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I quoted a prospective client a Medicare supplement rate that was significantly less than the plan he was currently on. When I explained that he would have to go through Medicare supplement underwriting and answer some health questions because he was no longer in his Open Enrollment, he wasn’t happy. 

Why was he upset? Because he remembered how time-consuming and intrusive it was to apply for life insurance.  A nurse came to his home, weighed and measured him, took blood and urine, and asked a bunch of questions. Then, they got reports from the various doctors and a letter about a certain health issue. 

The client claimed there was no amount of money that could induce him to go through all  again. That’s understandable. However, when I said I could probably do the Medicare supplement underwriting in sixty seconds or less, his tone changed.

How can Medicare supplement underwriting be so simple, though? Let me explain.

Medicare Supplement Underwriting

medicare supplement underwriting questions

How is Medicare underwriting defined in Omaha? In short, it’s a simple process used by insurance companies to learn more about you and your health. There’s no need for medical exams or doctor’s visits – all you’re doing is answering a basic set of health questions. 

What are the Health Questions for Medicare or Medigap Supplement Underwriting?

The questions can be grouped broadly into four categories:

  • Knock-out questions 
  • Height and weight
  • Current health issues
  • Smoking status

If you answer “yes” to certain knock-out questions, then you can’t get Medigap or a Medicare Supplement – here’s how it works.

Medigap Underwriting Questions: What Are Knock Out Questions?

They are questions relating to serious medical conditions. If you have this serious medical condition, you are ineligible for a Medicare supplement or “knocked out” of consideration.

Medicare Supplement Underwriting

To clarify, you can’t be denied Medicare, but a private insurance company can deny coverage for a supplement outside of your Open Enrollment Period.

What are some examples of knock out questions? They vary, but they include:

  • Are you currently confined to a wheelchair, nursing facility, or hospital bed? 
  • Do you currently receive assistance bathing, transferring, toileting, eating, dressing or need the assistance of a walker? 
  • In the last two years, have you received treatment for cancer, leukemia, heart attack, congestive heart failure, multiple sclerosis, chronic kidney disease, diabetes with hypertension, stroke, etc.?

Why Does Medicare Ask Questions About Height and Weight?

The second category of questions has to do with height and weight. This is always a difficult question. If I asked my wife her weight, it would be very quiet and cold in the Grimmond household for a while. However,height and weight is an important determiner of future health, so it has an impact on price.

What Are Current Medical Issues?

Current issues cover existing medical conditions and related future treatment. For example, you may have a diagnosis for a future treatment, like a knee replacement or cataract surgery. 

For Medicare supplement underwriting purposes, you’ll probably need to address these medical issues before you can change supplements or the insurer simply won’t cover that procedure for the first six months. 

You may have had respiratory issues in the past that do not exclude you now, but if you are currently being treated for the issue, they could prevent you from getting the supplement for a time.

Why Am I Asked About Smoking Status?

There is plenty of medical evidence about the health risks associated with smoking, which also includes chewing. 

I met with a gentleman who described himself as a non-smoker, but when I pointed out he had a circle print on his back jeans pocket, he fessed up that he dipped occasionally. In medical underwriting, even occasional dipping means you’re still considered a tobacco user. 

Smoker/Non-smoker is the one health question that can be asked during Open Enrollment.

Medicare Supplement Underwriting is Easy

Why does this matter to you? Because your answers determine whether the insurance company accepts or denies you. It determines your health category and consequently your monthly premium.  Underwriting is not a difficult or a daunting task with a skilled insurance agent such as myself. It just takes a few minutes of your time, and you may be able to save yourself some money and maybe improve your coverage as well.   

Medicare Supplement Underwriting Omaha Insurance Solutions

The key thing to understand is that not all insurance companies have the same underwriting guidelines. Some may be laxer or more restrictive than others. They may be lenient on one condition or more severe on another. That is when an experienced agent can help you with getting the best outcome for your underwriting. He can guide you to the company that will be most favorable to your condition for the best possible price.  

