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Prostate Cancer Treatments Covered By Medicare

Medicare Expands Treatment Options For Patients With Advanced Prostate Cancer

Medicare Coverage for HIFU – Medicare Elite Access Program


Medicare patients with metastatic prostate cancer can get a first-of-its kind treatment just approved by the Food and Drug Administration, under a final coverage decision issued today by the Centers for Medicare & Medicaid Services .

Autologous cellular immunotherapy, known clinically as sipuleucel-T, is marketed in the United States as Provenge, for treating some forms of prostate cancer in seriously ill patients. Todays decision is effective immediately.

Provenge activates a patients own immune system to defend him against prostate cancer. The treatment consists of a multi-day regimen in which the patients white blood cells are collected and exposed to proteins that direct the white blood cells to fight prostate cancer cells. After the patients cells are treated, the patient receives his own cells back into his body in order to stimulate his immune system to fight the prostate cancer. This regimen is repeated over several weeks for a total of three treatments.

We are optimistic that innovative strategies may improve the experience of care for our beneficiaries who have cancer, said CMS Administrator Donald M. Berwick, M.D. CMS is dedicated to assuring that these patients can seek the treatments they need in accordance with their wishes.

Contact Your Pasadena Oncology Center Today

Any cancer diagnosis is scary, but at Pasadena CyberKnife Center, we are here to support you through your entire treatment process. Were proud to provide world-class cancer treatments to patients throughout the Pasadena and greater LA area. With our state-of-the-art radiation therapy cancer treatments, we are able to treat patients with a wide variety of conditions.

If you or a loved one have recently been diagnosed with cancer, there is hope. To learn more about CyberKnife, call us today at 768-1021 to schedule a consultation. Our contact page also provides information on our location and hours. Let the cancer experts at Pasadena CyberKnife Center help you beat cancer to reclaim a healthy, happy life.

Does Medicare Cover Breast Cancer

Medicare pays 100% of the cost of an annual breast cancer screening. Part A pays for inpatient breast cancer surgery or breast implant surgery after a mastectomy. Breast surgeries done at a doctors office or outpatient center are covered by Part B.

Part B also covers breast prostheses after a mastectomy.

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Does Medicare Cover Wigs

Although Medicare has traditionally provided a number of medical treatment benefits related to cancer, it has consistently fallen short is with regard to the hair loss many cancer treatment patients experience. More specifically, it has never helped with the cost of purchasing a wig. However, some U.S. legislators are hoping to change that. On June 15, 2017, Rep. James P. McGovern introduced a bill that would amend title XVIII of the Social Security Act to include wigswhat the bill refers to as medically necessary cranial prosthesesas durable medical equipment under the Medicare program. If this bill passes, cancer patients with Medicare could get some or all of their wig-related expenses covered or reimbursed.

Does Medicare Cover Cancer Screenings

Medicare Coverage of HIFU treatment?

Medicare covers 100% of specific cancer screenings as a preventive health service as long as your doctor accepts Medicare assignment.


  • A mammogram every year for women over 40
  • Pap smears and pelvic exams to screen for cervical and vaginal cancer, once every 24 months, or once every 12 months for women who are at increased risk
  • Colorectal cancer screening, including a colonoscopy every ten years for anyone over 50, and additional screenings for people at increased risk
  • Annual lung cancer screenings for smokers or former smokers aged 55-77 whose doctors order a screening
  • Prostate cancer screening once a year for men over 50

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What To Expect With Radiation Treatments

If you and your doctor have decided that radiation therapy is right for your type of cancer, youll begin with a radiation simulation. During the simulation, youll lie on a table and a CT scan or X-ray will be done to see where your cancer is and where the energy beams should focus.

After the images are taken, your treatment team will mark the area where radiation is needed. This will help the team direct the radiation precisely to the right place.

During radiation therapy, youll likely have treatments 5 days per week for up to 10 weeks. How much radiation you receive and for how long will depend on the extent and type of your cancer.

Depending on the kind of treatment you get, you may experience

Fees For Services In Hospital

If youre treated as a public patient, Medicare pays for your treatment, medicines and care while you are in hospital, and for follow-up care from your treating doctor in an outpatient clinic.

For private patients in a public or private hospital, Medicare pays 75% of the Schedule fee for services provided by your doctor. If your doctor charges more than the Schedule fee, your health fund may pay the gap fee or you may have to pay it as an out-of-pocket cost. You will also be charged for hospital accommodation, operating theatre fees and medicines. Private health insurance may cover some or all of these costs, depending on your policy. You may have to pay an agreed amount of the hospital fee , depending on the type of hospital cover you have. Fees charged by private hospital emergency departments are not covered by Medicare or private hospital cover.

