Does Medicare cover leukemia care? Treatment, costs and options

There are benefits included in Medicare plans that can help with treatment costs relating to leukemia. Out-of-pocket expenses may apply, but there may be additional support available.

Medicare covers many of the costs of care relating to leukemia. As with other cancer, doctors customize treatment options for people based on their medical history and type of cancer.

In this article, we discuss the different treatments for leukemia, what Medicare covers, and other options that may be available.

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.

Original Medicare has two parts that each provide coverage for care received in different settings.

Medicare Part A

Medicare Part A is sometimes called hospital insurance and covers inpatient hospital stays, including cancer treatment a person receives while in the hospital.

Part A also pays for skilled nursing facilities, hospice, and home healthcare. Home healthcare can include:

  • physical therapy
  • speech and language therapy
  • occupational therapy
  • skilled nursing care

A person enrolled in an eligible clinical research study may also have some costs covered by Part A.

Medicare Part B

Medicare Part B is sometimes called medical insurance. This part of Medicare pays for medically necessary, cancer-related treatments and services a person may need outside the hospital.

This can include:

  • doctor visits
  • chemotherapy drugs administered intravenously in an outpatient clinic or doctor’s office
  • some oral chemotherapy
  • durable medical equipment (DME) like wheelchairs or walkers
  • mental health services
  • nutritional counseling
  • radiation treatment

In some instances, Medicare Part B will cover the cost of a second opinion for surgery. This happens if the surgery is not an emergency. They may cover a third opinion if the first and second opinions differ.

Medicare Part D

Medicare Part D, also known as a prescription drug plan (PDP), covers outpatient prescription drugs. Private insurance companies administer these plans.

Some chemotherapy drugs that are not covered by Part B, may be covered under a PDP, as well as prescribed pain relief and anti-emetics.

Surgical options

Surgery plays a limited role in treating leukemia since blood carries the disease throughout the body.

An individual may get a central venous catheter, which is a flexible tube that is inserted into a large vein, making it easier to administer chemotherapy. This is an inpatient surgical procedure that is covered by Part A.

A person may also have a biopsy of the lymph nodes or bone marrow that can help diagnose leukemia. The biopsy is an outpatient procedure and is covered by Part B.

The body has several

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Study in Nature Medicine Shows Superior Outcomes for Patients in The Leukemia & Lymphoma Society’s Paradigm-Shifting Beat AML Clinical Trial

RYE BROOK, N.Y., Oct. 26, 2020 /PRNewswire/ — Patients participating in The Leukemia & Lymphoma Society’s (LLS) groundbreaking precision medicine Beat AML Master Clinical Trial had superior outcomes compared to acute myeloid leukemia (AML) patients who opted for standard chemotherapy treatment, according to findings published today in the prestigious Nature Medicine journal.

Leukemia & Lymphoma Society logo (PRNewsfoto/The Leukemia & Lymphoma Society)

The Beat AML trial achieved its primary endpoint by showing genomic analysis of the leukemia cells to identify AML subtypes can be completed within an unprecedented seven days, giving patients, caregivers and their doctors ample time to make a more personalized treatment decision without risking the patient’s chance for survival.

In other key findings, the study demonstrated a paradigm shift in how patients diagnosed with AML should be treated, proving that using genetic information to match patients to targeted therapies leads to better survival rates than the traditional one-size-fits all treatment approach.

AML is an extremely fast-moving cancer of the marrow and blood, affecting 21,000 people in the U.S. a year, and killing 10,000. For decades patients have been given the same treatments almost immediately upon diagnosis because waiting allows the cancer cells to grow out of control. This standard of care involves either infusion of a combination of two chemotherapies, cytarabine and daunorubicin, or treatment with a so-called hypomethylating agent, a drug that unleashes signals allowing the cancer cells to die.

“The study shows that delaying treatment up to seven days is feasible and safe, and that patients who opted for the precision medicine approach experienced a lower early death rate and superior overall survival compared to patients who opted for standard of care,” said John C. Byrd, MD, D. Warren Brown Chair of Leukemia Research of The Ohio State University, and one of the Beat AML leads and corresponding author of the study. “This patient-centric study shows that we can move away from chemotherapy treatment for patients who won’t respond or can’t withstand the harsh effects of the same chemotherapies we’ve been using for 40 years and match them with a treatment better suited for their individual case.”

Going on the Offensive Against AML

Recognizing the urgent need to do better for AML patients, LLS launched this clinical trial in fall 2016 to test multiple novel targeted therapies at major cancer centers across the U.S., in newly diagnosed AML patients aged 60 and older. In a historic first for cancer clinical trials, LLS is the first non-profit health organization to sponsor a trial and hold the IND (Investigational New Drug) application from the U.S. Food and Drug Administration. Beat AML partnered with Foundation Medicine Inc. to employ next generation genomic sequencing to rapidly analyze the patients’ cancer cells, and identify the patients’ AML subtype so they can be given a targeted therapy within a safe timeframe.

“The breadth of this collaboration, with every clinician, cancer center, pharmaceutical partner and all of the many operations and technical support companies, all unified in working toward the common goal of building a new model for tackling

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