Cancer Discussions with Your Clients
Did you know that 60% of the cost of cancer comes from indirect expenses?
Meaning that they are not covered by any health insurance including Medicare.
Travel expenses, lost income, out of network care, experimental treatments, hotel stays for outpatient treatment, etc. are all real consequences of cancer. It all adds up very quickly, but you can prepare your clients by educating them about these risks.
Below is a compilation, taken from the 2017 ebook, talkingMEDICARE, of the talking points we feel are important to cover with your clients in regards to cancer, the costs, benefits, and options. You can download the entire talkingMEDICARE ebook here.
Cancer Drugs Covered By Medicare Part B
Oral cancer drugs
Medicare helps pay for some oral cancer drugs you take by mouth if the same drug is available in injectable form or is a prodrug of the injectable drug. A prodrug is an oral form of a drug that when ingested breaks down into the same active ingredient found in the injectable form of the drug. As new oral cancer drugs become available, Part B may cover them.
Oral anti-nausea drugs
Medicare helps pay for oral anti-nausea drugs used as part of an anti-cancer chemotherapeutic regimen. The drugs must be administered immediately before, at, or within 48 hours after chemotherapy, and must be used as a full therapeutic replacement for an intravenous anti-nausea drugs.
https://www.medicare.gov/coverage/prescription-drugs-outpatient.html
Chemo and Other Drugs – Paid by Part B or Part D?
Medicare Part B covers cancer drugs that you have put in your veins or can take by mouth. If your drug is only made to be taken by mouth, your Medicare Part D plan should cover it.
Want to learn about how Medicare covers other drugs? This CMS tip sheet provides an overview of drug coverage under Medicare Part A, B, C and Part D: https://www.cms.gov/outreach-and-education/outreach/partnerships/downloads/11315-p.pdf
Understanding the Stages of Cancer
Cancer plans often pay according to the stage a cancer is in when discovered. Stage refers to the extent of your cancer, such as how large the tumor is, and if it has spread. The TNM system helps describe cancer in great detail. But, for many cancers, the TNM combinations are grouped into five less-detailed stages.
Stage 0 – Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer.
Stage I, Stage II, and Stage III – Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.
Stage IV – Cancer has spread to distant parts of the body.
Another staging system that is used for all types of cancer groups the cancer into one of five main categories. This staging system is more often used by cancer registries than by doctors. But, you may still hear your doctor or nurse describe your cancer in one of the following ways:
- In Situ Abnormal: Cells are present but have not spread to nearby tissue.
- Localized: Cancer is limited to the place where it started, with no sign that it has spread.
- Regional: Cancer has spread to nearby lymph nodes, tissues, or organs.
- Distant: Cancer has spread to distant parts of the body.
- Unknown: There is not enough information to figure out the stage.
Learn more at www.cancer.gov. Specific information on stages: http://www.cancer.gov/about-cancer/diagnosis-staging/staging
Reminder: In 2016, an estimated 1,685,210 new cases of cancer will be diagnosed in the United States and 595,690 people will die from the disease. Please remember to ask your clients if they have appropriate coverage for this costly illness.
Want more information on the Cancer plans we recommend to have in your portfolio? Click here to request more information.