What Are the Best Medicare Plans for Cancer Patients?
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The best Medicare plans for cancer patients are a Medigap Plan G from Mutual of Omaha and a Medicare Part D plan from Humana.
Alternatively, if your cancer diagnosis means you can't qualify for Medigap, we recommend a Medicare Advantage plan from AARP/UnitedHealthcare. Another good option if you have a low income is to enroll in both Medicare and Medicaid, which will reduce how much you pay for cancer treatments.
Cost of cancer treatment and chemotherapy with Medicare
If you have Medicare, the annual cost for cancer treatment and the plan ranges from $3,714 to $10,698, depending on the coverage you choose.
Without Medicare or other health insurance, the average cost of cancer treatment is $43,516 for the first year after diagnosis.
Coverage | Health care costs | Plan costs | Total |
|---|---|---|---|
| Medigap Plan G | $226 | $3,419 | $3,645 |
| Medicare Advantage | $5,343 | $2,315 | $7,658 |
| Original Medicare only | $8,658 | $1,979 | $10,637 |
| No insurance | $43,516 | $0 | $43,516 |
Average health care costs are for the first year after diagnosis, and plan costs are based on annual estimates. Calculations exclude the cost for oral prescription drugs, which averages $1,874 without a prescription drug plan.
Choosing coverage for cancer care
The rule of thumb for cancer coverage (or another expensive medical diagnosis) is that it is nearly always worth it to invest in a more expensive Medicare plan that has better benefits.
There are usually high costs for cancer treatment such as chemotherapy or radiation, and paying for more robust coverage can usually help you save thousands of dollars per year. For example, paying an extra $30 per month ($360 per year) for better coverage that lowers your medical costs by $3,000 annually means you'd save $2,640 overall.
Best cancer coverage: Medigap Plan G + Medicare Part D
Medigap plans (also called Medicare supplement plans) are expensive, costing more than $100 per month, but they provide the best limit on your medical costs.
Avoid medical underwriting when enrolling in Medigap
If you want a Medigap plan, the best time to enroll is usually during your initial enrollment period when you turn 65. This will give you the best rates, and you'll have Medigap guaranteed issue, which means you can’t be denied coverage because of a medical condition. However, you can be eligible for guaranteed issue at other times, depending on your situation and where you live.
Medigap Plan G will cover most medical costs except for the $226 Medicare Part B deductible. Plus, the plan is available to all new enrollees, and it's widely offered by most Medigap providers.
You'll also need prescription coverage, which requires a separate Medicare Part D plan. Because medications are often an important part of cancer treatment, it's helpful to keep in mind that medications administered at a doctor's office, hospital or medical facility would be a part of your Medigap coverage. However, the medications you take at home are typically part of your prescription plan.
If you go through medical underwriting after a cancer diagnosis without the protections of Medigap guaranteed issue, your Medigap application will usually be denied.
In this situation, enroll in a Medicare Advantage plan with good coverage for cancer during the fall open enrollment period.
Best Medigap companies for cancer
Mutual of Omaha is the best Medigap provider for cancer patients because of its high customer satisfaction and reasonable rates.
Company | Plan G cost | Customer satisfaction | |
|---|---|---|---|
| Mutual of Omaha | $133 | 5.0 |
| AARP/UHC | $126 | 4.5 |
| Cigna | $148 | 4.0 |
| BCBS | $121 | Varies by location |
| Aetna | $126 | 1.5 |
| Humana | $122 | 1.0 |
Average monthly rates for a 65-year-old female nonsmoker in Dallas. Customer satisfaction is based on the rate of complaints for each company's Medigap division.
Find Cheap Medicare Plans in Your Area
These sample rates show that insurers can charge similar prices for Medigap Plan G, with less than a $30 difference between companies. However, the cost for Medigap varies by location because the prices are regulated at the state level.
If you're considering Blue Cross Blue Shield, keep in mind that each local subsidiary is owned and operated independently rather than being a part of a centralized company. That means there is large variation between each subsidiary's effectiveness and customer satisfaction. For example, you can get a high-quality BCBS plan in NY, FL, ID, PA and MI. However, plans are poorly rated in IL, SC and AZ.
Mutual of Omaha Medigap
The cost for a Plan G from Mutual of Omaha is often similar to what you'd pay for a plan from AARP/UnitedHealthcare, and if you qualify for Mutual of Omaha's household discount of 7% to 12%, the plan could be one of the cheapest options available.
