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Introduction to Medicare Coverage

More than half of people with mantle-cell lymphoma are aged 65 years or older, and therefore are eligible for Medicare coverage.1 A thorough knowledge of Medicare coverage helps patients to plan ahead in estimating their out-of-pocket cost responsibilities associated with treatment.

Medicare is a federal health insurance program. Created in 1965, the program affords all seniors and certain people with long-term disabilities eligibility for benefits regardless of their income, medical history, or health status. Today, Medicare covers more than 60 million people. The program helps to pay for many medical care services, including hospitalizations, physician visits, and prescription drugs.2

When the Medicare program was created, there were 2 parts, called Part A and Part B. Currently, these 2 parts are called Original Medicare and can be obtained directly through the federal government by eligible people. Medicare Part A covers hospital care, skilled nursing facility care, and hospice care. Part B covers doctor visits, mental health care, laboratory tests, and outpatient medical procedures. Both parts are still available today.3,4

A significant change to the program took place in 1977, when the government established Medicare Part C as a way to allow private insurance companies to offer coverage to beneficiaries. Today, Part C, widely known as Medicare Advantage, replaces patients’ Original Medicare (Part A and Part B) coverage and may also include extra benefits.4

Part D is the most recent addition to the Medicare program. It helps beneficiaries pay for cost associated with prescription drugs. Like Part C, private insurance companies provide Part D coverage. Patients can purchase Part D as a stand-alone plan along with Original Medicare or packaged in with a Medicare Advantage plan. Many Medicare Advantage plans combine Parts A, B, and D in 1 plan.3,4

It is important to note that Original Medicare does not cover all healthcare costs. Beneficiaries are still responsible for monthly premiums, deductibles, copayments, and, in some cases, coinsurance. To help protect beneficiaries from some of these out-of-pocket costs, Medigap coverage was introduced. Private insurance companies sell Medigap plans, which are also called Medicare Supplement plans.5

With all of these choices, Medicare coverage can be structured in several different ways, and no option is one-size-fits-all. Many cancer centers and clinics have employees who are specially trained to help guide patients through the Medicare coverage options that best fit their needs and their budget. 

References

  1. Abbasi MR, Sparano JA. Mantle cell lymphoma. Medscape. https://emedicine.medscape.com/article/203085-overview. Updated March 15, 2019. Accessed April 11, 2019.
  2. Kaiser Family Foundation. An overview of Medicare. www.kff.org/medicare/issue-brief/an-overview-of-medicare. February 13, 2019. Accessed April 11, 2019.
  3. Blue Cross Blue Shield Blue Care Network of Michigan. How Medicare works. www.bcbsm.com/medicare/101/how-medicare-works.html. Accessed April 11, 2019.
  4. MedicareHealthPlans. Medicare 101: your ultimate guide to getting covered. www.medicarehealthplans.com/about-medicare. Accessed April 11, 2019.
  5. AARP. Health Care and You, Medicare 101. https://assets.aarp.org/www.aarp.org_/articles/health/handouts_of_slides_for_medicare_101.pdf. Accessed April 12, 2019.