Before being admitted to hospital as a private patient, ask:

  • your doctor for a written estimate of their fees , who else will care for you , and how you can find out what their fees will be
  • your private health fund what costs they will cover and what youll have to pay some funds only pay benefits for services at certain hospitals
  • the hospital if there are any extra treatment and medicine costs.

Health funds make arrangements with individual doctors about gap payments. Choosing to use the doctors and hospitals that take part in your health insurers medical gap scheme can help reduce out-of-pocket costs.

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Beware Of Excess Charges

I am in original Medicare plus Medigap plan N.

You may not know it, but the Mayo Clinic does not participate in MOST Medicare Advantage plans.

M D Anderson is another cancer treatment facility that does not accept MOST Medicare Advantage plans.

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was provider access problems. Number 4 on the list was cost sharing too high.

You may never receive a cancer diagnosis. I hope you dont. But one thing I can tell you with certainty is this. Original Medicare and a supplement plan provides assurance the funds will be there to pay for almost all of your care.

We have rates on over 240 different Medigap plans in Georgia. We will quote you a rate over the phone and tell you who has the lowest rate.

More than that, there is no charge for our advice. No pressure. No up-selling.

You can also shop and compare online Medigap quotes instantly.

One other thing.

You dont need a separate cancer insurance plan or a hospital plan. You can sleep well at night knowing the cost of your cancer treatment is covered in full.

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Medicare Advantage And Cancer

Prostate Health and a cancer screening test Medicare

If you have Medicare Advantage , this means that youve purchased your Medicare plan from a private insurance company as opposed to getting it directly from the federal government. These types of plans are required to give you the same basic coverages as Original Medicare, but the CMS warns that they can have different rules and costs. Therefore, its important to go through your individual plan so you understand what it says regarding cancer coverage specifically. And if any portion of that policy is unclear, follow up with your policys administrator so you know what is covered and what isnt.

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Does Medicare Cover Lung Cancer Treatments

Medicare pays the full cost of annual lung cancer screenings to your doctor if you between the ages of 50-77 and have a history of smoking.

If you have lung cancer, Medicare will cover:

  • surgery

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How To Increase Your Chances For Coverage If You Think The Testing Or Treatment May Be Denied

Take time to fully understand your health insurance plan before you begin treatment. This will help you to avoid surprises once youve started treatment. Here are some steps to take:

  • Obtain an updated, complete copy of your health plan .
  • Ask questions. Talk with your employers health benefits department. Call your health plans customer service line. Ask about any policies not included in the benefit book, such as appeal processes and how denials are formulated. Explore what legal health insurance requirements your state mandates.
  • Get a letter of referral from your physician that clearly indicates that he or she strongly recommends a particular treatment.
  • If coverage is an issue with your HMO, consider switching to a PPO plan with the same provider. The best time to make the change is during open enrollment or at policy renewal time.
  • Shop around for other insurance companies and switch to a provider that is known for approving the treatment being recommended. However, be careful not to cancel your original coverage until the new coverage takes effect.
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    Medicare And Cancer Treatment Coverage

    In 2009, just over 50 percent of all cancers occurred in individuals 65 years old or older, according to research published in the American Journal of Preventive Medicine. By the year 2030, though, that number is expected to grow to 70 percent. What is the cause of this level of increase?

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    How Prostate Cancer Is Diagnosed

    Medicare and Prostate Cancer Screening

    Depending on your risk factors, your doctor may recommend a routine blood test to screen for the disease. Doctors can also test for prostate cancer with a digital rectal exam, or DRE, during which a doctor uses his or her finger to feel the size and texture of the gland itself.

    If you have specific prostate cancer symptoms, however, your doctor may recommend diagnostic tests to determine whether prostate cancer is present. These tests include:

    • performing a trans rectal ultrasound to take a picture of the prostate gland
    • taking a tissue sample, or biopsy, for microscopic examination

    Both of these tests are performed in an outpatient setting and are frequently done at the same time if the ultrasound is suggestive of cancer.

    If cancer is present, your doctor will order additional tests to determine if the cancer has spread to other parts of the body. Your doctor needs this information to develop a treatment plan.

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    Medicare Coverage For Cancer Treatment

    The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

    Original Medicare covers about 80% of your cost of care. Most Medigap plans will pick up the remainder. You can pick your own doctor, hospital and treatment center and a referral is never required.

    Not all cancers require or even respond to chemotherapy, but there are some things you should know about the cost of chemo.