Call OmahaInsuranceSolutions.com  402-614-3389  for help with your Medicare Supplement underwriting in Nebraska

A prospective client called me about saving money on her Medicare supplement. I asked her the basic supplement health questions and gave a quote.  We set up a time to meet.  At the meeting, I started going through the standard health questions on the application.  When I came to the question about recommended future treatments, she said no, but the way she answered bothered me.  So I asked it a different way.  “Did the doctor suggest that you have anything done, like cataract surgery, knee or hip replacement?”  Then she lit up.  “My hips are really bad,” she said.  “He thinks I should replace them sometime.”  “So when you say sometime, are you talking about in a year or two?”  “Oh no,” she said.  “In the next couple of months.”  I closed my notebook.  We were done.

Supplement Health Questions Broken Down

Recommended treatments by a physician could potentially cause a problem when you switch supplements.  Three things to know: 1.) what is a recommended treatment, 2.) why does it matter, 3.) what should you do about it.

Most of the time when we see the doctor it is because we are sick right now. She makes a diagnosis and recommends an immediate treatment.  ‘Take this pill now.’  ‘Have open heart surgery next week.’  Sometimes the diagnosis leads to a recommendation for treatment sometime in the future. ‘Your knees are deteriorating.  You should have a knee replacement in the next year or so.’  When your doctor puts a recommendation in your medical records for a future treatment, that is a big deal. To an insurance company, that means there will be a future big bill for whoever is insuring you at that time.

Understand the Supplement Health Questions

shutterstock_279874211-300x274The problem is that you could get stuck with the bill instead of the insurance company if you don’t follow the rules. If you have something done that was recommend before you got the new policy, like cataract surgery within six months after getting a new Medicare Supplement, the insurance company will probably not pay their share of the expense.  The health questions in the application are designed to disclose recommended treats and prevent the new insurance company from getting stuck with the bill.  They would likely refuse payment and call for doctor’s records to see if there was a recommendation for treatment before you signed the application.  After six months, you are less likely to have any trouble.  They cannot hold back paying for treatment indefinitely.  The bottom line is, if you have any recommended treatments, finish them up before switching supplements.

Manage the Supplement Health Questions

b3c84bb379d3466025bbe2c14b628151This problem, of course, can be avoided. Check with your doctor.  See if he is recommending any treatments and see if he put that in your medical records.  Check with the insurance company if you recently switched supplements. Doctor’s offices will not usually check with an insurance company on a supplement because they will assume the insurance company will pay when Medicare pays.  If you recently switched supplements, call and ask ahead of time if there will be any issues about a procedure.  It is always good to cross your T’s and dot your I’s when it comes to new insurance plans.

Ask an Expert about Supplement Health Questions

A mistake around a recommended treatment when changing Medicare supplements could result in bills to you for thousands of dollars. Know whether you have any recommendations from a physician for future treatments in your records.  Understand what that means in relationship to a new Medicare supplement.  Talk with someone who can ask you the right questions when you are making a change to your supplement coverage 402-614-3389OmahaInsuranceSolutions.com

For two years, my father was on dialysis.  Those were tough years.  When I got a client on dialysis, I wanted the best for him.  Kidney dialysis is one of the pre-existing conditions that usually excludes you from a supplement.  My client had a one-time opportunity.  I was going to make sure he got it!

Obama Care Confuses Pre-Existing Conditions

logo-pcip-2Pre-existing conditions are confusing when it comes to Medicare.  The ACA (Affordable Care Act) a.k.a. Obama Care made it more confusing because ACA covers pre-existing conditions, but ACA is not Medicare.  Different rules govern Medigap policies.  ACA applies to everyone 64 and younger.  Medigap policies are for everyone 65 and older.

Medicare Has No Pre-Existing Conditions

Medicare itself cannot deny coverage to anyone because of pre-existing conditions.  Medicare means Original Medicare.  Original Medicare is Medicare Part A for hospital and Part B for doctors and outpatient.  Medicare Part D cannot be denied for pre-existing conditions no matter the condition or cost of the medications.  Medicare Part C (or Medicare Advantage) must accept you as well, but for one exception–ESRD (End Stage Renal Disease).  You can be denied entrance to Medicare Advantage if your kidneys are permanently shut down and you are on dialysis.  All Medicare beneficiaries may enroll in a Medicare Advantage plan, except for that one pre-existing condition.

