It can be really scary to be diagnosed with cancer. Treatment can include either medications or a chemotherapy drip. Which treatment is given should be decided by the person and his or her doctor. People who use Medicare, however, are finding that their insurer is making that decision for them.
No one wants to hear their doctor say that they have been diagnosed with a form of cancer. It is scary, and the treatment can be extremely expensive. Those who have a good health insurance plan often find that they still get stuck paying many medical bills out of pocket. However, they can be assured that their private insurance company will pay for at least some of the medical bills that come from their cancer treatments.
Right now, there are two options for the treatment of cancer. One option is for a patient to start taking one of the new cancer medications. These pills can target the cancer cells and destroy them while leaving the healthy cells undamaged. These types of medications can cost tens of thousands of dollars.
The other option is to undergo chemotherapy. To do this, a patient has to sit in a hospital for hours at a time while an IV slowly drips the cancer treatment medication into their bodies. It is less comfortable and less expensive than the medications are.
Insurance companies, of course, are going to want people to take the least expensive treatment option. That doesn’t mean that the least costly option is always going to be the best one for absolutely everyone. Nineteen states, and the District of Columbia, have made laws that require private health insurance companies to cover the drugs that are designed to fight cancer. The insurers have to cover them without charging patients more than they would if the patient was going to receive intravenous infusion therapy.
This protects people who are using a private form of health insurance, assuming that they live in one of the states that has this type of regulation. However, these laws do not protect people who are covered by a public form of health insurance, such as Medicare. This is a big problem!
Medicare comes in four parts. Part D is the portion that covers prescription medications. Not everyone who has Medicare signs up for Part D, mostly because they cannot afford it. Those who do sign up for it are at the whim of the Medicare system when it comes to coverage for prescription medications. The infamous “doughnut hole” has not yet been entirely closed.
A Part D plan could decide that it will exclude coverage for the medications that fight cancer, and there isn’t anything that the patient can do about it. This limits the treatment options for those who are diagnosed with cancer and who are using Medicare.
Image by Derek K Miller on Flickr