Medicare provides coverage for immunotherapy under each of its parts, but you can expect some out-of-pocket expenses as well. Your coverage may vary depending on where you receive the medication and what type of medication it is.
Letâ€™s find out more details about coverage under Medicare, what your costs may be, and what to expect when receiving immunotherapy.
What parts of Medicare cover immunotherapy?
Each part of Medicare covers a different portion of immunotherapy treatment. Hereâ€™s a breakdown.
Medicare Part A
Medicare Part A covers hospital stays when youâ€™re admitted as an inpatient. It also includes costs for limited stays at skilled nursing facilities.
These costs can be for:
- the stay itself
- any medications or therapies you receive during your stay
- other related expenses
Medicare Part B
Medicare Part B covers visits to outpatient centers like doctorâ€™s offices or freestanding clinics. When youâ€™re receiving cancer treatments, Part B will cover a variety of therapies, including:
- immunotherapy (specifically the CAR-T form)
- radiation treatments
Medicare Part C
Medicare Part C (Medicare Advantage) is a private plan that covers the same services covered under parts A and B; however, it may also include prescription drug coverage.
With a Part C plan, you must choose in-network providers and pharmacies to get the maximum amount of coverage.
Medicare Part D
Medicare Part D covers prescription drugs that you take outside of a healthcare facility, such as when youâ€™re at home.
The amount of coverage each plan provides depends on that planâ€™s formulary and tier system. A formulary is a list of medications the plan covers; those medications are then divided into groups, or tiers, typically based on cost.
Talk with your plan provider to get a better understanding of how much coverage youâ€™ll receive before you start your treatment.
Medicare supplement plans, also known as Medigap plans, cover leftover costs from your other Medicare coverage. This includes deductibles for parts A and B, as well as copayments or coinsurance for parts B and C.
However, Medigap plans donâ€™t offer their own prescription drug coverage or coverage for leftover costs from Part D.
How much does immunotherapy cost?
When beginning your fight against cancer, the cost of treatment may be a concern.
Medicare covers some of the costs associated with immunotherapy. Letâ€™s take a closer look at the costs when immunotherapy is covered under each part of Medicare.
Part A costs
The deductible amount for Medicare Part A in 2021 is $1,484 per benefit period. This will most likely be covered if youâ€™re completing all the necessary visits and cancer treatment sessions.
Part B costs
The typical costs for Part B in 2021 are as follows:
- Monthly premium: typically $148.50, but possibly higher depending on your income
- Deductible: $203
- Copayment: 20 percent of the Medicare-approved cost of your immunotherapy treatments after your deductible has been met
Part C costs
With Medicare Part C plans, costs will vary depending on which plan and provider you have. Each plan will have a different copayment amount, coinsurance, and deductible.
Check with your plan provider to get details about your specific coverage and costs, as well as answers to any other questions about your plan.
Part D costs
Medicare Part D costs and coverage for individual immunotherapy drugs can vary based on the medication.
Letâ€™s look at the costs of Keytruda as an example:
- Without insurance, a single dose of Keytruda costs $9,724.08. Typically, patients who receive Keytruda will need more than one dose of the medication.
- Eighty percent of patients with traditional Medicare plans and no supplemental insurance paid between $1,000 and $1,950 per Keytruda infusion.
- Forty-one percent of patients with a Medicare Advantage plan paid no out-of-pocket costs. For those who did have to pay out-of-pocket, the cost was between $0 and $925.
What is immunotherapy?
Immunotherapy is a type of cancer treatment that uses your bodyâ€™s own immune system to find and kill cancer cells. There are four different types of immunotherapy:
- Monoclonal antibodies. This provides either synthetic antibodies made in a laboratory or a boost to the antibodies you already have. These antibodies fight cancer cells.
- Oncolytic virus therapy. This immunotherapy uses a genetically modified virus to find and kill cancer cells.
- T-cell therapy. Commonly used to fight blood cancers, this therapy uses a type of immune system cell known as a T-cell to find and fight cancer cells.
- Cancer vaccines. These help your body create a defense system against cancer. This can be either a cancer prevention method or treatment method.
Often, immunotherapy can be given alongside other cancer treatments like chemotherapy or radiation. In addition, it can be given after surgery to ensure your body is fighting off any remaining cancer cells.
What can I expect during immunotherapy treatment?
Immunotherapy is prescribed for certain types of cancers, including:
- cervical cancer
- esophageal cancer
- hepatocellular carcinoma (liver cancer)
- Hodgkinâ€™s lymphoma
- non-small cell lung cancer
- renal cell carcinoma (kidney cancer)
The side effects of immunotherapy can vary, depending on the specific medication and whether youâ€™re taking it along with any other cancer treatments.
Common side effects of immunotherapy treatment can include:
- body aches
- skin reactions
- nausea and vomiting
These side effects can also indicate serious medical conditions. Call your doctor if youâ€™re experiencing any of these symptoms. Itâ€™s also important to tell all your medical providers that youâ€™re receiving immunotherapy.
Medicare plan options and costs are subject to change each year.
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