Medigap Has Pre-Existing Conditions–Sometimes

Denied-Stamp-ResizedAn insurance company, however, can deny you a Medicare Supplement/Medigap plan because of pre-existing conditions, except during your Open Enrollment Period or Guaranteed issue.  The rules around your Open Enrollment Period are confusing.  You can enroll in Medicare when you turn 65 and enroll in Medicare Part B.  That is called your Open Enrollment.  The time period for that is 3 months before the month of your birthday, the month of your birthday, and 3 months after your birthday.  The same term–Open Enrollment–is used for enrolling in a Medicare supplement, but the time period is different.  Open Enrollment for a supplement is from the month of your birthday and five months after.  Same term–Open Enrollment Period–but different time periods that apply to different things.  Isn’t that nice!

During your Open Enrollment Period for a supplement, the insurance company may not ask you health questions.  They must give you the best possible rate.  Even your weight is not counted against you if you are a few pounds over the normative height/weight charts.  You can be on chemo, dialysis, recovering from a stoke.  It doesn’t matter.  The insurance company MUST take you during this time period.  AFTER the six month Open Enrollment Period, they can ask health questions when you go to purchase a Medicare supplement, and based upon your answers, the insurance company could rate or even deny you.

pre-existing-conditionsWhat are some of the health questions?  Are you in a wheel chair?  Are you an insulin dependent diabetic?  Have you had a heart attack, stroke, or cancer in the past two years?  All of these questions are “knock out” questions.  If you answer in the affirmative, you will be denied a Medicare supplement.  You cannot be denied Medicare, but you can be denied the ability to purchase a Medicare supplement at any price.

Know the Rules or Find Someone Who Does

The ACA changes that permit acceptance into a health plan with pre-existing conditions created confusion in the Medicare world.  Beneficiaries need to clearly understand that a pre-existing condition can count you out of a supplement unless it is your Open Enrollment Period or Guarantee issue situation.  It is critical that persons with serious health issues be vigilant about these Medicare rules and/or find someone who will be vigilant for you.

Don’t miss your Open Enrollment Period.  If there are any questions, give us a call at 402-614-3389 or even call Medicare 800-633-4227.  Make sure you understand the rules that apply to you.

Contact: Omaha Insurance Solutions

 

 

One of the most painful calls I get is from a client who is calling on behalf of a parent.  They want to know if there is anything I can do for a parent who is paying huge monthly premiums for her Medicare supplement.  The agent who signed them up is long gone.  The supplement has increased over the years due to age and rate increases.  Now the parent is in her 80’s and in poor health, and the monthly premium is financially crushing.  Many times there is nothing I can do because their mom or dad cannot pass the underwriting questions to change to a supplement that would be significantly less.  They missed out on one of the keys to unlocking Medicare–an agent who shops her policy each year.

Five Keys to Unlocking Medicare

keysThere are five keys to unlocking Medicare.  First you need to do some research yourself.  The bible for Medicare is Medicare & You.  It is the official Medicare Handbook that the Center for Medicare & Medicaid Services publishes each year.  The Medicare.gov website is an endless source of resources.  It is important to do your own research so you are familiar with the proper Medicare terminology.  That way, you can better understand a serious discussion around Medicare.

 

The Big Key

Key number two: search for an experienced, independent agent.  Experience means they have been doing this for years.  Ask them when they got their insurance license.  They should be able to spit that out without thinking.  Ask if they do this fulltime.  There are a lot of insurance companies and agencies who hire part-time people to increase their production.  They give them little education or training.  Even less support.  Most drop out of the business after six or nine months.  That probably is not the person you want.  Ask if they are independent.  Some insurance agents can only offer one company.  They cannot shop the world of Medicare plans.  Ask them to list the companies they offer.  If they change the subject or only list one or two, you have your answer.

01-reuse-keysKey number three: ask questions.  As I tell my clients who are aging into Medicare, you turn 65 once in a lifetime.  I help people turning 65 going on Medicare four or five times in a day.  I am excited when someone asks me a question I haven’t heard before.  An experienced agent should be able to quickly and easily explain the details of Medicare, supplements, advantage plans, prescription drugs, etc.  If not, you may wish to look somewhere else.

