There are benefits included in Medicare plans that can help with treatment costs relating to leukemia. Out-of-pocket expenses may apply, but there may be additional support available.
In this article, we discuss the different treatments for leukemia, what Medicare covers, and other options that may be available.
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.
Original Medicare has two parts that each provide coverage for care received in different settings.
Medicare Part A
Medicare Part A is sometimes called hospital insurance and covers inpatient hospital stays, including cancer treatment a person receives while in the hospital.
Part A also pays for skilled nursing facilities, hospice, and home healthcare. Home healthcare can include:
- physical therapy
- speech and language therapy
- occupational therapy
- skilled nursing care
A person enrolled in an eligible clinical research study may also have some costs covered by Part A.
Medicare Part B
Medicare Part B is sometimes called medical insurance. This part of Medicare pays for medically necessary, cancer-related treatments and services a person may need outside the hospital.
This can include:
- doctor visits
- chemotherapy drugs administered intravenously in an outpatient clinic or doctor’s office
- some oral chemotherapy
- durable medical equipment (DME) like wheelchairs or walkers
- mental health services
- nutritional counseling
- radiation treatment
In some instances, Medicare Part B will cover the cost of a second opinion for surgery. This happens if the surgery is not an emergency. They may cover a third opinion if the first and second opinions differ.
Medicare Part D
Medicare Part D, also known as a prescription drug plan (PDP), covers outpatient prescription drugs. Private insurance companies administer these plans.
Some chemotherapy drugs that are not covered by Part B, may be covered under a PDP, as well as prescribed pain relief and anti-emetics.
Surgery plays a limited role in treating leukemia since blood carries the disease throughout the body.
An individual may get a central venous catheter, which is a flexible tube that is inserted into a large vein, making it easier to administer chemotherapy. This is an inpatient surgical procedure that is covered by Part A.
A person may also have a biopsy of the lymph nodes or bone marrow that can help diagnose leukemia. The biopsy is an outpatient procedure and is covered by Part B.
The body has several types of blood cells that have different functions, including the delivery of nutrients, oxygen, and immune cells to the organs and muscles in the body. The blood also carries away waste material and carbon dioxide.
Leukemia is a type of cancer that forms in the bone marrow and invades the blood. Blood starts as a stem cell or young cell in the bone marrow. The blood cells can grow into several different types, depending on what the body needs, including:
- plasma, which is the liquid portion of the blood
- red cells that carry oxygen from the lungs to the rest of the body
- platelets, which help the blood to clot
- white cells that are part of the immune system and fight infection
Each type has subtypes such as:
Most often, leukemia is a cancer of the white blood cells, but it can start in another type of cell. The cancer is named based on whether the leukemia is slow-growing (chronic) or fast-growing (acute).
The most common leukemia found in older adults includes:
- Chronic Myelomonocytic Leukemia (CML)
- Chronic Lymphocytic Leukemia (CLL)
- Acute Myeloid Leukemia (AML)
There are several types of treatment a person may receive when they are diagnosed with cancer.
- Bone marrow transplants utilize young cells from the bone marrow of a healthy person to replace bone marrow destroyed by cancer.
- Chemotherapy medicines aim to kill cancer cells. They can be in either pill form or can be administered intravenously.
- Hormone therapy stops or blocks hormones to slow or stop the growth of cancer, as some cancers depend on hormones to grow.
- Immunotherapy uses a person’s immune system to track and attack cancer cells.
- Radiation is a common treatment using high energy waves to kill or damage cancer cells.
- Surgery plays a key role in removing tumors and affected tissue. It can also be used to find out how cancer may be progressing.
- Targeted therapy is a drug therapy that identifies and attacks certain types of cancer cells.
A person may choose to receive alternative or complementary treatments, including diet changes, supplements, or natural extracts.
Medicare may not cover alternative treatment options, so it can be helpful to check plan documentation.
Currently, there are no screening tests that accurately find leukemia. In many cases, a physician will find leukemia through a routine blood test.
Some people have an increased risk of developing AML. People who have a higher risk include people with:
- Down’s syndrome
- certain blood conditions, such as myelodysplastic syndrome
- history of cancer treated with certain chemotherapy drugs or radiation
Out-of-pockets costs apply to both parts A and B and include:
- excess charges
Most people do not pay a monthly premium for Part A. The standard premium for Part B in 2020 is $144.60 per month.
The Part A deductible applies to each benefit period that starts the first day a person must stay in the hospital or skilled nursing facility (SNF).
The benefit period ends when an individual has not had any hospital or SNF care for 60 consecutive days. In 2020, the Part A deductible is $1,408.
There is no coinsurance for the first 60 days that a person stays in the hospital. For days 61–90, a person pays $352 per day. From day 91 onward, a person pays $704 per day.
For Part B, a $198 annual deductible applies in 2020. Once an individual has paid the deductible, Medicare pays 80% of eligible costs, and a person must pay the remaining 20% coinsurance.
Out-of-pocket costs for Medicare Advantage and Medigap plans will vary depending on the plan provider, region, or plan chosen.
There are support options available to those who may need help with out-of-pocket costs.
People who qualify for Medicaid or one of the savings programs mentioned below may also get Extra Help. This program helps pay for prescription drugs.
Medicare savings programs
A person who is not eligible for Medicaid may qualify for one of the Medicare savings programs (MSPs).
MSPs can help a person to pay for monthly premiums and out-of-pocket costs.
There are four different programs available, and an individual can check if they qualify by contacting their state’s Medicaid office.
American Cancer Society
For additional information, advice, and emotional support, the American Cancer Society has a wealth of information on their website.
Leukemia is a form of blood cancer. Medicare pays for many of the expenses needed to diagnose and treat the disease.
There is currently no preventive screening for leukemia, and often, routine blood tests provide a diagnosis.
A person may be required to pay out-of-pocket expenses, but they may enroll in a Medigap policy to help cover these costs.
Individuals with limited income and resources may qualify for additional support from Medicaid, a Medicare savings program, or Extra Help.
For emotional support and advice, the American Cancer Society offer specific services that may be of benefit to those affected by leukemia.
We will update the 2021 costs as soon as possible after the Centers for Medicare and Medicaid Services (CMS) have released them.
We last updated the costs on this page on October 29, 2020.