    If Your Coverage Is Denied Follow These Steps To Appeal Your Case:

  • Ask your health plan which guidelines they used to formulate the denial.
  • Submit documentation clearly stating the reason for the requested service. Health plans make their coverage decisions based on the documentation you provide, so its in your best interest to provide complete information up front. Print out any information that supports your position. Keep copies of all medical documentation. In many cases, your physician can provide the medical documentation you need. Your physician can also discuss the denial with your health plans physician reviewer.
  • You can also ask your doctor to appeal to the insurance company directly. Sometimes the insurance company needs very specific medical details to approve a test or treatment.
  • Follow up with your health plan if it hasnt responded in a timely manner.
  • If your appeal is not overturned on the first try, request a second appeal. Most plans also provide a third level of appeal. If all levels of appeal are overturned, consider filing with an independent review board or the insurance commissioner. At this point, you may require a lawyer. Be persistent, factual, and adhere to all requests and requirements of the health plan.
  • While this process may seem like a lot of work, it is absolutely worth it if it means you can choose the care option that is best for you. Work with your doctor to find and fund the best treatment you possibly can.

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    What Is The Cyberknife Vsi Treatment Process

    Pasadena Cyberknife® robotic treatments involve a team approach in which several specialists from our oncology center participate.Prior to the procedure, the patient is imaged using a high-resolution CT scanner, to determine the size, shape, and location of the tumor. Following the CT scan, the image data is digitally transferred to the Pasadena CyberKnife VSI Systems workstation, where the treatment planning begins.

    Your Board Certified physician then uses the CyberKnife VSI software to generate your specific treatment plan. The plan is used to match the desired radiation dose to the identified tumor location while limiting radiation exposure to the surrounding healthy tissue. Once the treatment plan has been developed, you are ready to undergo treatment.

    The process of prostate cancer radiation treatment with CyberKnife begins by placing the fiducial markers. These tiny golden seeds help the CyberKnife system locate your tumor and track its movements.

    Next, your treatment team creates your treatment cradle. The cradle is made from soft material that conforms to your shape. Youll lie in the treatment cradle during each session. It will help you maintain your physical position from one treatment to the next and ensure your comfort during treatments.

    Each treatment session will last between 20 and 45 minutes, once per day for five days or less. Patients may experience some minimal side effects, but those often go away within the first week or two after treatment.

    Cancer Drug Coverage Under Medicare Part D

    Prostate Cancer Treatment Options – Clinical Outcome and Medicare Cost Comparison

    Medicare Part D covers prescription medications and can either be purchased on its own to add more coverages to Original Medicare, or sometimes it is a benefit that is lumped in with an all-in-one type of Medicare Advantage Plan. If you have it as part of Original Medicare, the ACS says that it is still more likely that your medications will be covered under Part B instead. This is because the main cancer-related drugschemotherapy and anti-nausea medicationsare administered via IV, which classifies them as an outpatient service. On the other hand, if you take your cancer drugs orally, these are typically covered under Part D, the actual Medicare prescription plan. Additionally, if youre new to the Medicare prescription drug plan and it does not cover the medication youre currently taking as a result of having cancer, the CMS says that the plan must let you get a 30-day temporary supply of the prescription . This gives you time to work with your healthcare provider to find a drug that is just as effective and also covered under your new plan.

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    Does Medicare Cover Cancer Medications

    Part B covers some cancer medications, but others are not included unless you have a Part D prescription drug plan. Cancer drugs can be costly. This means that Medicare prescription drug coverage is an essential part of your cancer protection strategy. Part B covers 80% of the cost of intravenous cancer treatment and anti-nausea drugs. It also includes oral versions of these drugs if your doctor could have given you an intravenous dose but decided to provide you with a pill instead, and the medicine is taken within 48 hours of your cancer treatment.

    Part D covers cancer drugs that are not covered by Part B, including anti-nausea medications that are only available in pill form, injections that you give yourself, and medicines designed to prevent cancer from recurring.

    Your Part D prescription coverage offsets the high cost of cancer drugs. Your copays or coinsurance may be far less than what you would pay if you didnt have drug coverage at all.

    How Do The Parts Of Medicare Cover Cancer Treatment

    The amount that Medicare will cover for cancer treatments can vary based on the type of cancer you have and the type of treatment plan prescribed by your doctor.

    The type of policy you have can also play a role in your Medicare cancer coverage and how much you’ll have to pay out-of-pocket.

    There are four parts of Medicare, referred to as Part A, Part B, Part C and Part D.

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