- Popular plans
- High customer satisfaction
- Affordable rates, especially with a household discount
- Only offers Plans A, F, G and N
- Doesn't include extras like dental or fitness perks
Other companies to consider: Best Medigap plans
Best Medicare Part D companies for cancer
Humana is the best Medicare Part D provider for prescription drug coverage because plans are a good value and well rated.
Company | Monthly cost | Overall rating | |
|---|---|---|---|
|
| Humana | $45 | 4.0 |
|
| BCBS | $93 | 4.0 |
|
| AARP/UHC | $56 | 3.8 |
|
| Mutual of Omaha | $62 | 3.5 |
| WellCare | $37 | 3.5 |
|
| Aetna | $36 | 3.5 |
Cost is the national monthly average for Part D plans, and ratings are the average Medicare.gov star rating for prescription drug plans. Note that star ratings for Part D plans tend to be lower, and 89% of enrollees have a plan with 3.5 or 4 stars.
Find Cheap Medicare Plans in Your Area
What you pay for cancer medications largely depends on their tier classification. For example, generic drugs are usually cheaper than new, experimental or specialty drugs.
Eeach insurance company sets its own formulary about the drugs it covers. While all companies will provide broad coverage across all types of medication, choosing the best prescription plan usually means matching your list of prescriptions to a drug plan's formulary.
When managing your cancer treatment, remember that with all Medicare prescription plans, you can request an exception to the list of covered drugs in your plan's formulary or a drug's tier classification. To do this, your doctor must say that a particular medication is required for treatment and there are no cheaper options available. While this process can require more paperwork, it's a useful way to make sure your cancer medications are affordable and accessible.
Humana Medicare Part D
Humana's Part D plans are typically a good deal. The cost for generic drugs is usually under $5, and preferred brand-name drugs cost around $45 with the company's more expensive plan. However, Humana's coverage for non-preferred drugs is not great, and you could have very high costs if you need these medications.
- Affordable generics and preferred brand-name drugs
-
1 in mail-order prescription customer satisfaction
-
$0 deductible plan options available
- Non-preferred brand-name drugs can be expensive
- High rate of complaints company-wide
Remember you can update your Medicare Part D plan annually to find the best coverage for the drugs that you are taking at that time.
Other companies to consider: Best Medicare Part D plans
Good cancer coverage: Medicare Advantage plan with a low cap on your medical spending
With Medicare Advantage, plans are generally cheap and include lots of perks. However, your costs can vary widely based on the amount of medical care you need, which is a key consideration for those who are comparing Medicare Advantage vs. Medigap.
The different coverage options with Medicare Advantage plans means there are several key steps to take when choosing a plan that has the best cancer coverage.
- Look for a plan that provides a low limit to how much you spend on medical care. Your portion of costs for cancer treatment will usually reach the plan's cap, called the out-of-pocket maximum, and choosing a lower spending cap can reduce your medical expenses and save you money.
- Get a high-quality plan with good star ratings. Medicare Advantage plans often require prior authorizations before certain types of health care are covered, and a company with a high star rating could mean you’ll face fewer issues or delays when you're getting cancer treatment.
- Check the Medicare Advantage plan's network of medical doctors. If you go out of network for your cancer treatment, you'll either pay more (as with a PPO plan) or have no coverage (as with an HMO plan).
- Enroll in a Medicare Advantage plan that includes prescription drug coverage, unless you have a prescription plan through a former employer or union. In nearly all cases, you can't add on a Medicare Part D plan for prescription coverage if you're enrolled in Medicare Advantage.
- Look for a plan that doesn't use step therapy for chemotherapy drugs. A 2019 policy change now allows Medicare Advantage plans to first require patients to try a cheaper version of Medicare Part B-covered drugs before it would cover a more expensive prescription. Oncologists often see insurance companies applying this cost-control process to oral chemotherapies.
Best Medicare Advantage companies for cancer
AARP/UnitedHealthcare Medicare Advantage plans have the best overall benefits for cancer patients because they provide a reasonably low cap on your medical expenses for an affordable monthly cost.
Find Cheap Medicare Plans in Your Area
Among national insurers, coverage options can vary widely by location, so you'll need to look closely at the plans offered in your area to find companies that offer low out-of-pocket maximums.
