Cost of BC

Jean T. Szabo
Jean T. Szabo Member Posts: 193
edited March 2014 in Breast Cancer #1
How do we know what costs will be covered by Medicare/Medicare Plus Insurance programs for the radiation treatments. Does anyone know the procedure for getting financial assistance or finding out if you are eligible for Medicaid?

Comments

  • Christmas Girl
    Christmas Girl Member Posts: 3,682 Member
    #2
    Although I'm not an expert...
    In general, Medicare/Medicare Plus will cover the vast majority of medical expenses. For sure, one cannot collect Medicaid in addition to Medicare. It's one or the other.

    If you cannot cover whatever your out-of-pocket costs, deductibles, etc. may/will be - many hospitals/cancer centers/etc. have a "social worker-type" specialist who might be able to work out small monthly payment plans for your $ balance. Perhaps even some sort of financial assistance. So, maybe the best place to start is to ask at the facility where you'll receive treatment.

    General rule of thumb - doctors/hospitals don't arrange for expensive medical procedures/treatments/surgeries without first knowing their patient's insurance will cover at the very least the lion's share.

    With best wishes, and...

    Kind regards, Susan
  • Brooklynchele
    Brooklynchele Member Posts: 123
    #3
    Medicare vs. Medicaid
    MEDICARE
    Medicare is a federal health insurance program. Medical bills are paid from trust funds,
    into which those who are covered by Medicare have previously paid through payroll
    deductions. Generally speaking, Medicare is the same everywhere in the United States and is run by the CMS, an agency of the federal government. Medicare is governed by a federal
    statute that identifies with specificity who is and who is not eligible for the health insurance program.

    Medicare, according to CMS, is a health insurance program for: people age 65 or older,
    people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

    MEDICAID
    Medicaid is a federal–state program and is governed by state and local governments
    within federal guidelines. These state and local statutes vary from state to state, and,
    consequently, who does and who does not qualify for Medicaid varies between states. Even in each individual state, people can move in and out of eligibility depending on their financial status from month to month.

    Whereas Medicare is a federal health insurance program, Medicaid is an assistance program through which medical bills are paid from federal, state, and local tax funds. Medicaid
    serves low-income people of every age. Patients usually pay no part of costs for covered
    medical expenses, although, a small copayment is sometimes required. Within guidelines
    established by federal statutes, regulations, and policies, each state: establishes its own eligibility standards; determines the type, amount, duration, and scope of services;
    sets the rate of payment for services; and administers its own program.

    The list for Medicaid eligibility is huge and varies state-by-state. There are two eligibility groups related to specific medical conditions that some states include under their Medicaid plans. One special category of eligibility is a one time limited eligibility group for women who have breast or cervical cancer; the other is for people with tuberculosis (TB) who are uninsured. Women with breast or cervical cancer receive all plan services; TB patients receive only services related to the treatment of TB.

    You will need to check with you state's Medicaid office for eligibility and filing. Most states provide this online. You should be able to obtain a copy of the payment schedule's for both Medicare and Medicaid from your plan office.

    I hope this is helpful to you (and anyone else interested in this information).

    Michele

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