If you or a loved one have been newly diagnosed with endometrial cancer or have a high risk for this disease, you may be looking for answers about what Medicare will cover.
Medicare does cover endometrial cancer treatments, as well as screening and preventive services. But you may still have to pay out of pocket for certain parts of your care.
This article provides an overview of Medicare coverage and explains exactly what’s covered when it comes to endometrial cancer.
As with most types of cancer, Medicare provides coverage for endometrial cancer treatments. Different parts of Medicare cover different aspects of your care. These typically include services like annual wellness visits, cervical cancer screenings, surgical procedures, imaging tests, and more.
You can choose from among many different Medicare plans. Most people at least sign up for Part A and Part B, known as original Medicare, at age 65. Original Medicare covers your inpatient hospital costs (Part A) and outpatient medical services (Part B).
You’ll also likely need coverage for prescription drugs, which is offered through Medicare Part D. If you’d like a private insurance alternative to original Medicare, you may want to consider finding a Medicare Advantage (Part C) plan in your area.
In the next few sections, we’ll explore some of the common therapies and diagnostic testing you may need and which parts of Medicare cover them.
The type of treatments needed for your endometrial cancer will depend on multiple factors, including what stage it is and the outlook for your condition. Your doctor may suggest one or more treatments to create a comprehensive plan.
Surgery is often a main treatment for endometrial cancer. It consists of a hysterectomy, which is the removal of the uterus. This treatment also includes a salpingo-oophorectomy — the removal of the ovaries and fallopian tubes — as well as the removal of certain lymph nodes.
If your doctor declares your surgery medically necessary, Medicare will cover it. You can discuss the surgical plan with your doctor to determine projected costs and coverage. For example, your costs may vary if you’re considered an outpatient or an inpatient for the procedure.
Chemotherapy uses specific drugs that are taken orally or given through an IV to kill the cancer cells and stop them from spreading. Chemotherapy drugs used to treat endometrial cancer may include:
- paclitaxel (Taxol)
- doxorubicin (Adriamycin) or liposomal doxorubicin (Doxil)
- cisplatin docetaxel (Taxotere)
If you receive chemotherapy as an inpatient at a hospital, Medicare Part A will cover it. If you’re an outpatient (either at a hospital, freestanding clinic, or doctor’s office), Medicare part B will cover your chemotherapy.
Radiation therapy uses intense beams of energy to kill cancerous cells. For endometrial cancer, radiation is most often used after surgery to get rid of any cancer cells that remain in the treated area.
As with chemotherapy, Medicare Part A covers radiation if you’re an inpatient and Part B covers it if you’re an outpatient.
In addition to the common treatments we’ve discussed, Medicare also covers:
- Hormone therapy. Hormone therapy uses synthetic hormone and hormone blockers to target cancers that spread and grow through hormones. It’s most often used to treat endometrial cancer that’s in an advanced stage, such as stage 3 or 4. It can also be used if the cancer comes back after treatment.
- Immunotherapy. Immunotherapy drugs use your body’s immune system to attack cancerous cells. This treatment can be used for certain types of endometrial cancer that have come back or spread further.
Medicare Part B covers tests to screen for conditions like cancer and heart disease. Possible tests for the presence of endometrial cancer include:
- Pelvic ultrasounds. In a pelvic ultrasound, a transducer is moved over the skin of the lower part of your abdomen to check for abnormal growths or tumors.
- Transvaginal ultrasound. This test looks at the uterus and involves placing a probe (similar to the ultrasound transducer) into your vagina. Transvaginal ultrasound images can be used check endometrium thickness, which can indicate the presence of endometrial cancer.
- Endometrial biopsy. This is the most common test for endometrial cancer. An endometrial biopsy involves placing a very thin, flexible tube into your uterus through your cervix. Then, using suction, a small amount of endometrium is removed through the tube and sent for testing.
Medicare Part B also covers tests to detect the spread of cancer. These include:
- CT scans. CT scans use X-rays to create detailed, cross-sectional images that show the inside of your body.
- MRI scans. MRI scans use radio waves and strong magnets instead of X-rays to create images of the inside of your body.
- Positron emission tomography (PET) scans. This test includes radioactive glucose (sugar) that helps make cancer cells more visible. PET scans aren’t a routine part of the workup of early endometrial cancer but may be used for more advanced cases.
Part A costs
If your inpatient care is covered under Part A, you can expect certain costs, including a deductible of $1,408 for each benefit period and daily coinsurance costs if your stay lasts longer than 60 days.
Most people don’t have a monthly premium for Part A, but this depends on your working history. If you don’t qualify based on your past employment, you can purchase Part A.
Part B costs
Part B costs include:
- a monthly premium of $144.60, or higher depending on your income
- a deductible and coinsurance of $198, which you must meet before services are covered
- 20 percent of the cost of most services covered by Part B, once you meet the deductible
Part C costs
Part C, also known as Medicare Advantage, is required by law to cover at least as much as original Medicare (parts A and B). Many times, these plans will offer additional benefits as well, like prescription drug coverage.
The costs for these plans vary by provider and location. You’ll usually need to stay within the plan’s network of providers to get the most coverage. You can contact your plan provider with questions on out-of-pocket costs for your specific cancer treatment.
Part D costs
Part D covers prescription drugs that you buy from a retail pharmacy and take at home. For endometrial cancer, these may include:
- prescription drugs taken orally for chemotherapy
- anti-nausea medications
- pain relievers
- sleep aids
The costs of Part D plans also depend on the type of plan you choose, your provider, and your medications. Check with your Part D plan provider or look over the plan’s formulary, which is a list of covered prescription drugs, to make sure it will pay for your medications.
Be aware that most plans have deductibles or set out-of-pocket copays for your medications.
Sometimes referred to as uterine cancer, endometrial cancer begins in the endometrium (the lining of the uterus). It is often diagnosed at an early stage because of its symptoms, which can include:
- pain in the pelvic area
- changes in the length or heaviness of menstrual periods
- vaginal bleeding between periods and after menopause
Other symptoms include:
If you have any of these symptoms, it could be a sign of endometrial cancer or another gynecological condition. Make an appointment with your doctor as soon as possible. If you are diagnosed early, you can be treated sooner, and your condition may have a more positive outlook.
Medicare covers diagnostic testing and treatments for endometrial cancer. If you’re diagnosed with endometrial cancer, talk with your doctor about your Medicare-approved treatment options.