pocket. These doctors will have you sign a contract acknowledging this.
Need help paying for Medicare?
Consult the Medicare savings program. In some states, there are available programs that will help pay for costs like Medicare premiums, deductibles, co-pays, and more. These programs are very helpful for individuals who have low incomes and limited resources.
To find out more visit https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/medicare-savings-programs.
**Disclaimer: The Team at CARE does its best to provide you with accurate information but have to emphasize that we are not experts. Please consult your doctor/specialist to see what is best for you!
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