Medicare is government-funded health insurance for adults aged 65 and older, as well as younger adults with specific medical conditions. It includes extensive coverage for cancer care, including care needed for pancreatic cancer.

The different parts of Medicare provide various benefits that can help with the costs associated with pancreatic cancer care.

A person may pay certain out-of-pocket expenses for pancreatic cancer treatment.

This article looks at Medicare’s cover for pancreatic cancer, possible expenses, information about the disease, and the help and support 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.

Healthcare professional helping older male adult to walk whilst in hospital and discussing the question how does Medicare cover pancreatic cancer?Share on Pinterest
Credit Image: Stígur Már Karlsson /Heimsmyndir/Getty Images

The pancreas makes enzymes that help digest food. It also produces hormones, including glucagon and insulin, that maintain proper blood sugar levels in the body. Pancreatic cancer develops in the tissues or cells within the pancreas.

According to the National Cancer Institute, in 2020, there will be an estimated 56,700 new cases of pancreatic cancer.

The cause of pancreatic cancer is not clear, but identified risk factors include:

In many cases, pancreatic cancer does not have any symptoms in the early stages, which makes early diagnosis difficult.

When symptoms occur, they may include:

  • stomach pain, which may spread to the back
  • weight loss
  • light-colored stools
  • itchy skin
  • fatigue
  • new or worsening diabetes

Medicare covers pancreatic cancer treatment that is medically necessary. Treatment may vary based on the stage of the disease and an individual’s personal care decisions.

Treatment for pancreatic cancer may include:

Medicare Part A

Part A covers cancer treatment and care provided during an inpatient hospital stay.

Coverage also includes inpatient stays at skilled nursing facilities if needed.

Examples of Part A coverage for pancreatic cancer include:

  • surgical procedures
  • radiation therapy
  • chemotherapy
  • qualifying clinical trials
  • hospice care

Medicare Part B

Part B covers pancreatic cancer care provided on an outpatient basis. Care may include a variety of services, such as:

  • chemotherapy
  • radiation therapy
  • doctor’s office visits
  • diagnostic tests and procedures, such as a PET scan
  • limited prescription drugs

Medicare Part C

Individuals eligible for Medicare may instead opt for Part C, which is also known as Medicare Advantage.

These plans cover the same services for pancreatic cancer as original Medicare parts A and B and usually include Part D prescription drug coverage.

Additonal benefits may be available and can vary by plan type, region, or plan provider.

Private insurance companies administer Part C plans, and the federal government oversees them, ensuring they offer the required minimum benefits.

Medicare Part D

Part D, also known as a prescription drug plan (PDP), provides coverage for some chemotherapy drugs not covered by Part B.

Like Medicare Advantage plans, private insurance companies administer PDPs.

As well as often being included in Medicare Advantage plans, PDPs can work alongside original Medicare plans, and a person can compare plan options with Medicare’s helpful online tool.

Part D may pay for:

  • oral chemotherapy drugs
  • drugs to manage pain
  • anti-sickness or anti-nausea drugs

Enrollees in Medicare may have out-of-pocket expenses associated with cancer treatment.

For example, in 2020, the Part A inpatient deductible is $1,408. A person must pay the deductible before Medicare covers inpatient costs for pancreatic cancer treatment.

Other out-of-pocket expenses may vary, but can include:

  • coinsurance
  • copayments
  • excess charges

Hair prosthesis and wigs

Sometimes, certain forms of cancer treatment may cause a person to experience hair loss.

At this time, original Medicare does not cover a hair prosthesis or wig, as they are not considered medically necessary.

Some Medicare Advantage plans may offer benefits that can help with these costs, but a person may like to contact their plan provider for confirmation.

If a person chooses to purchase a hair prosthesis, they will generally have to pay for this out of pocket.

Screening tests are available for other forms of cancer, such as colon or prostate cancer, which help improve the chances of early diagnosis.

Unfortunately, there are no screening tests currently available for pancreatic cancer. According to the American Cancer Society, the screening tests attempted have not increased the chances of survival successfully.

In some cases, a person may have a higher risk of pancreatic cancer due to a genetic condition.

Medicare typically does not cover genetic testing for people without a history of cancer, including pancreatic cancer.

Once a physician confirms a pancreatic cancer diagnosis, original Medicare pays for varied medically necessary treatment.

The exact coverage varies according to individual treatment plans, but benefits may include:

  • outpatient chemotherapy and radiation therapy
  • surgery
  • inpatient hospital stays
  • chemotherapy
  • rehabilitative services
  • prescription drugs to treat side effects
  • doctor’s office visits
  • imaging tests
  • blood work

Knowing where to find the right kind of support can be important when navigating treatment and care-related issues.

National Pancreas Foundation

The National Pancreas Foundation offers various types of support, such as education about pancreatic cancer and information for caregivers. They also may be able to provide financial assistance.

Pancreatic Cancer Action Network

The Pancreatic Cancer Action Network provides information on finding support groups for those with pancreatic cancer, both in-person and online.

The American Cancer Society

The American Cancer Society offers various types of support for people with many types of cancer, including pancreatic cancer.

Support may include educational, financial, and emotional.

Qualified Medicare Beneficiary Program

Although it is not specifically for help with pancreatic cancer, Medicare offers the Qualified Medicare Beneficiary program to eligible individuals.

The program provides financial assistance to help individuals pay for Part A and B deductibles, premiums, and copayments.

Original Medicare and Medicare Advantage both cover pancreatic cancer care and treatment.

Coverage includes inpatient services, such as surgical procedures, and outpatient care, including doctor’s office visits. The part of Medicare that covers services may consist of parts A, B, and D.

A person may have out-of-pocket expenses related to their care, such as deductibles and copayments.

There are many support options available from organizations such as the National Pancreas Foundation, the American Cancer Society, and the Pancreatic Cancer Action Network.