Medicare covers many of the costs associated with the diagnosis and treatment of liver cancer. A person may have some out-of-pocket expenses, however.
According to the National Cancer Institute, data show that the median age a person receives a cancer diagnosis is 66 years. This means that half of all cancer cases occur in people older than 66. At this age, most of these people would have Medicare coverage.
Receiving a cancer diagnosis can be overwhelming, but knowing that Medicare covers most of the associated costs may relieve some financial pressures.
This article discusses liver cancer, how Medicare helps cover costs and the out-of-pocket expenses a person may expect to pay.
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.
Most Medicare plans cover medically necessary liver cancer treatments, including prescription drugs, services, and supplies.
Medicare Advantage combines the benefits of Part A and Part B and includes coverage for prescription drugs more often than not. It usually also includes other benefits, such as dental.
All plans offer coverage for liver cancer.
If a person receives a diagnosis of liver cancer, the inpatient coverage from Medicare Part A includes medically necessary hospital admissions, skilled nursing facility stays, hospice care, and required prescription drugs.
It also covers home health care services, such as physical therapy, occupational therapy, or skilled nursing care at home.
Medicare Part A may also cover some of the costs of clinical research studies if a person wishes to join one.
Part A coverage extends to medically necessary surgeries that are part of the standard care for liver cancer, including a partial hepatectomy or liver transplant.
A partial hepatectomy involves removing part of the liver. However, doctors only offer this procedure to people with:
- good liver function
- good health for surgery
- a single tumor
- a tumor that has not grown into the blood vessels
Where this is not possible, a person may be medically eligible for a liver transplant.
Medicare covers treatment for and relating to a liver transplant, as long as the surgery takes place in a Medicare-approved facility.
All outpatient care, services, and treatment carry a 20% coinsurance after a person has met the deductible.
Medicare Part B covers many medically necessary outpatient treatments, such as:
- doctor visits
- durable medical equipment, such as wheelchairs or canes
- feeding pumps
- mental health services
- nutritional counseling
- radiation treatment in an outpatient clinic
- some oral medications
- many chemotherapy drugs administered intravenously in a doctor’s office or outpatient facility
Part B also covers diagnostic tests relating to liver cancer, including initial consultations with a doctor. Because of the liver’s location under the ribs, it is hard for doctors to identify liver cancer during a physical examination.
There are currently no recommended screening tests for people who are at average risk for developing liver cancer. However, the American Cancer Society (ACS) advise that a person with an increased risk of liver cancer should have preventive tests every 6 months.
An individual may be at increased risk of liver cancer if they have cirrhosis, which is progressive and long-term chronic liver damage. Some causes of cirrhosis include genetic diseases, hepatitis B or hepatitis C infections, and long-term alcohol misuse.
The liver is found underneath the right side of the ribs and is an essential internal organ that has several functions, including:
- storing nutrients
- making clotting proteins to stop bleeding
- delivering bile to the intestines to help break down fats
- breaking down alcohol, drugs, and toxic waste
Cancer causes cells to grow uncontrollably, forming a malignant tumor. This can happen anywhere in the body, including the liver.
Cancer that starts from inside the liver is called primary liver cancer, with the most common liver cancer known as hepatocellular carcinoma.
Secondary liver cancer begins somewhere else in the body and spreads to the liver.
Symptoms of liver cancer can include:
- unintentional weight loss
- loss of appetite
- feeling very full after a small meal
- nausea or vomiting
- yellowing of the skin and eyes, known as jaundice
Some people have benign tumors that can cause problems when they grow larger, but they do not spread like malignant tumors.
In most cases, surgery to remove benign tumors is successful.
Many people will have out-of-pocket costs associated with Medicare plans. These costs include monthly premiums, deductibles, coinsurance, and copayments, and they vary in amount depending on plan type.
There are different programs available that can help an individual to manage costs. Some of them are:
- Medigap: These are supplementary insurance policies that help a person pay some of the out-of-pocket costs of original Medicare.
- Medicaid: This is a joint federal and state program that helps people with limited income and resources. A person can check their eligibility by visiting the Medicaid website.
- Medicare Savings Programs: These plans help people pay premiums, deductibles, coinsurance, copayments, and prescription drug costs.
- Extra Help: This program helps people pay for prescription drug costs.
Medicare helps pay for the costs associated with the diagnosis and treatment of liver cancer.
Individuals with liver cancer may be eligible for surgery to remove a cancerous tumor. In some cases, a doctor may recommend a liver transplant. Medicare plans cover both.
Doctors only offer early detection tests to people with a higher risk of developing liver cancer. This includes those with cirrhosis or damage to the liver caused by hereditary conditions, chronic hepatitis B and C, or prolonged alcohol misuse.
Additional financial support through several programs, such as Medicaid and Extra Help, may be available to some people.