Does Medicare Cover Pancreatic Cancer?
This article was updated on: 10/06/2018
The American Cancer Society estimates that:
- More than 55,000 Americans will be diagnosed with pancreatic cancer in 2018.
- More than 44,000 Americans will die of pancreatic cancer in 2018.
- About 3% of the cancers in the U.S. is pancreatic cancer.
- About 7% of cancer deaths in the U.S. are due to pancreatic cancer.
What is pancreatic cancer?
According to the Mayo Clinic, pancreatic cancer begins in the pancreas — an organ in your abdomen behind your stomach that helps with digestion and makes important hormones. Unfortunately, pancreatic cancer often goes undetected in its early stages and can spread rapidly to other organs.
What are common pancreatic cancer treatments?
The National Cancer Institute lists five standard treatments for pancreatic cancer:
- Surgery removes the cancerous tumor.
- Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
- Chemotherapy uses powerful medications to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
- Chemo-radiation therapy combines radiation therapy and chemotherapy to boost the effects of both therapies.
- Targeted therapy uses medications or other substances to identify and attack specific cancer cells without harming normal cells.
Pancreatic cancer care treatment may involve prescription medications to control pain, or if the cancerous pancreas is removed, replacing enzymes that help the body digest food and process nutrients.
Does Medicare cover pancreatic cancer screening and treatment?
Generally, Medicare covers medically necessary treatment for pancreatic cancer when your health providers accept Medicare assignment. You’ll typically pay Medicare deductibles, coinsurance, and/or copayments.
Screenings for pancreatic cancer
According to the Mayo Clinic, pancreatic cancer may be difficult to detect. Your doctor might look at your family history and symptoms. Also, diabetes may be one possible sign of pancreatic cancer, especially when you also have weight loss, jaundice (a yellow tint to the eyes or skin), or pain in the upper abdomen that spreads to the back.
Medicare Part B (medical insurance) might cover certain screenings for cancer and/or diabetes, if your doctor decides you’re at risk. You might be eligible for a diabetes screening at no cost to you.
Inpatient hospital care for pancreatic cancer treatment
Medicare Part A (hospital insurance) may cover:
- Inpatient hospital care to treat pancreatic cancer.
- Inpatient care as part of a qualifying clinical research study.
- Limited home health services for you if your doctor orders them and Medicare approves
- Hospice care for final stages of pancreatic cancer
The Part A deductible and/or coinsurance amounts may apply to some of these services.
Doctor visits, outpatient chemotherapy, radiation therapy, and some prescription drugs used in pancreatic cancer treatment
Medicare Part B may cover:
- Diagnosis of pancreatic cancer
- Outpatient pancreatic cancer treatment, such as radiation therapy and chemotherapy
- Certain prescription drugs such as oral cancer medications and oral anti-nausea medications
The Part B deductible and/or coinsurance or copayment amounts may apply to some of these services.
Prescription drugs for pancreatic cancer treatment
There are some prescription drugs that might not be covered under Original Medicare, Part A and Part B. You may be able to get coverage for prescription drugs under Medicare Part D. Most Medicare Advantage plans include prescription drug coverage. If you stay enrolled in Part A and/or Part B, you may usually enroll in a standalone Medicare Part D Prescription Drug Plan. Every Medicare Prescription Drug Plan has a formulary, or list of covered medications, that may include pancreatic cancer treatment medications. While a plan’s formulary may change at any time, the plan will notify you of changes when necessary.
Medicare Supplement plans and pancreatic cancer treatment costs
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Would you like to learn more about your Medicare coverage options? Please feel free to contact me by using the links below. If you wish to compare some of the Medicare plan options where you live, use the Compare Plans button on this page.
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