 

Price Compare Med Sups

Key number four: compare every year.  I talk to my clients at least once a year.  I want to know that everything is going well.  Part of the conversation is the price of their supplement.  With age and rate increases, what are you currently paying?  I shop their supplement right then and there over the phone.  I tell them if there is a plan of equal or better value at a lower price.  That prevents you from getting into the situation in your later years of a plan with back breaking premiums.

reuse-keys-xKey number five: stay healthy!  Go to the gym.  Eat healthy.  Chase grandchildren, pets, moving cars, anything that will get your heart rate up.  One of the keys to unlocking Medicare supplements is your ability to pass underwriting questions so you can change plans and pay less.  I can try different companies that have more liberal underwriting guidelines, but ultimately there are limitations for serious health issues.

Medicare and Medicare supplements are awesome health insurance, but to enjoy the greatest benefits from this awesome resource, you need to follow these simple five keys.  Call me 402-614-3389 or the American Association of Medicare Supplements to find an experienced, independent agent near you.

 

You may have been caught up in the recent political circus on TV and missed the political power play behind the scenes.  Congress voted to eliminate a Medicare supplement that provides first dollar coverage.  (First dollar coverage means you pay no co-pays, deductibles, or co-insurance.  Medicare and the Medicare supplement pay everything.)  This will change everything about how you approach your Medicare, and it is a cause for re-evaluation of your Medicare Supplement plan.

Congress’s change potentially creates a problem for beneficiaries who have a Plan F supplement.  Or, at least, it is reason for re-evaluation.  There are other supplement plans, but which one should you choose?

Congress Tinkers with Medicare Supplement

Congress is constantly trying to fund government programs.  The balancing act is to generate sufficient revenue to pay for adequate benefits without over burdening the taxpayer.  Congress discovered that Medicare beneficiaries who do not pay any co-pays, co-insurance, or deductibles unnecessarily over use the medical system and consequently Medicare.  The Medicare Trust Fund is stressed to the breaking point.  Congress found that beneficiaries who pay co-pays, deductibles, and co-insurance do not over use the medical system.  Their solution is to stop first dollar coverage.  That means, supplement plans cannot pay everything.  Beneficiaries must pay some kind of co-pay, deductible, or co-insurance.  There must be some disincentive to over using the system.

Medicare Supplement Plan F Going Away

f-400The Medicare supplement plan that covers all co-pays, deductibles, and co-insurance is Plan F.  You will not be able to purchase a new Plan F after December 2019.  Those who have Plan F will be grandfathered in and may keep the plan.  The consequence of this change is that no new beneficiaries will be joining Plan F.  Insurance is built upon pools of people.  Of the 10,000 people turning 65 each day in the U.S., no one will be purchasing Plan F’s after 2019.  Those who have Plan F will age and die, reducing the number of persons who pay premiums.  If there are fewer people paying in less premium but more and larger medical claims being paid out, the insurance company will be forced to raise rates on the existing members of the plan to keep the plan viable.  While it is hard to know the future, it would be hard to say Plan F’s future will be positive after 2019.

Plan G is the New Plan F

g-400The next plan up is Plan G.  The two differences between Plan F and G are: you pay the Part B deductible, which is currently $166.  It is a one time annual deductible.  After you pay the Part B deductible of $166, there are no more co-pays, deductibles, or co-insurance for the year.  Everything will be covered 100%.  Second, Plan G premium is noticeably less than Plan F’s.  The other point of interest is that Plan G’s have fewer and smaller rate increases than Plan F’s.

Shrinking Pool of Insured

Medicare trustees are trying to slow the drain on the trust fund.  Eliminating first dollar coverage that Plan F’s afford was the solution.  The problem is that no new members will join the pool of insured who have Plan F.  Traditionally, insurance companies raise premium rates when the pools of people who pay premiums becomes smaller.  Plan F members will be forced to look other places for more affordable coverage.  Plan G will likely become the new Plan F.

You may wish to reconsider your supplement plan if it is Plan F.  The ground is shifting.  Visit OmahaInsuranceSolutions.com for the most current education on Medicare.

Sheep get sheared.  They follow the other sheep into the pen, down the shoot, then in to the hands of the shearer and are fleeced.  The ram is a alert.  He doesn’t go with the flow he leads the way and butts heads when he is force to go where he doesn’t want to go.

