Learn About Medigap Cancer Coverage Options

Understanding How Different Medigap Plans Address Cancer Care Costs

Original Medicare covers many aspects of cancer treatment, but it leaves patients responsible for certain out-of-pocket expenses. Medigap policies, also known as supplemental insurance plans, are designed to help bridge these gaps. However, not all Medigap plans provide the same level of coverage, and understanding these differences is important when considering your options for managing cancer-related medical expenses.

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Medigap comes in ten standardized plans labeled A through N. Each plan offers a different combination of coverage options. Some plans focus on covering coinsurance amounts—the percentage of costs you pay after Medicare pays its share. Other plans emphasize copayment coverage, which addresses fixed dollar amounts you owe for specific services. A few plans even help with the annual deductible that Original Medicare requires you to pay before coverage begins.

Plan G, for example, covers a substantial range of costs including coinsurance for hospital stays, physician visits, and other services. Plan N also provides broad coverage but requires you to pay copayments for certain doctor visits and emergency room care. Plan F historically offered the most comprehensive coverage available, though it is no longer open to people newly enrolled in Medicare after January 1, 2020.

For cancer patients specifically, the differences matter significantly. Chemotherapy often involves frequent office visits, imaging scans, and laboratory work. A plan that covers coinsurance percentages will reduce what you owe for these recurring services. Hospital stays during cancer treatment can trigger substantial coinsurance costs—plans with strong hospital coverage help manage these expenses. Radiation therapy and surgical procedures also generate coinsurance obligations that certain Medigap plans address.

Plan A and Plan B offer more limited coverage, focusing on hospital coinsurance and some preventive care costs. These plans may work for people with minimal healthcare needs but typically leave cancer patients with higher out-of-pocket costs. Plans C, D, G, and N tend to address a wider range of cancer-related expenses, though each has different specific inclusions.

Practical Takeaway: Review what each Medigap plan covers by requesting detailed plan comparison materials from insurance carriers. Focus on which plans cover hospital coinsurance, physician coinsurance, and whether they address the Medicare deductible—all relevant to cancer care expenses.

Specific Out-of-Pocket Costs That Medigap Plans May Help Cover

When you receive cancer treatment under Original Medicare, several categories of costs appear as your financial responsibility. Understanding what these costs represent helps you evaluate which Medigap plan might reduce your burden.

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Hospital Coinsurance is a major expense for cancer patients requiring inpatient care. Under Original Medicare in 2024, you pay coinsurance of $389 per day for days 61-90 of a hospital stay, and $778 per day for days 91-150. For extended hospitalizations during chemotherapy or surgery recovery, these amounts accumulate quickly. Most Medigap plans rated A through N cover this hospital coinsurance entirely, meaning once you meet any plan deductible, the Medigap policy pays these daily amounts on your behalf.

Physician Office Visit Coinsurance applies after you've met your annual Medicare deductible ($240 in 2024). Medicare typically pays 80% of approved charges for office visits, and you pay the remaining 20%. For a cancer patient seeing an oncologist monthly at $200 per visit, that 20% coinsurance amounts to $40 per visit. Over a year of treatment, monthly visits total $480 in your coinsurance responsibility. Plans C, D, G, and N all cover this physician coinsurance, whereas Plan A does not.

Diagnostic Testing and Imaging generate substantial coinsurance when you need CT scans, PET scans, MRIs, or laboratory work. A single PET scan might have a Medicare-approved charge of $2,000 to $3,000. Your 20% coinsurance responsibility could be $400 to $600 per scan. Many cancer treatment protocols involve scans every few months to monitor response to treatment. Medigap plans covering physician services coinsurance also cover these diagnostic services since they fall under the same 20% coinsurance structure.

Chemotherapy Administration Costs are covered by Medicare, but you owe coinsurance on the facility fees and some drug administration services. An infusion center visit for chemotherapy administration might generate $1,500 to $5,000 in Medicare-approved charges depending on the drugs and duration. Your 20% coinsurance obligation would be $300 to $1,000 per session. Cancer patients undergoing active chemotherapy may have weekly or biweekly infusions, making this a recurring and substantial expense.

Radiation Therapy Sessions also involve coinsurance. A course of radiation therapy typically includes 15 to 40 treatment sessions. Each session's facility and physician charges generate coinsurance obligations. A full course of radiation might result in $2,000 to $5,000 in total coinsurance across all sessions.

Surgical Procedure Coinsurance for cancer surgery includes facility fees, surgeon fees, and anesthesia—all subject to the 20% coinsurance after your deductible. Cancer surgery can range from minor biopsies to major resections. Surgeon fees alone might be $3,000 to $10,000 or more, generating substantial coinsurance.

Blood Products and Injectable Drugs covered under Medicare Part B (administered in outpatient settings) are also subject to 20% coinsurance. Supportive care medications given during cancer treatment, such as certain antiemetics or blood cell growth factors, may carry significant approved charges.

Skilled Nursing Facility Care is sometimes needed after cancer surgery or during recovery from intensive treatment. Original Medicare covers the first 20 days fully but charges $194.50 per day for days 21-100 in 2024. Medigap plans vary in how much of this coinsurance they cover, with Plan G and some other plans providing full coverage.

Practical Takeaway: Calculate your expected coinsurance by considering your treatment plan. If your oncology team anticipates monthly office visits, quarterly imaging, and potential chemotherapy infusions, estimate the total 20% coinsurance you might owe. Use this figure to evaluate whether the cost of a Medigap plan premium is offset by the coinsurance coverage it provides.

How Medigap Works Alongside Original Medicare During Cancer Treatment

Medigap plans function as a secondary insurance layer. They do not replace Original Medicare; rather, they work in coordination with it. Understanding this relationship helps you grasp how your cancer care costs are managed when you have both coverages.

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The Coordination Process works as follows: When you receive cancer treatment, you present your Medicare card. Medicare evaluates the charge, applies its approved amount, pays its share (typically 80% after deductible), and sends you an Explanation of Benefits (EOB) detailing what you owe. Your Medigap plan then receives this same claim information and, according to the plan's coverage rules, pays the portion designated by your specific plan design.

For a concrete example, imagine you have a chemotherapy infusion with a $3,000 Medicare-approved charge. You've already met your annual deductible. Medicare pays $2,400 (80%). You would normally owe $600 (20% coinsurance). If you have Plan G or Plan N, your Medigap plan receives notice of this $600 balance and pays it on your behalf. You owe nothing additional. Without Medigap, you would pay the $600 directly.

Cancer Screening Coverage receives special treatment under both Medicare and most Medigap plans. Original Medicare covers preventive cancer screenings without requiring you to meet the deductible or pay coinsurance. These include mammograms for breast cancer, colonoscopies for colorectal cancer, and Pap tests for cervical cancer. Because Medicare already covers these screenings at no cost to you, Medigap plans don't add value here. However, if a screening leads to diagnostic testing (such as a biopsy following an abnormal mammogram), that diagnostic work does trigger the deductible and coinsurance structure, where Medigap becomes beneficial.