Medicare Coverage of Stage 4 Lung Cancer
This article was updated on: 09/12/2018
When your doctor talks about your cancer’s stage, he or she is generally referring to details such as the size of the cancer and how far it has spread, according to the American Cancer Society. To a large degree, your treatment options and prognosis (outlook), depend on the stage, reports the American Cancer Society. Staging relies on three different factors:
- The size of your main, or primary, tumor
- Whether the regional lymph nodes are affected
- If the cancer has spread (metastasized) to other parts of the body
According to the American Cancer Society, Stage 4 (sometimes written as stage IV) lung cancer is often widespread throughout the body and is very difficult to cure.
How is stage 4 lung cancer treated?
According to the American Cancer Society, stage 4 lung cancer may have already spread to distant sites in the body such as the liver, bones, or brain and it is rarely possible to cure the disease at this point. Treatment options usually focus on relieving some of the worst symptoms, making you feel better, and extending your life as long as possible according to your wishes.
The stage 4 lung cancer treatment plan might depend on factors such as the size and location of your cancer, the organs to where it has spread, and your overall health. Your doctor may recommend some combination of surgery, chemotherapy, radiation therapy, and targeted drug therapy if you are in relatively good health. For stage 4 lung cancer that has spread widely throughout the body, the first step is usually testing your cancer for gene mutations susceptible to treatment with targeted prescription drugs.
For cancers that don’t respond to targeted drug therapy, chemotherapy is often the treatment of choice if you are healthy enough to tolerate it, says the American Cancer Society’s website. If you are not, you may be offered radiation therapy to shrink your cancer and relieve some of your symptoms.
In most cases, you will be offered palliative care to help you manage the symptoms of your stage 4 lung cancer and any side effects from the treatments you elect to receive. Palliative care includes draining any fluid collections around your lungs or heart that make you feel short of breath, for example, or placing a stent in your superior vena cava if it becomes blocked, a common symptom of stage 4 lung cancer. Palliative, or supportive care, also means taking steps to help you stay relaxed and comfortable, managing your pain, nausea, and other unpleasant symptoms. Palliative care is not intended to cure your cancer.
Does Medicare cover stage 4 lung cancer?
Under Original Medicare (Part A and Part B), treatment you receive as an inpatient in a hospital or skilled nursing home is generally covered under Part A, while your doctor visits, chemotherapy drugs, and outpatient procedures are usually covered under Part B.
If you and your doctor feel that your stage 4 lung cancer has progressed beyond your ability or desire to continue treatment, you may be eligible for hospice care, at home or in an inpatient hospice facility, at no cost to you under Part A. Some of your hospice care benefits include:
- Doctor and nursing care
- Medical equipment (walkers, wheelchairs) and medical supplies
- Prescription drug coverage for symptom relief and pain control
- Physical, occupational, and speech therapy
- Homemaker services and hospice aide
- Short-term respite care for the patient’s caregiver
- Grief and loss counseling for family members
Your doctor must certify that you are terminally ill with a life expectancy of six months or less, and you must sign a paper certifying that you no longer want treatment to cure your disease. Keep in mind, once you choose hospice care, Medicare will no longer cover any treatment to cure your stage 4 lung cancer, including hospitalizations or emergency room visits not arranged by your hospice care team. You do have the right to stop hospice care at any time.
It’s understandable if you’re overwhelmed with questions about Medicare coverage for stage 4 lung cancer; I’m available to help you learn about your options. You can also get an email with information about your options, or request a telephone call, by clicking one of the buttons below. To see a list of plans in your area, click the “Compare Plans” button.