Medicare Standards for Cancer Treatment

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    Screenings

    • Medicare covers most cancer under Part B. Primarily breast cancer, ovarian cancer, colon cancer, and prostate cancer screenings are available.

    Treatment Coverage

    • Medicare will cover chemotherapy and radiation therapies. Billing is contingent on whether it was an outpatient (Part B) or inpatient (Part A) procedure.

    Advance Beneficiary Notice

    • Health providers must furnish an Advance Beneficiary Notice (ABN). According to Medicare Interactive, an ABN is a notice that explains that Medicare may not cover the service. If the provider does not furnish an ABN and Medicare does not cover the procedure, then the beneficiary is not responsible for the bill.

    Drug Coverage

    • A beneficiary should contact her Part D drug plan to see if the necessary drugs are covered. If a drug is not covered, the beneficiary can appeal to the plan to cover it.

      Many cancer drugs are used experimentally and are not FDA approved. These drugs are excluded from coverage by Medicare unless the indication can be found in medical compendium or peer-reviewed medical journals.

    Smoking-Related Cancers

    • If a Medicare beneficiary is diagnosed with a smoking-related cancer, Medicare will cover smoking cessation counseling.

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