How do people pick their Medicare supplement plan and company?  They talk with their buddy on the left and their buddy on the right.  ‘They both can’t be wrong.’  Everyone says Plan F is “the best.”  “I never have to pay anything”—no co-pays.  That’s great!  Sign me up.  That is the thought process of the sheep.  Insurance companies love it.  Insurance agents love it.  Plan F is the most expensive plan in all kinds of way.

Plan F

Plan F

There are ten possible Medicare supplement plan types that an insurance may offer–A–N.  In reality, they usually only offer 4 or 5.  Plan F is the most popular as well as the most expensive.  Insurance companies and agents like that because it brings in the most money and pays the highest commission.  But is it the best for a client?

Plan F does cover all the deductibles and co-insurance that Medicare doesn’t cover.  That is nice, but you pay a price for that convenience.  It raises the question whether Plan F is the best.

Is there an alternative?  How about Plan G?  Plan G is very close to Plan F.  The difference is that you pay the Part B deductible of $147.  It is a one-time annual deductible.  Once you pay your Part B deductible of $147, for let’s say a doctor’s visit, you are done for the year.  Everything else will be covered 100% which is similar to a Plan F.  So why plan G?  Because the premium is lower—quite a bit.

Plan G

Plan G

Let’s do some simple math.  Let’s say that a plan F is $150 per month for a 65 year old male and a plan G is $110 for the same person.  The difference is $40 per month and $480 per year less for the Plan G.  Subtract the $147 Part B deductible, and you are still ahead $333.  Putting it another way, you are paying $333 for the convenience of having the insurance company pay your Part B deductible so that you don’t have to write a check IF you go to the doctor or have some other procedure.  Multiply that times 10 years and you are at $3,330.

The second and more important consideration about Plan G is that the rate increases are smaller and less frequent.  Yes premiums go up because medical costs go up, but the unusual reality about Plan G policy holders is that they generally do not go to the doctor or emergency room as frequently as Plan F policy holders.  There is something about the $147 deductible that causes people to pause and think.  ‘Is this really medically necessary?’  The result is that, because Plan G policy holders do not over use medical benefits to the extent Plan F policy holders do, the claims and cost are not has high.  Consequently the rate increases for Plan G’s are fewer and smaller than Plan F.  Plan F is the best?

Don’t be a sheep.  Don’t follow the herd.  Stop and look at the different plans.  Ask yourself the hard question in light of the facts whether Plan F is the best.  Do some analysis, and you will save money in the short, long, and longer run.

ChrisGrimmond402-614-3389; [email protected]

The question that I am constantly asked during the course of a consultation on Medicare is ‘which is the best plan?’  My answer to the question of the best Medicare supplement is always the same.  It all depends.  Each person is different.  Needs are different.  Perception of reality is different.  If you ask my wife, which is better—two piece or one piece swim suit?  Her opinion will differ greatly from mine.

Best Medicare SupplementWhen it comes to Medicare, the first fork in the road is a choice between Medicare Advantage or Original Medicare and a supplement.  Once someone makes that first choice, the second fork in the road is between Medicare supplements.  There are potentially ten possibilities—Plan A—N.

Plan F has been the most popular plan among the bunch.  Because of that, some would say that Plan F is the best Medicare supplement, even though it is the most expensive.  Its appeal, however, is convenience and a sense of security.  With a Medicare Supplement Plan F, there are no co-pays, deductibles, or co-insurance.  You don’t have to worry about maximum out of pocket expense.  You plop down your red, white, and blue Medicare card, your Plan F card, and you’re done.  The bills may make Medicare and the insurance company cringe, but no matter.  You are covered 100% for the services that Medicare covers.  For that sense of complete, comprehensive coverage and convenience of payment, Plan F’s are the most expensive among the various insurance companies.

Plan F’s are expense for other reasons as well.  As medical expenses go up, so do Medicare supplement premiums.  You can almost count on an annual rate increase from the insurance company, especially for a Plan F.  Why is that?  Because people on Plan F use their benefits frequently.  Whether they go to the doctor no times or fifty times a year, the price is still the same.  Whether they go to the hospital zero times or a hundred times, the price is still the same.  No co-pays.  Just the same monthly premium.  Consequently member over-use increases cost, which is reflected in regular rate increases.

