As with other types of cancer, Medicare covers the care needed to investigate and treat colorectal cancer.
Other parts of Medicare will cover different costs associated with cancer care, and out-of-pocket expenses may apply.
This article will look in more detail at Medicare coverage for colorectal cancer.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare covers healthcare services related to colorectal cancer for adults over age 65. A person who is under 65 and has a qualifying health condition may also be eligible for cover.
Standard treatment for colorectal cancer may include:
Medicare Part A covers hospital stays that a person may need while they are receiving treatment for colorectal cancer, including:
- surgical procedures
- inpatient chemotherapy
- home health services related to cancer treatment
- treatment for complications that may arise from a colonoscopy, such as excessive bleeding
A person is usually required to pay a deductible for inpatient hospital stays. In 2020, the Part A deductible is $1,408.
Medicare Part B pays for outpatient care and may include the following:
- some outpatient chemotherapy drugs
- radiation therapy
- doctor’s office visits
- outpatient surgeries, such as placing a port for chemotherapy
- screenings and tests
In 2020, a person must pay a $198 deductible for Part B.
Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans vary in coverage, but as a minimum, they must provide the same benefits as original Medicare parts A and B.
This means that the same benefits apply to colorectal cancer treatment.
Medicare Part D, also known as a Prescription Drug Plan, covers some chemotherapy medication that Part B does not cover.
Part D is an optional plan available to those that have original Medicare. For colorectal cancer treatment, Medicare Part D may pay for:
- oral chemotherapy drugs
- prescription medications to treat cancer side effects, such as pain
- anti-nausea drugs
Colorectal cancer involves cancer in the rectum or intestines. Although anyone can develop colorectal cancer, certain factors increase a person’s risk, including:
The American Cancer Society estimate that in the United States in 2020, there will be:
- 104,610 news cases of colon cancer
- 43,430 new cases of rectal cancer
Early detection helps improve a person’s outlook, and colon cancer screening, including a colonoscopy, can help detect cancer early.
Medicare covers many preventive services for colorectal cancer.
A colonoscopy involves inserting a scope into the rectum and passing it into the large intestine to check for polyps or tumors.
Medicare pays for a colonoscopy:
- once every 2 years for those at high risk
- once every 10 years for those at average risk
- 4 years after having a sigmoidoscopy for people at average risk
Medicare Part B usually covers colon cancer screening when a person undergoes it on an outpatient basis. If a screening takes place during a hospital stay, Medicare Part A covers the cost.
Usually, Part B covers preventive colon cancer screenings once a person is age 50 or over, as recommended by the U.S. Preventive Services Task Force (USPSTF). There is no charge if the person does not have polyps that need removing. The Part B deductible does not apply.
Fecal blood test
This test involves a person providing a stool sample for analysis.
A scientist then assesses the stool sample under a microscope to check for blood.
Medicare pays for the fecal blood test once each year upon referral by a doctor, doctor’s assistant, clinical nurse specialist, or nurse practitioner.
Stool DNA test
The stool DNA test involves testing for changes to DNA cells in a stool sample.
Medicare pays for a stool DNA test every 3 years for those between the ages of 55 and 85 that do not have a high risk of colon cancer and do not have any symptoms.
There is no charge for this test if the healthcare provider accepts assignment.
A flexible sigmoidoscopy involves inserting a scope into the rectum to check for polyps or tumors. It only views the lower portion of the intestines.
Medicare covers the cost of this screening every 4 years but not within 10 years of having a previous colonoscopy.
For people that are not high risk, Medicare covers the test every 6 years.
There is no charge for the test if the healthcare provider accepts assignment, and the person does not have growths that need removing. The Part B deductible does not apply.
There may be out-of-pocket expenses for colorectal cancer care. The actual costs may vary depending on the services received, but may include:
- excess charges
Additionally, if a person chooses to receive alternative or holistic therapies that Medicare is unlikely to cover, they may be liable for additional out-of-pocket costs.
Once a doctor makes a colorectal cancer diagnosis, Medicare pays for various services related to care.
Common benefits include:
- inpatient hospital stays for surgery, inpatient chemotherapy, and treatment for side effects
- outpatient treatment, including chemotherapy and radiation therapy
- clinical trials
- home health services
- blood transfusions
- chemotherapy drugs
- anti-nausea medications to treat any side effects
Both before and after a cancer diagnosis, a person’s needs will differ.
Sometimes, a person may benefit from additional support, including help navigating treatment and emotional and financial support.
Private insurance companies sell Medigap policies, and due to this, monthly premiums may vary.
Medigap policies may help someone with expenses, including:
- excess charges
Medicare Savings Programs
The American Cancer Society
The American Cancer Society offer various supportive services, including help with the costs associated with cancer treatment.
They also have resources and services available to provide emotional support through what can be a very challenging time.
The Colorectal Cancer Alliance
Colorectal Cancer Alliance offers several programs for people with colorectal cancer, including financial assistance, family support navigators, and a buddy program.
Medicare covers colorectal cancer treatment, which may include chemotherapy, surgery, and radiation therapy.
The part of Medicare that provides coverage depends on the setting and treatment given. Usually, Medicare parts A, B, and D provide coverage for colorectal cancer treatment.
Medicare Part B also covers preventative colorectal cancer screenings and tests, including colonoscopies.
There are different ways a person can seek financial and emotional support, including enrolling in a Medigap plan or utilizing services offered by The American Cancer Society and The Colorectal Cancer Alliance.
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