Treating any form of cancer, including ovarian cancer, can be expensive. But your health insurance may help cover many of the bills that come from hospital visits, tests, and treatment.
Medicare covers most costs for treatment of ovarian cancer, as long as your doctor accepts Medicare.
In this article, we’ll go over the specific items and services Medicare covers for ovarian cancer treatment, what isn’t covered, and the basics of what you need to know if you receive this diagnosis.
Medicare covers treatment for ovarian cancer the same way it does for any type of cancer. Different parts of Medicare will cover different aspects of your care, such as wellness visits, bone mass measurement, cervical cancer screenings, and cardiovascular screenings.
Each part of Medicare covers certain items and services. You may consider enrolling in several of the options offered, depending on your coverage needs. Original Medicare, made up of Part A and Part B, is the standard plan and covers the majority of services.
There are two main ways to get Medicare coverage: through original Medicare or through a Medicare Advantage (Part C) plan. You may also need additional coverage for prescription drugs, which you can get through Medicare Part D.
When you’re faced with a serious illness like ovarian cancer, it’s important to know what coverage your plan includes. We’ll go over some of the common therapies you might need and which part of Medicare covers them.
Cancer is treated in various ways. Surgery and chemotherapy are often used to treat ovarian cancer. Radiation therapy and immunotherapy may also play a role in your treatment plan. The cost of each service depends on which part of Medicare covers it and which Medicare plan you’re enrolled in.
You may need surgery to remove cancer cells from your body. All Medicare plans cover the costs of surgery. These costs include fees for each of the following:
- operating room
- equipment and medications
Medicare Advantage (Part C) plans also cover the costs of surgery, but you typically need to get services from in-network providers.
Radiation therapy kills cancer cells and shrinks tumors. Medicare parts A and B each cover the costs of radiation treatment at inpatient or outpatient facilities, respectively.
Medicare Advantage plans also generally cover these treatments, as long as you use in-network physicians and facilities.
Chemotherapy is a medication used to treat cancer. It’s either administered through oral pills or an IV line, or it’s injected directly into a muscle. The type of chemotherapy you may need depends on the cancer you have.
For ovarian cancer, common chemotherapy medications include:
- capecitabine (Xeloda)
- cyclophosphamide (Cytoxan)
- ifosfamide (Ifex)
- liposomal doxorubicin (Doxil)
- melphalan (Alkeran)
Your Medicare plan may cover chemotherapy treatment in different ways, depending on how it’s administered. If you get chemotherapy through an IV at a hospital, Part A will cover it. If you get it through an IV at a doctor’s office, Part B will cover it.
Medicare Advantage and Part D will help pay for prescription drugs you take at home. For example, the oral chemotherapy medication olaparib, which stops cancer cells from growing, is covered by both Medicare Advantage and Part D.
In immunotherapy, medications help treat cancer by using your own immune system. Part A covers immunotherapy if you’re an inpatient, while Part B covers outpatient treatments. Medicare Advantage also covers immunotherapy if it’s ordered and given by an in-network physician.
If you’re formally admitted to the hospital as an inpatient, you’ll have coverage under Medicare Part A. But it’s also possible you may be in the hospital as an outpatient for observation. Ask the hospital staff if you’re unsure of your status, since it may affect your coverage.
Part A premiums are generally free, depending on your working history. Other costs include a deductible of $1,408 for each benefit period and daily coinsurance costs if your stay lasts longer than 60 days.
Medicare Part B covers medical insurance and many of the necessary outpatient services and treatment for cancer. In addition to the therapies discussed above, Part B will cover:
- doctors’ visits
- diagnostic tests, like X-rays and CT scans
- durable medical equipment, such as wheelchairs or a feeding pump, which you may need to use at home if you can’t take food by mouth
- mental health services
- preventive screenings
In 2020, the annual Part B deductible is $144.60, which you’ll have to meet before services are covered. After that, Medicare will cover most services and items at 80 percent of the Medicare-approved cost, leaving you to pay 20 percent out of pocket.
Finally, you’ll have to pay a monthly premium for Part B coverage. For most people, this amount is $198 in 2020.
To be eligible for Part C (Medicare Advantage), you must be enrolled in original Medicare (parts A and B). Part C is required to cover at least as much as original Medicare does.
Part C often provides additional services beyond original Medicare, but these come at a higher cost. Some plans also include prescription drug coverage.
The costs and coverage for each plan varies by provider and your location. Advantage plans may have different rules and costs for services compared with original Medicare. Contact your plan directly for specific questions on the out-of-pocket costs you can expect with your cancer treatment.
Part D covers prescription drugs that aren’t covered under Part B. This may include:
- prescription drugs taken orally for chemotherapy
- anti-nausea medications
- other prescription drugs you may take during treatment, such as pain relievers
The costs of Part D coverage depend on the type of plan you have, the medications you take, and where you get your medication.
Check with your plan provider to make sure your coverage includes your medications. Even if your plan does cover your medications, you’ll likely have deductibles or out-of-pocket copays.
Medicare doesn’t cover everything related to ovarian cancer. You might want to consider additional coverage if you need long-term care.
Medicare coverage doesn’t include:
Ovarian cancer occurs when malignant (cancerous) cells grow inside, near, or on the outer portion of the ovaries. Ovaries are part of a woman’s reproductive system and consist of two almond-shaped organs on each side of the uterus. Their job is to store eggs and produce female hormones.
The signs and symptoms of ovarian cancer aren’t always obvious but can include:
- pelvic or abdominal pain
- difficulty eating or feeling full quickly
- increased urgency or frequency of urination
If you have any of these symptoms for 2 weeks or more, consult a medical professional right away.
Medicare can help pay for many of your ovarian cancer treatment costs. Along with the therapies needed after a cancer diagnosis, Medicare offers coverage for preventive services and screenings for ovarian cancer.
Getting treatment as quickly as possible is important, so talk with your doctor if you notice any unusual symptoms.