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Does Medicare Cover Endometrial Cancer Care? What you should know.

Endometrial and other related uterine cancers are a common diagnosis of patients we care for at the Gynecologic Oncology Institute, and this is generally covered by Medicare. Minimally-invasive robotic-assisted surgery is one of our specials areas of expertise and Dr. Steven Vasilev MD is a renowned pelvic surgeon located in Southern California.  We use state of the art techniques including ways to limit surgical pain using mainstream and integrative healing to get patients home the same day very often. Most of the time, surgery is all that is needed because this cancer is usually diagnosed early.  But you need an expert in your corner, specifically a gynecologic oncologist.  The only question then becomes, do insurance and Medicare cover the surgery and any possible additional therapies like chemo, biological therapies, immunomodulation, and radiation?  This is a good review for you about the nuts and bolts of it.

“Medicare pays the medically necessary costs for people with endometrial cancer. You may have to pay some out-of-pocket costs, but there are programs that provide additional support.

The following sections describe each part of Medicare in more detail.

Original Medicare

Original Medicare consists of Part A and Part B. Both cover Medicare-approved and medically reasonable costs associated with endometrial cancer.

Medicare Part A helps pay for cancer treatment and treatment that a person receives as an inpatient in a hospital, qualified care facility, or hospice, and covers some home health therapies. It can also cover short-term qualified care facilities and end-of-life expenses.

Medicare Part B includes outpatient appointments, for example, to diagnose and treat conditions, including endometrial cancer. It also includes preventive care like cancer screening.

Part B also helps pay for outpatient treatments such as radiation and chemotherapy that a person receives in a doctor’s office. However, Part B alone does not cover the majority of prescribed drugs.

Prescription Drug Plans

If a person has genuine Medicare, they can purchase a Prescription Drug Plan (PDP), also known as Medicare Part D.

Private health insurances manage PDPs. These plans include prescribed take-away drugs that may include chemotherapy or drugs that may help with the side effects of cancer treatment, such as: B. Antiemetics.

PDPs are not available to most people on a Medicare Advantage plan.

Medicare advantage

Medicare Advantage or Medicare Part C offers the same endometrial cancer benefits as Original Medicare. Private health insurances manage these plans.

Medicare Advantage combines Parts A and B under one policy that sometimes includes additional benefits and prescription drug coverage.

Medigap

Medicare supplementary insurance (Medigap) helps to cover the expenses associated with original Medicare. These costs include co-insurance, additional costs and deductibles.

Private health insurers also manage these plans.

With Medicare, people can expect some out of pocket costs. These are explained in more detail in the following sections.

Part A.

A person is normally eligible for Part A No Premium Cover provided they have worked at least 40 quarters in their lifetime.

In 2021, an individual must pay the Medicare Part A Deductible of $ 1,484 before the plan will cover the eligible costs.

Individuals must pay the deductible for each benefit period that begins and ends with hospital admission if they have not received inpatient treatment for at least 60 days.

Part A also has a daily co-payment of:

  • $ 0 for days 1-60
  • $ 371 for days 61 through 90
  • $ 742 for days 91 and up

Part B.

The withdrawal cost for Medicare Part B 2021 consists of:

  • a premium of $ 148.50 per month
  • an annual deductible of $ 203
  • 20% co-insurance of the eligible costs as soon as a person has paid the deductible in full

Medicare advantage

Medicare Advantage may have different costs depending on the type of plan or plan provider.

PDPs

As with Medicare Advantage, the costs associated with PDPs depend on certain factors, including:

  • the private health insurance company that manages the plan
  • the prescribed drug
  • the type of plan

PDPs can also have co-payments and deductibles, but in 2021 a PDP deductible cannot cost more than $ 445.

All major Medicare plans include many endometrial cancer services and treatments, including preventive, diagnostic, and inpatient services.

There may be expenses for premiums, deductibles, co-payments and co-insurance.

However, those with limited incomes and resources can qualify for Medicaid, MSPs, or Extra Help, all of which can help with healthcare costs.

Read more below, but also consider the Gynecologic Oncology Institute for your expert endometrial cancer care. Our approach is uniquely individualized.

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Dr Steve Vasilev MD
“I help and guide women to defeat gynecologic cancers and advanced pelvic conditions such as endometriosis, using a unique combination of minimally invasive robotic surgery, precision medicine therapies and complementary holistic natural support towards thriving in survivorship." Dr. Vasilev is the only physician quadruple board certified in Ob-Gyn, Gynecologic Oncology and Integrative & Holistic Medicine in the United States. He is an accomplished advanced robotic surgeon and serves as Medical Director of Integrative Medicine and Integrative Gynecologic Oncology at Providence Saint John's Health Center, Professor at John Wayne Cancer Institute in Santa Monica, California and is Clinical Professor at Loma Linda University School of Medicine. He is former faculty and professor at UC Irvine, UCLA, USC and City of Hope. He is an active member of multiple medical societies and has been nationally listed in "Best Doctors" for 18 years.

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