Most clients don't think of Cancer coverage when they look into going on to Medicare, but it's incredibly important.
Does Medicare cover cancer treatment? Yes!
There can be some holes in your coverage though. The first on is glaring.
Part D (Prescription Drug Coverage)
No matter your election Medigap or Medicare Advantage unless you have drug coverage elsewhere (incredibly uncommon), you'll be dealing with Medicare Prescription Drug coverage. This coverage will often be used for things like oral chemo drugs.
For example let's look at an oral chemo drug for non-operable kidney cancer called Inlyta. At the time of writing Inlyta is running a cost of about $18,000 per month. Currently there is also no generic. That's right. Just over $18,000/ month. That in the first month will take you straight to the catastrophic coverage portion of your Part D plan. When you hit the catastrophic coverage level (assuming you don't qualify for a low income subsidy or state subsidy plan) you will owe 5% of high cost name brand drugs. The plan covers 95%. For this drug this still leaves in the ball park of $900/ month out of pocket. With costs like this, there's no question that a recent study found that 1 in 3 Medicare beneficiaries without a low income subsidy don't fill their cancer medications.
Hypothetically if you were on Inlyta for 12 months, without a subsidy you could be looking at over $10,000 in out of pocket for your drug treatment alone.
Medicare Advantage Cancer costs
When my clients who choose Medicare Advantage look at their coverage I get the same question often: "What would cause me to hit my out of pocket maximum?" Most often it is critical or chronic illness. Especially cancer. The worst part is that your maximum out of pocket amounts are based around the calendar year. That means you could hit your maximum out of pocket multiple years in a row. Thankfully it is rare to hit this maximum amount, but in the event of a cancer diagnosis it can be helpful to have some backup. We recommend 2x your annual maximum out of pocket in cancer coverage. For example if your maximum out of pocket is $10,000 we recommend $20,000 in cancer coverage as a minimum.
Let's be clear, this coverage is optional, but cancer is an expensive diagnosis. It is smart to head it off at the pass.
Because of the ongoing risks of critical illness, we often recommend clients on Medicare Advantage plans consider a critical illness policy that covers more than just cancer.
The good news is that cancer is becoming increasingly treatable. Advances in medicine are insuring more people diagnosed with cancer live longer.
With that good new is the bad news that as we live longer, more of us fight cancer. The median cancer diagnosis is at age 66 (just after we hit Medicare age). 1 out of 100 people over the age of 60 are diagnosed with cancer. 60% of cancer diagnoses are in people over age 65. This is why we all know someone who had to battle with cancer. Cancer can be diagnosed at any age, and cancer coverage is available to all age groups, but it is particularly important for those who are at Medicare age.
How to Buy Cancer Insurance
Many companies offer cancer coverage. We recommend clients obtain lump sum cancer coverage. This means if you're diagnosed with a serious internal caner you're paid a lump sum of money to cover that cancer cost. Also, with lump sum cancer coverage the decision is yours on how that money is spent.
We offer cancer coverage over the phone as well as through an online poral. If possible, obtain lump sum cancer coverage with a recurrence benefit. This means if you continue paying for coverage after the first diagnosis there's a chance of a second diagnosis (or recurrence) being covered with an additional lump sum benefit.
You can often qualify for coverage if you've been cancer free for the past 5 - 10 years. Be aware that underwriting requirements vary from carrier to carrier. It's important to reach out to us by phone if you have a question about qualifying for coverage.