How Medicare Covers Breast Cancer Prevention and Treatment

Medicare does cover certain breast cancer screenings and treatments.

Medicare Part A (hospital insurance) helps cover the costs associated with any inpatient hospital breast cancer treatment, such as surgery and chemotherapy. Medicare Part B (medical insurance) helps cover the costs of your outpatient care and annual mammograms.

Learn more about how Medicare helps to cover the costs associated with detecting and treating breast cancer.

Doctor reviews xrays with patient

Medicare Part B covers mammograms

Medicare Part B covers mammograms in the following ways:

  • One screening mammogram every 12 months for women age 40 and older
  • One baseline mammogram for women ages 35-39
  • Additional diagnostic mammograms that are considered medically necessary may be covered for women of any age

Screening mammograms are covered in full by Medicare Part B, while women receiving a diagnostic mammogram will typically pay 20 percent of the Medicare-approved amount after meeting the Part B deductible.

The Medicare Part B deductible is $185 per year in 2019.

Medicare Part A and Part B cover chemotherapy

Medicare covers chemotherapy and radiation treatment of breast cancer in different ways, depending on whether you are a hospital inpatient or if you receive treatment in an outpatient setting.

  • Medicare Part A provides coverage for chemotherapy treatment received in a hospital as an inpatient.

    You must meet your Part A deductible before Medicare coverage kicks in. The 2019 Medicare Part A deductible is $1,364 per benefit period.

  • Medicare Part B covers chemotherapy treatments that are performed at an outpatient facility, such as a doctor’s office or a freestanding clinic.

    You must meet your Part B deductible before Medicare will cover your chemotherapy costs. As mentioned above, the Part B deductible is $185 per year in 2019. After you meet your Part B deductible, you typically pay 20 percent of the Medicare-approved amount for chemotherapy.

Be sure to ask your doctor how Medicare will cover your chemotherapy treatments so that you have a good understanding of your potential costs.

Medicare Part B helps pay for anti-nausea and oral cancer drugs

Medicare Part B may provide some coverage for certain drugs taken for cancer, such as anti-nausea drugs used for symptoms of chemotherapy.

  • Oral cancer drugs
    Medicare Part B will help pay for oral cancer drugs if the drug is available in injectable form or if it is a prodrug of the injectable drug (it breaks down into the same active ingredient as the injectable drug).

    Medicare Part B will also cover new oral cancer medications as they are developed and become available.

  • Oral anti-nausea drugs
    Medicare Part B helps cover the costs of oral anti-nausea drugs if you take them before, during, or within 48 hours after receiving chemotherapy. Part B will also cover these drugs if they’re used as a replacement for an intravenous anti-nausea drug.

If Medicare Part B covers drugs you use to treat breast cancer or to alleviate nausea related to chemotherapy, you will pay 20 percent of the Medicare-approved amount for the drug.

If you receive prescription drug coverage through a Medicare Part D prescription drug plan or a Medicare Advantage plan that offers prescription drug coverage, your plan may provide additional coverage for your cancer drugs. Be sure to check with your plan provider for detailed coverage information.

Medicare Part A and Part B cover breast cancer surgery

Medicare covers many medically necessary surgical procedures. If you have a mastectomy and are admitted for an inpatient hospital stay, Medicare Part A will help cover your hospital costs.

  • If you have surgery to remove a breast affected by cancer (mastectomy), Part B will cover the procedure if performed in an outpatient setting, along with the cost of a post-surgical bra.
  • Part A of Medicare will cover surgically implanted breast prostheses following a mastectomy if performed in an inpatient hospital setting.

As with other covered items and services, your Medicare Part A and Part B deductibles and coinsurance apply.

Medicare covers some costs of clinical cancer research studies

Medicare Part A and Part B will cover some of the costs associated with clinical research studies for patients wanting to test a new breast cancer drug or treatment.

Some of the covered costs include office visits, tests and screenings required for program acceptance. Your Medicare Part B or Part A deductible and coinsurance may apply, depending on the setting in which the study takes place.

Medicare Advantage plans cover breast cancer treatments and screenings

Medicare Advantage plans (Medicare Part C) are required to offer all of the same benefits that are covered by Original Medicare, combined into a single plan.

This means that the breast cancer screenings, treatments and drugs listed above are covered by Medicare Advantage plans in the same way that they are covered by Medicare Part A and Part B.

Some Medicare Advantage plans may also offer coverage for potentially more breast cancer drug costs than what Original Medicare covers.

According to breastcancer.org, two out of every three cases of invasive breast cancer occur in women over the age of 55. And breast cancer accounts for the second-highest number of cancer-related deaths for U.S. women, behind only lung cancer.

Don’t let your breast cancer screenings and treatment go without adequate medical attention and insurance coverage.

If you want to learn more about how a Medicare Advantage plan could help offer the benefits you need, speak with a licensed insurance agent today by calling TTY Users: 711, 24 hours a day, 7 days a week.

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