Medicare Coverage for Brain Cancer Treatment

A Cancer Diagnosis is Never Easy…

That feeling of anxiety and uncertainty following a diagnosis is ramped up, especially when your brain is involved. Yet, even in the midst of this upheaval, there is one thing you can be certain of: Medicare will be able to help cover your brain cancer treatments, though how much you pay will be dependent on your specific Medicare plan.

What is Brain Cancer?

Cancer occurs when our cells make a mistake while replicating, creating a cancerous cell. Ordinarily, our cells only replicate while we are maturing or to replace cells lost due to damage or natural processes. Due to an error in their genetic code, cancer cells never stop replicating. They form masses called tumors, which cannot contribute to normal bodily functions. Eventually, these cancerous cells invade vital organs and bodily systems, inhibiting their function and causing death.

Brain cancer occurs when a tumor forms in the brain. In most cases, this is because a tumor formed elsewhere in the body and those cancerous cells traveled to the brain. This process is called metastasis. As the cells cannot stop replicating, they result in the growth of tumors throughout the body. However, in less common cases, cancer can form in the brain, resulting in a primary brain tumor. 

Regardless of how it forms, a brain tumor can cause problems for the body. Even non-cancerous (benign) tumors can put pressure on the brain, resulting in changes to behavior and disruption of bodily functions. Symptoms of a brain tumor can include:

Brain tumors are usually diagnosed with a computerized tomography (CT) scan, though biopsies, laboratory tests, and neurological exams are performed beforehand.

Brain Cancer Treatment Options

Unfortunately, brain cancer is among the most challenging cancers to treat, in part due to the brain’s non-fungible nature. Something is “fungible” when it can be replaced with a similar item with no loss in value or function. Your liver, for example, could be replaced with another compatible liver. You could also remove part of your liver and maintain bodily function. 

One of the most common treatments for cancer is excision: surgically removing the tumor. Much of the other parts of cancer treatment, like chemotherapy and radiation therapy, are designed to shrink the tumor (making it easier to excise or debulk) or prevent cancer cells from metastasizing. 

However, the brain cannot be replaced. If a part of it is removed or destroyed, you lose that part forever. It does not regrow and cannot be replaced. Even damage to the brain through surgery can lead to loss of function, which is why many brain surgeries are performed using the most precise tools available. Complicating things is the fact that brain tumors can grow anywhere in the brain, often growing near or around key structures. As such, the process of treating brain cancer can be particularly challenging. 

Surgical Excision

If the tumor is located on the outer surface of the brain, or in another accessible area, it can simply be removed. This is the first line treatment for any brain tumor, as many of the debilitating symptoms of brain cancer result from intracranial pressure.

Surgical excision can, and typically is performed before a formal cancer diagnosis, as the tumor’s tissue can be examined in a lab to determine if it is benign (non-cancerous) or malignant. This process of taking a portion of possibly cancerous tissue from the patient for study is called a biopsy. 

Unfortunately, not all tumors are located in accessible areas. They may be located deep within the brain structure, or be woven between vital structures in a way that makes full excision impossible. These are called inoperable tumors, though that does not mean surgery will not be required. If possible, these tumors will be partially removed to relieve pressure in a process called debulking. 

Surgical treatment of brain tumors, including biopsies, debulking, and excision, are covered under Medicare Part A. Under Original Medicare, you pay 20 percent of the Medicare approved price for these services, though Medigap and Medicare Advantage may be able to reduce cost-sharing obligations.

Radiation Therapy

Following initial surgery, you may undergo radiation therapy to stop the growth of cancer cells.

Radiation therapy usually uses x-rays, though protons or gamma radiation are also used in some cases. During radiation therapy, a precisely controlled dose of radiation is delivered to a specific part of your body, selectively killing off cancer cells while leaving healthy cells untouched. This causes tumors to shrink, relieving symptoms and making them easier to remove. 

Radiation therapy is typically performed as an outpatient procedure, covered under Medicare Part B. However, you may be required to stay in the hospital for a few days, which would fall under Medicare Part A. Like with surgery, you pay 20 percent of the approved cost under Original Medicare, though Medigap and Medicare Advantage plans can reduce that obligation.

Chemotherapy

Chemotherapy is a type of drug treatment in which you are given powerful anti-cancer medications to kill cancerous cells. While it can be used as the sole treatment for brain tumors, it is often administered prior to surgery to shrink the tumor, then continued after surgery to prevent the cancer from metastasizing. Unlike radiation therapy, which is precisely targeted, chemotherapy affects the entire body. This makes it effective at treating cancer, but can lead to exhausting side effects. 

Chemotherapy is typically given in an outpatient setting, covered under Medicare Part B with a 20 percent copay. However, some chemotherapy drugs are taken orally, as pills. These can be taken at home, and are covered under Medicare Part D. In addition, any other medications prescribed to treat your cancer and its symptoms fall under Medicare Part D.

Brain Cancer Recovery

Following treatment for brain cancer, you may experience some lingering effects, particularly if the tumor was located near a sensitive part of the brain. Medicare covers a variety of rehabilitation services for people recovering from cancer, including occupational therapy, which may be required to restore speech, movement, or other functions. It may also cover durable medical equipment — like walkers, canes, and wheelchairs — with a 20 percent copay, though Medicare Advantage may be able to reduce the costs even further.

Palliative Care

Unfortunately, while survival rates for brain cancer are on the rise, there are cases where recovery simply is not feasible. This is particularly common with inoperable tumors, or tumors resulting from metastasis. In these cases, you may elect to choose palliative care instead. Original Medicare covers 100 percent of hospice-related expenses, including home care.

Due to the nature of brain cancer, you may continue to undergo debulking surgery, chemotherapy, or radiation therapy as part of your treatment. This is designed to reduce the burden of symptoms rather than attempting to cure the disease. As the side effects of some of these treatments can be quite harsh, it is up to you and your hospice team to determine if they are worth pursuing.

Complementary and Alternative Cancer Therapies

Complementary Cancer Therapies are undergone in addition to clinically proven cancer treatments, often with the goal of reducing symptoms. These can include…

Occasionally, people will seek out the above or similar treatments in place of clinically proven interventions. These are called alternative cancer therapies. 

Medicare will NOT cover alternative cancer therapies. While they can help you feel like you’re taking more control over your disease, they cannot and will not cure you, and may make your condition worse. Speak with your doctor before beginning any new treatment, diet, or supplement.

That said, although most complementary therapies are not covered under Original Medicare, they may be covered under certain Medicare Advantage plans. After approval from your doctor, you can check with your provider to see what services may be covered under your Medicare Advantage plan.

How Can Medicare Advantage Help?

Medicare Advantage covers everything Original Medicare does, though it may have a more limited network of providers. In addition, a brain cancer diagnosis qualifies you for a Special Needs Plan (SNP), a type of Medicare Advantage plan that covers medication and certain condition-specific services and benefits. The benefits vary from plan to plan, but an SNP can provide more comprehensive treatment than Original Medicare alone.

If you are looking for a Medicare Advantage plan, our licensed insurance agents can help. Call MedicareInsurance.com today at (800) 950-0608 to begin exploring your options.