Medicare covers medically necessary expenses for people with endometrial cancer. There may be some out-of-pocket costs to pay, but there are programs that offer extra support.
Suspected or diagnosed cancer can be a difficult time for many families. Medicare covers treatment for most types of cancer, including endometrial cancer.
The different parts and plans of Medicare cover various aspects of care, which could relieve some of a person’s financial pressures.
This article discusses endometrial cancer, which parts of Medicare cover treatment, and how to get help with costs.
Medicare covers preventive screenings, diagnostic tests, and inpatient and outpatient care for people with endometrial cancer.
The following sections will look at each part of Medicare in more detail.
Original Medicare is made up of Part A and Part B. Both of these cover Medicare-approved and medically reasonable costs relating to endometrial cancer.
Medicare Part A helps pay for cancer care and treatment a person receives as an inpatient in a hospital, skilled nursing facility, or hospice setting and covers some home health therapies. It may also cover short-term skilled nursing facility care and end-of-life expenses.
Medicare Part B covers outpatient appointments, such as those for the diagnosis and treatment of medical conditions, including endometrial cancer. It also covers preventive care, such as cancer screening.
Part B also helps pay for outpatient treatments, such as radiation and some chemotherapy that a person receives in a doctor’s office. However, Part B alone does not cover the majority of prescribed medications.
Prescription drug plans
If a person has original Medicare, they can purchase a prescription drug plan (PDP), also known as Medicare Part D.
Private health insurance companies administer PDPs. These plans cover take-home prescribed drugs that may include chemotherapy or medications that can help with cancer treatment’s side effects, such as antiemetics.
PDPs are not available to most people who have a Medicare Advantage plan.
Medicare Advantage, or Medicare Part C, covers the same benefits for endometrial cancer as original Medicare does. Private health insurance companies administer these plans.
Medicare Advantage combines parts A and B under one policy, sometimes including additional benefits and prescription drug coverage.
Medicare supplement insurance, or Medigap, helps cover the out-of-pocket costs associated with original Medicare. These costs include coinsurance, excess charges, and deductibles.
Private health insurance companies also administer these plans.
People can expect some out-of-pocket costs with Medicare. The following sections will look at these in more detail.
A person is usually eligible for premium-free Part A coverage, providing they have worked for at least 40 quarters during their lifetime.
In 2021, a person must pay the Medicare Part A deductible of $1,484 before the plan covers eligible costs.
Individuals must pay the deductible for each benefit period that begins when they are admitted to the hospital and ends when they have not received any inpatient care for at least 60 days.
Part A also has a daily copayment of:
- $0 for days 1–60
- $371 for days 61–90
- $742 for days 91 onward
The 2021 Medicare Part B out-of-pocket costs consist of:
- a $148.50 premium each month
- a $203 annual deductible
- a 20% coinsurance of eligible costs once a person has paid the deductible in full
Those with Medicare Advantage may have varying costs, depending on the plan type or plan provider.
As with Medicare Advantage, the costs associated with PDPs depend on certain factors, including:
- the private health insurance company that administers the plan
- the medication prescribed
- the type of plan
PDPs may also have copayments and deductibles, but in 2021, a PDP deductible cannot cost more than $445.
The endometrium is the inner lining of the uterus, which is the organ in the lower part of a female’s abdomen.
The uterus has two parts. The upper part is where a fetus can develop. The lower part is called the cervix, which is the junction between the uterus and the vagina.
Endometrial cancer develops when the cells lining the uterus grow at an uncontrollable rate. This type of cancer does not begin in the cervix.
There are two different types of endometrial cancer: type 1 and type 2. Type 1 usually grows slowly and does not spread to other parts of the body. Type 2, however, grows quickly and is more likely to spread to other body parts. This type is less common.
The way that endometrial cancer cells look can determine how they may respond to different forms of treatment.
Healthcare professionals divide the cells, based on their appearance, into different types. They will then prescribe treatments and recommend care based on the appearance of the endometrial cells.
There are several different types of treatment for endometrial cancer. These include:
- Surgery: This is often the primary treatment for endometrial cancer. A surgeon will remove as much of the cancerous material as possible. This may also include the removal of the uterus, ovaries, and surrounding lymph nodes.
- Radiation: This can either kill the remaining cancer cells after surgery or shrink a tumor. A healthcare professional may place radioactive material inside a person’s body, or a machine may beam radiation at the cancer from outside the body.
- Chemotherapy: These are drugs that a person takes by mouth or intravenously to kill cancer cells. Healthcare professionals commonly use chemotherapy for cancers that have spread throughout the body.
- Hormone therapy: Healthcare professionals use hormones or hormone-blocking drugs to treat advanced cancers. Many recommend this option alongside chemotherapy, as no single type of hormone therapy is best.
- Targeted therapy: These are new drugs that can target changes in cancer cells. They may have less severe side effects than those associated with chemotherapy.
- Immunotherapy: This is a drug treatment that helps a person’s immune system kill cancer cells. If cancer has spread, a healthcare professional may be more likely to suggest using immunotherapy.
Medical costs can be overwhelming, but there are programs in place to help those who qualify due to having limited incomes and resources.
A person may also qualify for one of four Medicare savings programs (MSPs) to help pay premiums, deductibles, copayments, and coinsurance.
In addition, if an individual qualifies for Medicaid or an MSP, they also qualify for the Extra Help program. This helps a person pay for the costs associated with prescription drugs, such as premiums, deductibles, and copayments.
All main Medicare plans cover many services and treatments for endometrial cancer, including preventive, diagnostic, and inpatient services.
There may be some out-of-pocket costs for premiums, deductibles, copayments, and coinsurance.
However, people with limited incomes and resources may qualify for Medicaid, MSPs, or Extra Help, which can all help with healthcare costs.