Choosing a Medicare plan when you have cancer
The plan that is cheapest for a healthy 68-year-old is often the wrong one for someone starting chemotherapy, and the ordinary way of comparing plans — sort by premium, pick the low one — is how people end up out of network from their own oncologist. This walks you through Medicare’s official plan finder in a different order.
Why we don’t list plans here
Medicare plans differ by county, change every January, and can be amended mid-year. Any copy of that data we kept would be out of date for someone, and being wrong about an out-of-pocket maximum could cost you thousands. So we send you to Medicare Plan Compare, which is authoritative, always current, free, and does not sell your details to an agent. What we add is the order to do things in, and the questions it will not ask you.
Nine steps, in the order that matters
This usually takes more than one sitting, and several of the steps mean waiting on a phone call. Tick them off as you go — your place is saved on this device.
0 of 9 done
Before you open any plan finder, make two lists: every prescription with its exact name and dose, and every doctor, hospital, infusion center, and lab you use. Plan Compare will ask for the drug list, and the network question is the one you have to answer yourself.
Build both lists using the two worksheets in this section.
Watch out: Include drugs you are about to start, not just the ones you are on today. If your oncologist has mentioned a next-line treatment, add it.
Start your medication listMedicare Plan Compare is the only complete, current list of the plans available where you live. It is free, it takes no personal identifiers to browse, and it is run by Medicare rather than by an insurer or a broker.
Search by your ZIP code. You can browse without logging in.
Watch out: Sites that look like plan finders but ask for your phone number are usually selling leads to agents. Medicare.gov never needs your phone number to show you plans.
Open Medicare Plan ComparePlan Compare will show you a premium the moment you land, and it will be misleading until you have entered your prescriptions. Once your drug list is in, it recalculates and shows an estimated total yearly cost instead.
Add every medication, then add the pharmacy you actually use.
Watch out: The same plan can cost hundreds more at a non-preferred pharmacy. If you use a specialty pharmacy for an oral cancer drug, check whether it is in the plan's network.
Premium is the smallest number on the screen and the least informative. Total yearly cost adds the premium, the deductibles, and what your specific drugs will cost you across the year.
Change the sort from “Lowest monthly premium” to “Lowest yearly drug + premium cost”.
Watch out: Even total yearly cost leaves out your medical cost sharing — the infusions, scans, and hospital stays. That is what the comparison worksheet is for.
For a Medicare Advantage plan this is the ceiling on what you can be charged for medical care in a year, and in a cancer year most people get nowhere near it in an ordinary year but can hit it in a treatment year. It is the number that matters most and it is not on the summary card — you have to open the plan details.
Open “Plan details” and note the in-network out-of-pocket maximum.
Watch out: If you have Original Medicare instead, there is no out-of-pocket maximum at all. That is the main reason people pair it with a Medigap policy.
This is the step that Plan Compare cannot do for you, and the one that goes wrong most often. Online provider directories are frequently out of date. The answer that counts comes from the provider's billing office.
Call each provider, name the exact plan, and ask: “Are you contracted with this specific plan for next year?”
Watch out: A hospital can be in network while the oncologists practising inside it are not, and a doctor can be in network at one office location and not another.
Use the network checklistMost Medicare Advantage plans require approval before imaging, radiation, surgery, and infused drugs. That is not a reason to avoid them, but it changes how treatment feels, and the requirements differ a lot between plans.
Ask the plan directly which cancer services need prior approval, and how long it takes.
How approvals and appeals workTwo or three plans, in one table, with the cancer-specific rows. Seeing them together is what makes the trade-off obvious.
Fill in the comparison worksheet.
Open the comparison worksheetA SHIP counselor will go through your worksheet with you at no cost and with no stake in the outcome. They catch the things a checklist misses — a Medigap enrollment window you are about to lose, a state program you qualify for, a plan whose reputation for denials does not show up in any published number.
Book a free appointment.
Find your state's counselor
Talk it through with a Medicare counselor
Every state has a State Health Insurance Assistance Program — trained counselors who sit down with you one-on-one, go through your own medications and doctors, and help you work out what your options actually cost. It is free, it is confidential, and they earn nothing whichever plan you choose. If you only do one thing on this page, do this one.