The Best Medicare SupplementPlan G, however, has a small deductible.  You pay the first $147 on Part B expenses, such as doctors’ visits, outpatient procedures, emergency room visits, etc.  After you pay the first $147, then the Plan G is like a Plan F.  Everything is covered.  The two benefits of a Plan G are 1) the premium for Plan G’s is lower, even with the deductible factored in, 2) the rate increases are smaller and less frequent.  Plan G people tend to not over use their benefits as much as Plan F folks.  A great deal is being written on this Plan G topic right now.  It is very arguable that Plan G is the best Medicare supplement.

Which is the best?  It all depends on you.  I tell my wife I would rather see her in a two piece bikini.  That is the best for me, and that is final!

Would you be interested in a service that you must absolutely have? As a matter-of-fact, almost everyone has it. It’s not free. You will have to pay, but let’s say you could get the same thing for 400% less than what most people pay. Would you be interested in a bargain like that? Most people would enthusiastically say ‘YES!’  You ask, ‘what is the bargain?’  Medicare.  Medicare is a bargain!

Medicare is a BargainEveryone needs health care because everyone gets sick and needs doctors, hospitals, drugs, treatment, etc. The average cost of a decent group health plan is going to be $1,000+ per month per person. If you go into the exchange to purchase an individual plan, you are looking at $500-$600 per month WITH a $2,500 deductible, and that is not including the maximum out of pocket.

You may say that you only pay $50 or a $100 per month for your health plan at work. That is because your employer is paying the majority of the cost. You are not getting it for free. You’re not even getting it for a reduced price. It still costs $1,000. Your employer is taking your compensation and applying a portion to your health insurance instead of paying the money to you. It’s your money, your compensation. You are not given a choice on how to receive it. That employer portion is just part of your total compensation. And it is still part of your employer’s total expense for an employee.

You might complain that now I have to pay the full cost of health care myself. Yes, your employer is not paying for your health care because you are not working any longer. Your employer is also not paying you a salary any longer. When you go to the grocery store, you can’t use your salary to pay for the groceries. You have to use your Social Security check, savings, investments, IRA’s, etc. Your source of earned income stopped when you retired, which includes your employer subsidy for your health insurance.

The realization of the true costs of services, like health care, doesn’t diminish the fact that Medicare is a bargain!

Medicare is a BargainWhat does Medicare cost? For most people, you paid for Medicare Part A during the working years, so there is no charge. Medicare Part A covers the hospital. Medicare Part B is for doctor and outpatient procedures and that is generally $104.90 per month currently. With a Medicare supplement—let’s say a plan F—you will pay around $100-$140 when you turn 65 depending on male or female and location (Omaha, Lincoln, Council Bluffs). Add in a Part D prescription drug plan. It is possible to come in around $250 per month in total for your Medicare health coverage. With a plan F, there will be no deductibles, co-pays, or co-insurance. Incredible Cadillac health insurance for approximately $250 per month. Much better than a group plan or an individual plan on the ACA (Affordable Care Act) exchange that costs $1,000+ per month which also includes deductibles, co-pays, and co-insurance.

Medicare is a bargain! Medicare is something that you should be excited to become a part of when you turn 65. I am 53 as of the writing of this blog. I purchase my own insurance on the exchange as a self-employed individual. I would happily pay triple what Medicare beneficiaries pay for that same coverage, and it would still be a bargain for me.

does medicare cover cancer treatment after age 76Does Medicare Cover Cancer Treatment After Age 76

My mother had her routine physical in Nov of 2011. There were many tests.  One test came back positive for cancer. We were stunned. She had no symptoms. Everything was fine, we thought. 

As the doctors performed more tests, they determined my mother had stage four ovarian cancer.  The next week, she was in chemotherapy.

I learned a lot about Medicare and cancer after that.  Yes, cancer treatment is covered by Medicare.

Medicare covered her cancer treatments, radiation treatment for cancer, and chemotherapy.  She had a Medicare Supplement Plan F.  Medically, everything was covered.  My mother was 76.  Medicare covers cancer treatment after age 76.  There is no age at which Medicare will not cover radiation treatment for cancer or chemotherapy.  

