Leukemia, Lymphoma, and Medicare

In 2020, nearly 1.8 million people will be diagnosed with cancer in the U.S., according to seer.cancer.gov. Cancer can affect any area of the body, including the blood cells, bone marrow, and lymphatic system. Did you know that September is worldwide leukemia and lymphoma awareness month? 

These are two forms of blood cancer. If you or a loved one has been diagnosed with leukemia or lymphoma, you may be worried about which cancer treatment, services, supplies, and medications Medicare will cover.   

Treatment for Leukemia 

It depends on the severity. The primary form is chemotherapy — a drug treatment that uses chemicals to destroy leukemia cells. Depending on the kind of leukemia you have, you may get a single prescription or a mix of drugs. The medications may be injected into a vein or come in a pill form.        

Treatment for Lymphoma 

It depends on the stage. Lymphoma treatment can include chemotherapy, immunotherapy, radiation therapy, medication, and occasionally stem-cell transplant. 

Original Medicare and Chemotherapy

Original Medicare has two parts: Part A (hospital insurance) and Part B (medical insurance). 

• Part A covers chemotherapy if you have cancer and are hospitalized.  
• Part B covers chemotherapy if you are a hospital outpatient or a patient in a doctor’s office.

You could be in a hospital and still be deemed an outpatient. Part B also covers some preventative services for those who are at risk for cancer. Some services require you to meet certain conditions.

Your Costs

You still have a copayment for chemotherapy covered under Part B — in a hospital outpatient setting. For chemotherapy received in a doctor’s office, you pay 20% of the Medicare-approved amount, plus the Part B deductible.

Note: Your doctor may recommend services that Medicare does not cover. If this occurs, you may have to pay a portion or all of the costs. Ask your doctor to see how much your service, test, or item will cost and whether Medicare will pay for it. The amount you will owe could depend on the following:

• The kind of facility
• Other insurance you have
• How much your physician charges
• Where you get your service, test, or item
• Whether your doctor accepts assignment

Medicare Coverage Other Than Original Medicare

Medicare offers prescription drug coverage to all users, but it isn’t automatic. You must be enrolled in a Medicare drug plan (Part D) or be enrolled in a Medicare Advantage plan with Part D coverage. 

Fortunately, Part D covers most prescription medications and some chemotherapy treatment. If Part B doesn’t cover it, your Part D plan might. You can check with your plan to make sure.    

Part D

Medicare Part D may cover these cancer drugs:

• Prescription drugs for chemotherapy — only if taken by mouth
• Anti-nausea drug
• Paid medication

Changing Medicare Coverage

After getting leukemia or lymphoma diagnosis, it’s a good idea to review your current Medicare coverage. Each year, you can change your health and prescription drug coverage for the next year — during the Medicare Open Enrollment Period — October 15 to December 7.  

For all your Medicare questions, contact Bobby Brock Insurance!