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Monday, October 7, 2019

How Does Medicare Cover Skin Cancer?


According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States. Seniors are particularly at risk as most skin cancer cells typically appear after 50-years-old, according to the American Society of Clinical Oncology.

Medicare provides its beneficiaries with substantial skin cancer coverage. The two original parts of Medicare, Part A and Part B, will provide the majority of care when treating skin cancer, while Part D provides some coverage as well. Depending on the type of Medicare plan the beneficiary has, the beneficiary may even be able to cut treatment costs to a small annual deductible.

Coverage for an Inpatient Hospital Stay

Although most skin cancer treatments are done on an outpatient basis, some cases may require an inpatient stay in a hospital. When Medicare beneficiaries have inpatient hospital stays, Part A, Part B, and Part D will cover parts of their stay.

To be an inpatient, the doctor must officially admit the beneficiary to the hospital. Once admitted, the beneficiary will owe the Part A deductible, which is $1,364 in 2019. This deductible covers the first 60 days while the beneficiary is in the hospital. If the hospital stay goes past 60 days, the beneficiary will owe a daily copay for each day past.

Part A covers a semi-private room, meals, some medications while admitted, and more. Part B covers most other medical services, such as lab work, surgery, doctor visits, radiation, some medications, and more. Part D covers the medications you give yourself while in the hospital. For example, if a pill is handed to the patient to take, that will be subject to Part D coverage, not Part A or Part B.

Outpatient Treatment Coverage

Medicare Part B covers outpatient doctor visits and outpatient hospital services. If the doctor never admits the patient to the hospital, the patient remains as an outpatient. A patient can remain as an outpatient for 48 hours max. If the patient is under observation for longer than 48 hours, the patient is automatically considered inpatient. In the case, Part B and Part D would provide coverage while in the hospital, not Part A.

Skin cancer can be treated by dermatologists. Medicare Part B will cover dermatologist exams and services as long as they are medically necessary. Medicare requires doctors to prove the medical necessity of each service they provide beneficiaries. For example, if a beneficiary with no history or risk of skin cancer wants a full-body exam to check for cancer, Medicare may not cover it.

Services covered under Part B are subject to an annual deductible and 20% coinsurance. As of 2019, the Part B deductible is $185. After this is met, the beneficiary is only responsible for 20% of Part B bills.

Medicare Prescription Coverage

Part D provides prescription coverage. Part D covers several types of medications, such as pills, topicals, inhalers, some injections, and more. Medications the beneficiary administers to himself is subject to Part D coverage.

When shopping for the most cost-effective Part D plan, beneficiaries should review each plan’s premiums, deductible, copays, and formulary. The formulary shows which medications the plan covers. Beneficiaries should enroll in a Part D plan that covers all or most of their prescriptions.

To Sum It Up

In the end, Medicare provides substantial coverage for medically necessary skin cancer treatment. Remember, it’s all in the coding of the claim whether Medicare Part B will cover a particular service. If Medicare Part B denies a claim at first, the doctor may be able to recode the claim and resubmit it for coverage.

Written by: Danielle K. Roberts

Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits, where her team of experts helps baby boomers with their Medicare decisions nationwide.

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