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What Women on Medicare Should Know

August 12, 2017

A dear aunt of mine was recently diagnosed and treated for breast cancer, and it’s quite amazing just how many questions one can have when dealing with such a horrible disease.  Of course, my whole family took to reading in order to help her get through this terrifying ordeal.  After inquiring myself, I realized a few facts that aren’t widely known not only by people not on Medicare, but also by recipients, or those that are covered by Medicare. 

 

Below are a few facts that may help those unaware of exactly what is covered:

 

Mammograms

How often is it covered?

Medicare Part B (Medical Insurance) covers a:

  • Screening mammogram once every 12 months (11 full months must have passed since the last screening)

  • Diagnostic mammogram when medically necessary

Who's eligible?

  • Women with Part B 40 or older are covered

  • Women with Part B between 35-39 can get one baseline mammogram

Your costs in Original Medicare

  • Screening mammogram: You pay nothing for the screening test if the doctor or other qualified health care provider accepts assignment

  • Diagnostic mammogram: You pay 20% of the Medicare-approved amount, and the Part B deductibleapplies.

Chemotherapy

How often is it covered?

Medicare covers chemotherapy if you're a cancer patient who's a hospital inpatient or outpatient, as well as if you're a patient in a doctor's office or freestanding clinic.

 

Who's eligible?

All people with Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) are covered. Part A covers hospital inpatients, and Part B covers hospital outpatients and patients in a doctor's office or freestanding clinic.

 

Your costs in Original Medicare

You pay a copayment if you're a hospital outpatient.

You pay 20% of the Medicare-approved amount if you get your treatment in a doctor's office or freestanding clinic. The Part B deductible applies.

 

Breast prostheses

How often is it covered?

Medicare Part B (Medical Insurance) covers external breast prostheses (including a post-surgical bra) after a mastectomy. Medicare Part A (Hospital Insurance) covers surgically implanted breast prostheses after a mastectomy if the surgery takes place in an inpatient setting. Part B covers the breast reconstruction surgery if it takes place in an outpatient setting.

 

Who's eligible?

All people with Medicare Part A and/or Part B are covered.

 

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount for the doctor's services and the external breast prostheses. The Part B deductible applies.

 

For surgeries to implant breast prostheses in a hospital inpatient setting, you pay the Part A hospital care costs.

 

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have

  • How much your doctor charges

  • Whether your doctor accepts assignment

  • The type of facility

  • The location where you get your test, item, or service

 

Original post provided by Medicare.gov

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