The Battle of Cancer Coverage: Medicare Advantage vs. Medicare Supplement

How does Medicare cover cancer?
Maybe the better question is - how do Medicare Supplement (Medigap) and Medicare Advantage plans cover cancer.

We'll look at some actual costs for someone currently going through chemotherapy to show how Medicare works with Original Medicare only vs Original Medicare and a Supplement Plan G vs a Medicare Advantage plan.

Did the results surprise you?

Need help? Email me!

Federal Disclaimer:

Chapters:
0:00 Introduction
2:11 Monthly Premiums
4:29 Deductibles
4:45 Specialist Visits
6:51 Outpatient Surgery
7:25 Chemotherapy
8:32 Totals
10:27 Cancer Policy Implications
11:44 Wrapping Up

[dcnsteveg]

As an Oncology provider for over 40 years I will tell you that there are other issues to consider which in my opinion make a G plan even more helpful. One of these issues is that G plans allow you to seek expert care outside of an Advantage plan PPO list of providers and institutions. I practice in a rural community and often send my patient to larger Comprehensive Cancer Centers around the country where they can get the best care for their unique situation. As I understand it, some Advantage plans may not pay as well in these situations. The other issue is prior approvals. If I order a diagnostic study such as a PET scan or MRI, or an IV chemotherapy medication agent, with a G plan there is no authorization process and these items will be paid for (assuming I am practicing within accepted guidelines). An Advantage plan may require a prior authorization before the test or medication can be ordered. These prior authorizations are a huge burden to providers and staff. Indeed, at many large institutions they will not spend any time on these and that means a less than ideal test or drug may need to be substituted.

[roger]

Let's also remember that many Advantage plans are HMOs. As a former health insurance broker, EVERY HMO health plan that I ever reviewed defines 'medically necessary' as 'the least aggressive, least expensive treatment options available'. If my family member has cancer, I don't want my treatment options limited by this definition. Advantage plans get to set their own rules and they don't necessarily have to comply with Medicare rules. NOBODY in my family will ever be on an Advantage plan if I have a say in the decision.

[susanmcalister]

Wow, those costs are incredible. I am a senior living in Ontario Canada. There would be zero cost to me for all that treatment. That is not because I am a senior. The cost would also be zero for any citizen. All my medications are covered with the exception of a 100-dollar deductible at the beginning of the year. I cannot imagine having to go through a serious illness and having to worry about paying for the treatment.

[joannc]

Oh, you are a wonderful man and your Mom is proud! Great presentation 👍🏻 At 69 yrs of age, I was diagnosed with cancer. Five weeks of daily radiation and weekly chemo, followed by 5 sessions of internal radiation which included anesthesia. Throw in 4 ER visits, plus a few bags of blood and platelets. I’m on Medicare with Plan G Supplement. My total treatments and hospitalization? Out of pocket $190 — whew, I am amazed! We ALL deserve adequate healthcare! ❤ May God bless every one of you fighting cancer. 🙏🏻 Thank you for your video!

[janiceellery]

I survived stage four cancer ten years ago. When I turned sixty five last year I got supplement N plan. I would never let my life depend on an HMO again. Dealing with the HMO was worse than the cancer.

[masterlee]

I am all over the place on this video. First of all so selfless of you to do this video using your mom as the example while going through such a personal heartbreaking issue with her. Second this hits home for me as we were visiting my mom and sister to have dinner. My wife being a nurse noticed something was not right with my mom. She took her to the doctor the next day. They put her in the hospital and 2 weeks later she passed away while still there. She had Pancreatic Cancer. That was in 1999. As far as biased, well none of your videos are ever biased. You put out the most informative, easy to understand videos that anyone can understand. This one was no different. My thoughts and prayers are with your mom, you and all the family. From all the videos I have watched on this site if there is one thing I know about your mom it is that she has raised an awesome son.

[sharontorgerson]

In 2013, my husband was diagnosed with a terminal, metastasized, primary liver cancer, he was gone in 4 months; and, had previously had many treatments for skin cancers, including costly surgeries. We had a supplemental. Our total out of pocket (after annual deductible) was about $30. Those "expensive" supplemental premiums were SO worth it.

Two years after he died, I was diagnosed with triple negative breast cancer and was under treatment for 15 months, including 15 months chemo, 35 radiation treatments, and surgery. My total outof pocket after annual deductible was about $30 also (some kind of funny thing slipped through somehow).

If we had not had the "expensive" supplemental, I would have lost my house. There would have been NO way for me to pay those bills. The higher premiums for a solid supplemental guarantee me that I will never face catastrophic medical bills that I can't pay. In my opinion (and I'm 79 years old with all the predictable hearing and dental problems)....I would never feel comfortable letting my supplemental go for the attraction of a low premium on an advantage plan.

[evansdolyna]

Just found this! Great timing. Thank you❤

[lesliec]

Thank you. I appreciate seeing the detailed information and wish your family members well in their healing.

[michaelgreskamp]

As a parent of older children I know how proud your parents are of their mom did good. Excellent video and as someone who worked in a fortune 100 company for 35 years you have excellent presentation skills.

[jodiecox]

Excellent information! Sending prayers and good thoughts for your Mother and family! Thank you Erik!

[josephrogers]

I have Medicare part a & b with a supplement plan Which is free Tri-Care-for-Life from being retired military. As a backup I have a 10% VA rating. I HAVE HAD a quad bypass, A TUMOR ON MY pituitary gland, Bladder and Kidney Stone operations and almost no out of pocket expenses. Plus not required to have a In-network doctor or hospital.

[njlifeandhealth]

Your mother is a strong woman and we are rooting for her and the rest of your family! Keep doing the great work you do and adding transparency to the market.

[teams]

Great job. I love this kind of analysis/comparisons.

[Charlie]

Great information. Thank you. Original Medicare is not a profit-making endeavor, which may feel better for some people for getting care.

[joannekearney]

One reason I like a supplement plan is that as I get older keeping track of medical bills becomes more difficult..particularly if you don't have someone to manage that for you

[Bsquared]

What most people don’t know or think about is that with an Advantage plan, you have access to a nurse Case Manager to help you navigate all of the specialists and treatments, check up on you when you go home from the hospital and basically be there to be sure you have what you need. The older you get, the more important that type of support becomes. You don’t get that benefit with traditional Medicare or a supplement plan.

[MJFisher]

Another excellent video! Sadly, as an Agent in CA, I can't find a Cancer policy that issues to individuals over 65. For those looking to go the Advantage route, the Max out of pocket is very much a deciding factor. You can usually find a way to save on eyewear, hearing aids, even dental work if you're not picky, but $1000's extra each year for Chemo adds up! My mom beat her first breast cancer diagnosis, but 10 years later I lost her, at age 88. She went with it, not from it. Here's hoping your mom does better!

[SuRFerretti]

Prayers for your mom. She's lucky to have you to help navigate through all the claims processes and know what to expect so $ isn't an extra stressor at this time.

New whiteboard is pretty, but I liked the personal touch of seeing you write it out by hand. I'm sure it makes it easier to film, though.

[PaulHaenze]

Thanks for sharing a personal story to help us understand the costs. Very practical.