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Does Medicare cover bladder cancer care? Screening and more

Medicare covers a wide range of services for the treatment and diagnosis of bladder cancer when received on either an inpatient and outpatient basis.

When a person receives a cancer diagnosis, it can be a challenging time. Aside from medical and emotional care, financial support can be vitally important.

Medicare has a comprehensive range of cancer-related benefits available, with additional support options to help with out-of-pocket expenses.

In this article, we discuss bladder cancer, how Medicare covers treatments and services, and resources that may provide more help.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Medicare covers medically necessary treatment options for bladder cancer, including:

  • surgery
  • chemotherapy
  • radiation
  • targeted therapy
  • intravesical therapy
  • immunotherapy

Sometimes, a doctor may plan treatment more often than Medicare will approve, or they may order services that Medicare does not cover.

In these cases, a person may have to pay some or all of the costs out of pocket.

For someone with an average risk of developing bladder cancer, there are currently no preventive screenings that would increase an individual’s chance of survival.

Some healthcare providers screen people who have a high risk of bladder cancer. These include people who:

  • have had bladder cancer before
  • have an irregularity in the bladder that has been present since birth
  • are exposed to certain chemicals at work

Screening can include examining a person’s urine under a microscope to look for blood and cancer cells.

Some tests also look for tumor markers. These tests look for substances in the urine that indicate there may be cancer cells present.

Medicare Part A covers medically necessary cancer treatments that take place while a person is admitted to the hospital. This includes surgical procedures, chemotherapy, and radiation treatments.

Part A also covers necessary skilled nursing facility care, hospice, and home health care. If a person is enrolled in an eligible clinical study, Part A covers some inpatient costs.

Medicare Part B covers tests and treatments when a person is not required to stay in the hospital. The treatments must be medically necessary and they must be standard medical treatments.

These can include:

  • doctor visits
  • durable medical equipment (DME)
  • many intravenous chemotherapy drugs
  • radiation
  • outpatient surgery
  • nutritional counseling
  • mental health services
  • feeding pumps

Surgical options

Several different types of surgeries may help treat bladder cancer, and which type a doctor chooses depends on the type and spread of cancer.

Transurethral resection of bladder tumor (TURBT)

This surgery may be used for diagnostic testing. It can also