Lost amongst the fight against cancer itself is a patient’s crusade for affordable coverage of cancer therapies and other benefits that could improve quality of life and care. For cancer patients on Medicare, that means keeping up with any changes to Medicare costs and coverage that might affect treatment.
Here are a few areas of Medicare that have seen some changes in 2021 that may be helpful to you and your loved ones living with cancer.
Medicare health plan prices went down
While the costs of health care seems to increase all the time, the private Medicare industry has seen the opposite trend. The average premium of a Medicare Advantage (Medicare Part C) plan decreased 11% in 2021 to $21 per month. With this latest decrease, Medicare Advantage plan premiums have dropped 34% since 2017.
Medicare Advantage plans include all of the health benefits of Original Medicare (Medicare Part A and Part B), including the cancer treatment services and cancer treatment drugs that are covered by Part A and Part B.
Medicare Advantage plans, however, typically offer numerous addition benefits that Original Medicare doesn’t offer, some of which can be helpful to cancer patients. Depending on the plan, some of these extra benefits can include things such as home meal delivery, transportation to doctor’s office appointments, prescription drug coverage (including cancer treatment drugs not covered by Medicare Part B), home modifications like bathroom grab bars and more.
Medicare benefits went up
As mentioned above, the “advantage” in Medicare Advantage plans is their ability to offer benefits that are not included in Original Medicare, such as coverage for dental, vision, hearing, prescription drugs, fitness programs and so much more.
Those extra benefits are becoming more commonplace. In 2021, Medicare Advantage plans around the country increased their benefits offerings in 36 out of 41 benefit categories. This year, more than half of all Medicare Advantage plans offer some type of healthy meal benefit, and 46% cover transportation to and from doctor’s appointments.
The focus shifted from quantity to quality
Health care providers have historically been reimbursed by Medicare based on the number of times they saw a patient or the amount of services rendered. But Medicare has initiated a recent push to transition away from this volume-based approach and has more toward a value-based one, where providers are reimbursed based on patient results.
Value-based programs date back to the Affordable Care Act of 2012 and the Medicare Improvements for Patients & Providers Act of 2008, but they have continued to gain momentum as a popular Medicare strategy.
A value-based program can help give a cancer patient some peace of mind knowing their doctor truly has their best interest in mind.
Telehealth benefits were expanded
The COVID-19 pandemic prompted Medicare to expand its coverage of telehealth services. And while the benefit expansion was designed to end once the public health emergency did, many of the temporary changes were made permanent, and Medicare Advantage plans are expected to take telehealth coverage even further in years to come.
Telehealth coverage can allow cancer patients to consult with their doctor from the comfort of their own home and avoid what can at times be difficult or even dangerous trips to a health facility.
The Part D Donut hole closed
Medicare Part D plans have long featured a coverage gap, or “donut hole,” where patients were forced to pay more out of their own pockets for covered drugs until a certain limit was reached.
But the donut hole closed in 2020, which will help cancer patients better afford their generic and name brand drugs. Medicare drug plan beneficiaries are only now required to pay – at most – 25% of the cost of their generic or brand name drugs after they reach this coverage stage. Some Medicare drug plans may feature additional coverage during this “gap” so that beneficiaries’ spending is even lower.
Medicare added coverage for acupuncture
Medicare has historically not provided any holistic health care coverage, but that began to change as recently as 2020. Original Medicare now covers acupuncture to treat lower back pain, and Medicare Advantage plans can offer even broader coverage for acupuncture.
Acupuncture can provide relief from back pain experienced by patients with certain cancers like spinal, ovarian and colorectal.
Beneficiaries with ESRD have more opportunities
Before 2021, beneficiaries under the age of 65 who qualified for Medicare because of kidney failure had few Medicare Advantage enrollment options and were restricted to only select plans under certain circumstances. But the 21st Century Cures Act lifted those restrictions and paved the way for those diagnosed with End-Stage Renal Disease (ESRD) to freely enroll in Medicare Advantage plans the same way as any other beneficiary.
Cancer has been shown to have some troubling links with kidney disease, and kidney disease can be a risk factor for cancer.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.