Cancer Is Scary, And So Are Medical Billsdoes medicare cover proton treatment for prostate cancer

The C-word is a scary word.  I don’t know your relationship to the C-word.  You may have had a family member or friend contract cancer?  Did she die, recover, or is still struggling?  Or maybe it was you? 

Cancer is a dirty word that ignites intense feelings because you are fighting for your life. 

You also realize there is a price tag, and you immediately begin to ask, ‘Is cancer treatment covered by Medicare?‘  ‘What will I have to pay?’  

I suggest you ask yourself several serious questions about your Medicare health coverage. 

  • How much would you be willing to pay out of your pocket in a year–$2,000, $5,000, $7,550?
  • How much would you be willing to pay to avoid paying hefty bills? 

The cost of cancer is high, both emotionally in terms of pain and financially. I remember seeing some of my mother’s EOBs (Explanation of Benefits).  There were no small bills.  

does medicare cover proton treatment for prostate cancerDoes Medicare Part A Cover Cancer Treatment?

Medicare Part A covers the hospital, and Part B takes care of doctors and outpatient services.  You will not be in the hospital as an inpatient with cancer most of the time.  The oncological treatments are done as an outpatient, but there may be instances when you need hospitalization. 

My mother was admitted to the hospital during the year because the pain was too intense.  The doctors needed to use intervenience medications to beat back the pain that was overwhelming mom.  In those instances, Medicare Part A picked up the tab. 

Medicare Part A also includes skilled nursing, home health care, and hospice, not just inpatient hospital. 

After a 3-day stay in the hospital, a person may be admitted to skilled nursing for a number of reasons.  The person can continue cancer treatment while in the skilled nursing facility, and Medicare Part A will pay.  My mother did that toward the end.   

Does Medicare Part B Cover Cancer Treatment?

Medicare Part B is where most patients will experience Medicare for cancer treatments. The doctorsdoes medicare pay for prostate cancer treatment administer chemotherapy drugs through your veins in an outpatient clinic or doctor’s office. Some oral chemotherapy is administered in the doctor’s office, though more are moving toward self-administration. The doctors also give radiation treatments in an outpatient setting.  Medicare Part B covers cancer treatment when administered in this way.   

The doctors need to check on the progress of treatments, so Medicare Part B covers cancer treatment for diagnostic tests like X-rays and CT scans.

Cancer treatment is incredibly taxing for the person, so durable medical equipment is often needed. Medicare covers wheelchairs, walkers, and feeding pumps for cancer treatment.

When appropriate, surgeons will operate to stop or curtail cancer. You see this most often with skin cancer.  Outpatient surgeries are likewise covered.

The strain is not only physical for the patient but mental. Counseling and other mental health support may be appropriate and would be covered by Medicare.

does medicare cover radiation treatment for cancerWhat Does Medigap Do to Cancer Costs?

Beneficiaries on Original Medicare would be responsible for the Part A deductible and the Part B coinsurance unless they have a Medigap policy.  Depending on the type of Medigap policy, it will come in and pay most or all of the remaining amounts.  Regarding cancer treatments, Medigap policies, such as Plan G and Plan N, are very powerful in the amount of coverage, filling in the 20% Part coinsurance gap after the Part B deductible. 

What Are Cancer Policies?

Medicare does not cover some benefits that may be helpful for people going through cancer treatment, like room and board in assisted living facilities, adult day care, long-term nursing home care, and services of daily living–bathing and feeding.  Neither Medicare nor the Medigap policy will cover those expenses.  Another type of insurance could be helpful in these instances–indemnity plans. 

You should ask us about cancer policies.     

Does Medicare Advantage Cover Cancer Treatment?

Each Medicare Part C (or Medicare Advantage) plan is unique.  Looking at the Medicare Advantage plans in the Omaha Metro area, most cover cancer treatment at 80%.  Beneficiaries will need to pay the 20% for chemo and radiological treatments for cancer.  Your coinsurance payments will go against the maximum out-of-pocket for the particular plan, and because of the high cost of cancer treatment, it would not be unusual for you to reach the maximum out-of-pocket (MOOP).  Each plan has a designated MOOP amount, for example, $4,900, $5,500, or even $6,700.  Once the Medicare beneficiary reaches the MOOP, you pay no more.  The Medicare Advantage plan covers everything at 100%.  The MOOP, however, is a large expense for most people in a given year.  

