Medicare Supplements and Cancer Coverage
“You’ve got cancer,” words that none of us ever want to hear. It’s more than enough worrying about treatment options, prognosis, and finding the best providers. The last things you want to be thinking about is your health insurance, who you can see for treatment, and how much treatment will cost.
Having access to the best coverage and the broadest choice of providers in the event of serious, life-threatening health conditions are key reasons why my clients overwhelmingly choose a Medicare Supplement (Medigap), like the Plan G over Medicare Advantage plans.
There are several very important coverage considerations in differences that I always point out to prospective Medicare enrollees who are comparing Medicare Supplement coverage to Medicare Advantage coverage.
Part B Drug Coverage
With most Medicare Advantage plans, the enrollee is responsible to pay 20% of Part B drug costs. Part B drugs include infused or injected medications that are administered by a healthcare provider as well as some oral cancer drugs and oral antinausea drugs. Obviously, these types of drugs can be very expensive and even 20% can amount to thousands in out-of-pocket costs.
Most of the time when I show my clients the Medicare Advantage plan summary of benefits with a 20% coinsurance cost on Part B drugs they have no idea they could owe thousands if they need chemotherapy treatments. Costs can easily double if treatments start at the end of one year and resume early the following year because the plan out-of-pocket maximum co-pay resets in January.
Referrals and Staying In-Network
Medicare Advantage HMO plans, require referrals for specialty care, generally within your primary care doctors medical group. Access to the best doctors in the state or country may not be available to you.
Medicare Advantage PPO plans generally don’t require a referral to see a specialist but like HMOs your choice of in-network providers can be limited and and out-of-network doctors are not required to accept your plan. If an out-of-network doctor does agree to treat you you will spend significantly more out-of-pocket with an out-of-network provider.
With a Medicare Supplement Plan you can see any doctor, anywhere in the country, who accepts Medicare, and agrees to see you. Over 90% of doctors in the country, except Medicare, including virtually all top teaching, research, and cancer treatment centers in the country. With a Medicare Supplement, you have access to the best doctors and treatment facilities in the country best suited to treat your particular type of cancer. Your Medicare Supplement insurance company can never require a letter of referral or ask for “prior authorization.”
Prior Authorization and Delays
Medicare Supplements, like the Plan G or Plan N never require the insurance company to call for prior authorization of services. If your doctor thinks you need the treatment and it’s covered by Medicare, your insurance company will never second guess your doctor. They must follow Medicare and have absolutely no authority to intervene in care covered by Medicare.
Medicare Advantage plans, however frequently require prior authorization for care. The use of prior authorization by Medicare Advantage companies can lead to delays and even denials of care. You and your doctor may have to push for expedited approval or to appeal a denial. Delays in getting care your doctor has ordered and the stress of waiting or having to appeal a coverage decision can negatively impact the outcome of your treatment and your whole life.
Finding the Best Medicare Coverage for Cancer Treatment
I have gotten feedback from dozens of clients over the years who have been diagnosed and treated for different types of cancers. Not once have I ever had any of these clients complain about the coverage their Medicare Supplement provided for their treatment. These Medicare Supplement clients expressed gratitude for the strength of the coverage and freedom of choice to seek providers they believe offer the best chance of a positive outcome. This is why I recommend Medicare Supplement plans for any prospective clients who can afford the Medigap plan premiums.