You may also have access to regional insurance companies, which offer a good spending cap. For example, HealthTeam Advantage in the Greensboro area of North Carolina has an average spending cap of $3,450 for its $0 Medicare Advantage plans, which is a very good value.
AARP/UnitedHealthcare Medicare Advantage
Nationwide, AARP/UHC Medicare Advantage plans typically have lower out-of-pocket maximums than other companies like Humana. And its low monthly costs and good ratings make it stand out as a good value.
- Popular and widely available
- Good overall ratings from Medicare.gov
- Good value on coverage
- Ratings are not as high as regional insurers like Kaiser Permanente, which has 5 stars
Other plans to consider: Best Medicare Advantage plans
If you have a low income: Medicare and Medicaid dual enrollment
When facing the high cost of cancer treatment, those who have a low income can enroll in both Medicare and Medicaid to reduce costs.
In states with expanded Medicaid eligibility, you can qualify for Medicaid if you are an individual earning less than $20,120. Medicaid eligibility varies by state, and talking to your Medicaid state agency can help you to determine if you qualify.
Plus, the high cost of cancer treatment can also make it easier to qualify for Medicaid because of the spenddown program.
If the amount you pay for Medicare coverage, deductibles and copayments is more than your available resources, this can be a useful way to lower your costs. Program details vary by state, but generally, the program allows you to subtract your medical expenses from your countable income, and this new income figure can be used to qualify for Medicaid.
What cancer costs are covered by Medicare?
Most cancer treatments are covered by Medicare, no matter what age you are. Whether you have a bundled Medicare Advantage plan or a combination of Medigap and Medicare Part D, most cancer care is considered medically necessary and is covered.
Medicare covers:
- Visits to oncologists and other physicians
- Diagnostic tests like CT scans and PET scans
- Cancer surgery and hospital care
- Chemotherapy treatment (inpatient and outpatient)
- Chemotherapy drugs
- Radiation treatment and proton therapy
- Immunotherapy
- Medications for cancer and to ease side effects
- Breast reconstruction after a mastectomy
- Transplants
- Durable medical equipment such as wheelchairs
- Mental health services
- Some clinical research cost
- Cancer screenings (mammogram, colonoscopy, lung cancer screening, prostate cancer screening, cervical cancer screening)
- Physical therapy and rehabilitation
- Home health care
- Skilled nursing facility care after a three-day hospital stay
- Hospice
Medicare does not cover:
- Experimental cancer treatment
- Medical marijuana
- Wigs
- Acupuncture (unless needed for chronic low back pain)
Frequently asked questions
What is the best Medicare plan for someone with cancer?
A cancer patient will have the best coverage with a combination of Medigap Plan G to reduce medical costs and Medicare Part D for prescription drugs. If you don't qualify for Medigap and need Medicare Advantage, we recommend a plan with a low cap on your medical spending from AARP/UnitedHealthcare.
Can you get a Medicare supplement plan if I have cancer?
If you have cancer, you can still enroll in a Medicare Supplement plan if it's your initial enrollment period at age 65 or if your situation otherwise qualifies you for "guaranteed issue." In both cases, you can't be denied enrollment because of a preexisting condition.
Is Medicare good for cancer patients?
A patient's cost for cancer treatment is about the same with either Medicare or an employer-sponsored health insurance plan, according to a study from Johns Hopkins. However, choosing the right Medicare coverage can help you save thousands of dollars on cancer treatment.
How much does cancer treatment cost with Medicare?
With Medicare Supplement Plan G, most of your medical expenses for cancer treatment are fully covered, reducing the $43,516 in medical bills to $226. With a Medicare Advantage plan, your typical cost for cancer treatment is $5,343, and with Original Medicare, the cost is $8,658.
Sources and methodology
Plan costs are based on rates provided by the Centers for Medicare & Medicaid Services (CMS) and Medicare.gov. We used standard costs where applicable without household discounts.
The customer satisfaction rating for Medigap plans is a one-to-five score based on the National Association of Insurance Commissioners (NAIC) complaint index of the company's Medigap division. The top score of 5.0 means the company has less than a quarter of the complaints that a typical insurer of its size.
The cost of cancer treatment is based on averages from the National Cancer Institute, and comparative out-of-pocket costs for employer insurance coverage is from research by the Johns Hopkins University School of Medicine.
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