Medicare covers cancer treatmentsDrugs Are An Essential Partdoes medicare part b cover cancer treatment

Medications are also an essential part of cancer treatment. Beneficiaries may purchase a stand-alone Medicare Part D prescription drug plan.  Most Medicare Part C/Medicare Advantage plans have a Medicare Part D prescription drug plan included in the plan.

Part D covers some oral chemotherapy drugs not covered under Part B. Anti-nausea drugs and other prescriptions used in cancer treatment, like pain medications, will come under Part D. 

Questions To Ask Yourself About Medicare & Cancer Treatment

There are two important questions I would ask myself about Medicare and cancer treatment in the Omaha metro area.

  • How likely do you think you will contract cancer? 
  • How easily will you cover the costs out of your pocket?

The Ais cancer treatment covered by medicaremerican Cancer Society says that the elderly are ten times more likely than younger people to get cancer.  Medicare beneficiaries over age 65 account for 54% of all new cancer cases.  Cancer is the leading cause of death among the elderly. 

While those are generalizations, you can further add your own analysis to the formula if you have had cancer.  Cancer among family members raises your chance of you contracting cancer. 

The reality is that there is a probability that you may develop cancer during your time on Medicare.  What is your estimate of that probability?  

The second question to consider is cost. There is no one number for the cost of cancer. It depends on the type of cancer, the number of treatments, the type of treatments, etc. But there are ranges.

A study bydoes medicare cover lung cancer treatment Avalere Health gives prices as low as $25,000 to as high as $45,000 for chemotherapy. What do you think of that cost?

With Medicare, you will only pay 20% of the expense.  Most of it will probably be covered if you have a Medigap policy.  The relevant cost for a Medigap policy will be the ever-growing monthly premium. 

A Medicare Advantage plan will guarantee you pay no more than the maximum out-of-pocket (MOOP).  In 2022, the largest possible MOOP nationally is currently $7,550.  The MOOP in the Omaha Metro area is about $4,500 on average.  

does medicare cover breast cancer treatmentIs that something you can afford?

Does Medicare Cover Breast Cancer, Prostate Cancer, and Lung Cancer Treatment?

Medicare does not make any distinction between the types of cancer.  All cancer is covered by the customary treatments doctors and hospitals use to combat cancer.  

The Wheel of Fortune Or Misfortune?

James Bond was so cool when I was growing up.  When he would sit down at the Roulette table in the casino across from the pretty girl, I was rooting for him to win.  But would you want to leave the cost of your health care to the spin of the wheel? 

Does Medicare cover breast cancer treatmentThere are 37 slots in a roulette wheel–0-36.  The numbers divide into the colors red and black.  Predicting the color is much easier than choosing a winning number.  The house takes it most of the time, but people keep playing!  It is incredible. 

Most people will not get cancer, though a certain percentage will.  Do you want to spin the wheel and take your chances that you won’t end up with back-breaking bills, or do you want to offload the problem?   

You could purchase a Medicare Supplement for a reasonable monthly premium.  The Medigap policy will cover the 20% that Medicare does not.  You then can go to any of the excellent medical systems we have in the Omaha, Lincoln, and Council Bluffs metro area or anywhere in the country without concern about costs.

You could choose a Medicare Advantage plan that limits your maximum out-of-pocket to a manageable number, and you will pay very little or nothing beyond your Part B premium. 

The choice is yours.  Choose wisely.  

My mother died on February 4, 2013.  We worried a lot about her during the illness.  There was fear,Is Cancer Treatment Covered by Medicare pain, and grief.  I think about her daily and all she did for me to make me the man that I am.  I pray for the repose of her soul.  But during the trial that was her treatment and ultimately her death, there was no concern about medical bills.  She had prepared.

RIP Mom.

 

What Our Clients Are Saying About Omaha Insurance Solutions

Steve S.

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Medicare can be confusing, but Chris did a great job of explaining all our options to us. He patiently answered all our questions and gave us knowledgeable advice. We are so appreciative of Chris and Angie’s guidance, and we highly recommend them to anyone needing help with Medicare insurance.