A lung cancer diagnosis can be overwhelming, and the costs of care may add up quickly. Medicare covers many expenses associated with cancer care to support a person both financially and emotionally.
Treatment for lung cancer is customized for the person depending on the type of lung cancer and other factors.
There may be some out-of-pocket costs based on the part of Medicare covering the care.
In this article, we discuss lung cancer, Medicare benefits, and some of the out-of-pocket expenses that may apply.
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 one lung cancer screening each year under certain circumstances.
To be eligible for a yearly lung cancer screening with no out-of-pocket expenses, a person:
- must be between 55-77 years of age
- must not have signs or symptoms of lung cancer
- must be a current smoker or have quit within 15 years
- must have smoked an average of one pack (20 cigarettes) per day for 30 years
- must have an order from a doctor
The screening test is known as a low dose computed tomography (LDCT) scan. LDCT scans, approved in 2015 as a lung cancer screening, may help find lung cancer early, which could create a positive outlook.
Like all radiological tests, there is some risk to low dose radiation. The test has up to a 14% false-positive reading. This means the test may say there is lung cancer when there is not.
A doctor may recommend more tests if the LDCT scan result is positive, and may ask for an LDCT screening test every year.
Medicare has different parts, some of which are administered by private insurance companies. Most parts cover lung cancer care.
Medicare Part A is sometimes called hospital insurance. It pays for expenses when a person with lung cancer stays in a hospital, skilled nursing facility, or hospice, and may also cover some home health care.
Medicare Part B is sometimes called medical insurance. Many of the lung cancer treatments provided outside of the hospital are covered by Part B.
Medicare Part C is also known as Medicare Advantage. Private insurance companies administer these bundled plans and combine the benefits of Medicare parts A and B into one policy. Many plans also cover prescription drug benefits.
Medicare Part D is also called a prescription drug plan (PDP). Also administered by private insurance companies, the plans cover many of the outpatient medications that treat lung cancer.
PDPs are available to those with original Medicare only, as most Medicare Advantage plans already include coverage for prescription drugs.
Medicare supplement insurance is called Medigap. Administered by private insurance companies, the policies help fill in gaps in Medicare parts A and B. A person cannot have a Medigap and a Medicare Advantage plan at the same time.
Lung cancer starts in the lungs when the cells change and begin to grow uncontrollably. Cells in the lungs may change for several reasons, such as exposure to dangerous chemicals.
There are two main types of lung cancer and different subtypes in each.
Small cell lung cancer is typically associated with cigarette smoking. Chemotherapy is a common treatment for this type of lung cancer.
Non-small cell lung cancer is a more common type of lung cancer. It is also slower to grow.
Under a microscope, a doctor will look for biomarkers and may find more information that can help build a treatment plan.
Biomarkers check for changes in a person’s DNA and can give important information about treatment that may work. Treatment is then customized to the person since no two lung cancers are the same.
The most significant risk of lung cancer is smoking. Other things that raise the chance of developing lung cancer are air pollution and radon.
Cancer-related care services, also known as oncology services, can help to diagnose and
Some of the treatments available for lung cancer include:
- Surgery: This option may only be suitable for a small number of people who have lung cancer. It involves removing part or all of one lung.
- Chemotherapy: This is used to kill cancer cells, relieve symptoms, or shrink a tumor before a surgical procedure takes place.
- Radiation: There are different types of radiation treatment. Some are used to stop cancer growth and others to help relieve symptoms.
- Targeted therapy: This works on certain types of lung cancer. Drugs are used to stop the growth or spread of lung cancer.
- Immunotherapy: Medicines are used to help a person’s immune system recognize and kill cancer cells.
- Complementary medicine: These are treatments used in addition to standard treatments. They can include acupuncture, hypnosis, or dietary supplements.
- Alternative medicine: These treatments are used instead of standard therapy. They can include diet, vitamins, or herbs.
- Clinical trials: These are new treatment options for those who are willing to try something new. A person who would like to take part can search for a clinical trial through the National Cancer Institute.
Medicare pays for medically necessary and approved treatments. If a person chooses to use complementary or alternative therapy, they may be required to pay out of pocket.
Clinical trials relating to cancer do not pay people to participate. Medicare covers routine costs and services in specific trials.
After a lung cancer diagnosis, Medicare parts A and B cover many of the medically necessary benefits.
Medicare Part A coverage includes:
- treatment a person receives while an inpatient in the hospital
- skilled nursing facility care after meeting the 3-day related hospital stay requirement
- hospice care
- blood work
- cost of some clinical research studies while in the hospital
- home healthcare
- rehabilitation services such as
- physical therapy
- occupational therapy
- speech and language therapy
- skilled nursing care
In some cases, a person may be in the hospital but considered an outpatient. This is called observation status. Medicare Part A does not pay for these services, but they may be covered under Part B.
Medicare Part B coverage includes:
- doctor visits
- durable medical equipment (DME)
- many intravenous or oral chemotherapy given in a clinic or doctor’s office
- radiation therapy
- tests to diagnose lung cancer such as x-rays or CT scans
- outpatient surgeries
- mental health services
- some costs of clinical research as an outpatient
- a second or third opinion on surgery that is not an emergency
- a feeding pump prescribed by the doctor when a person cannot eat or absorb the required nutrition through their intestines
Medicare works with healthcare practices to provide coordinated care through the “Oncology Care Model.” The program helps provide person-focused quality care to people with cancer, such as:
- a plan of care customized to a person’s specific healthcare needs
- a health professional available to answer questions 24 hours each day
- help coordinating care with healthcare professionals and community organizations
- financial, emotional, and social support services
The American Lung Association offers many helpful resources, and a person may find information on financial assistance programs and local support groups.
A lung cancer diagnosis can be life-changing, and the costs can grow quickly. Medicare parts A and B help pay medically necessary expenses related to a person’s diagnosis, treatment, and care.
An LDCT test can be done yearly to screen for lung cancer. There is no charge to those who are eligible.
Medicare helps pay for treatments inside and outside of the hospital. They also pay for some clinical trials.
Medicare Advantage and Medigap may offer financial help to cover the costs of treatment and other organizations such as The American Lung Association.