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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

M Health Fairview Applauds PreferredOne as First in Minnesota to Cover Innovative Prescription Digital Therapeutics to Treat Addiction

Largest Minnesota health system urging others to cover the FDA-authorized treatments

PreferredOne, Fairview’s health benefits management company, is the first health insurance provider in Minnesota to cover two innovative prescription digital therapeutics (PDTs) to treat addiction: reSET® and reSET-O®, which are manufactured by Pear Therapeutics, Inc. The software-based treatments are authorized by the U.S. Food and Drug Administration (FDA) and are indicated to treat substance use disorder and opioid use disorder, respectively.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20200930005985/en/

PreferredOne, Fairview’s health benefits management company, is the first health insurance provider in Minnesota to cover two FDA-approved prescription digital therapeutics to treat addiction. (Provided by Pear Therapeutics)

reSET and reSET-O are the first two PDTs to receive market authorization to treat disease from FDA. PDTs are apps that are downloaded to a patient’s mobile device after being prescribed. Both products, which are adjunctive to outpatient counselling, provide patients with algorithm-driven cognitive behavioral therapy, fluency training, and contingency management, while clinicians receive access to clinical dashboards to inform in-office and tele visits. reSET is used as a monotherapy and reSET-O is used in combination with transmucosal buprenorphine.

“M Health Fairview is committed to ensuring our patients have coverage for these innovative mental health resources, and we’re excited that PreferredOne is leading the way in Minnesota by offering these products,” said Beth Heinz, executive of mental health and addiction services for M Health Fairview. “The only way to ensure broad access is for other payors to join us in reimbursing these products. Patients in all systems will benefit when more providers join this effort and enable physicians to prescribe these solutions.”

The COVID-19 pandemic arrived amid an ongoing addiction crisis, and it exacerbated health issues for many Minnesotans. Only 1 in 10 people with a substance use disorder receive treatment in the U.S., according to the Minnesota Department of Health.

“We applaud PreferredOne and M Health Fairview’s commitment to addiction and mental health coverage,” said Corey McCann, M.D., Ph.D., President and CEO of Pear Therapeutics. “Now, more than ever, people struggling with substance use disorders need access to recovery support and treatment due to the impact of the pandemic. Together we can address this unmet need, and we hope that other health plans in Minnesota will join in taking this step to ensure access to innovative evidence-based therapeutics for all Minnesotans.”

About M Health Fairview

M Health Fairview is the newly expanded collaboration between the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine – expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.

About PreferredOne

PreferredOne, a wholly-owned subsidiary of Fairview Health Services, leads the market with products and services that conserve employer health plan dollars while helping more than 364,000 members achieve their best health. Comprehensive local and national provider networks together with an emphasis on health care cost and quality maximize the value of employee health

Does Medicare cover prostate cancer care? Screening, tests and more

Medicare provides its beneficiaries with many different options for helping with the costs of prostate cancer care.

If someone is scheduled for a prostate cancer screening or has recently received a prostate cancer diagnosis, they may be thinking about which treatments, supplies, services, and prescription drugs Medicare may cover.

In this article, we will look at the Medicare coverage available for both the prevention and treatment of prostate cancer. We will also look at general costs, out-of-pocket expenses, and more.

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.

The prostate is a small, spongy gland approximately the size of a ping-pong ball. It is located deep inside a person’s groin, sitting between the penis and the rectum.

The prostate is important for reproduction because it provides the seminal fluid, which mixes with sperm. Seminal fluid assists the sperm with transport and survival.

If something goes wrong with prostate cells, cancer may develop. Prostate cancer starts when a normal prostate cell shows irregular growth. One of the principal treatments is hormone therapy, which involves lowering a person’s hormone levels with drugs.

Different parts of Medicare cover different treatments and services, depending on their setting.

Medicare Part A

Part A, which is inpatient hospital insurance, covers:

  • inpatient hospital admissions, including cancer treatments a person receives during their stay
  • skilled nursing facility care following a 3-day hospital stay
  • home healthcare, such as rehabilitation services for speech-language, physical therapy, or skilled nursing care
  • hospice care
  • blood work
  • eligible clinical trials

It may be important to note that there are times when hospital stays can be considered outpatient. This may affect Medicare benefits, so if a person is unsure, they may ask the medical staff to clarify.

Medicare Part B

Part B covers outpatient care, including:

  • some preventive services for those who are considered at-risk for cancer
  • doctor visits
  • many intravenous chemotherapy drugs when administered in a doctor’s office
  • radiation treatments performed in a clinic
  • diagnostic tests such as x-rays and CT scans
  • durable medical equipment (DME) such as wheelchairs and walkers
  • outpatient surgical procedures
  • mental health services that are received in a clinic, doctor’s office, therapist’s office, or hospital outpatient department
  • certain preventive and screening services
  • some clinical trials

In some cases, Medicare will also cover the cost of a second opinion for non-emergency surgery, and a third opinion if the first and second opinions differ.

Screenings

Medicare covers prostate cancer screenings for the early detection of prostate cancer. Procedures covered include a digital rectal exam