Published on August 28, 2019
During this ClinicalTrial MythBusters highlight, Mark Fleury, from the American Cancer Society Cancer Action Network (ACSCAN), discusses the difference between Medicare and Medicaid coverage for cancer patients who are participating in a clinical trial. Watch now fora closer look at the insurance policies and their impact on patients. Watch to hear his expert insight on coverage of cancer costs.
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Transcript | Cancer Coverage: How Are Medicare and Medicaid Different?
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Can you touch briefly on what actually is different between the two programs in terms of clinical trial, the actual coverage? You mentioned routine care; is that for both programs?
Well, so what’s important to note is that Medicare is a federally administered program. And so, there is one universal federal policy, and if you’re in Medicare, it doesn’t matter if you’re in Florida or if you’re in Idaho, the policies are identical. Medicaid is an insurance program that while partially funded by federal dollars, it’s administered by each state. And as such, each state has quite different policies. So, if you’ve see one Medicare policy, it’s uniform. If you’ve seen one Medicaid policy, it’s only relevant in the state in which you happen to be. So, it could vary significantly from state to state.
Right. And so, depending on your state, you would need to follow up with your local maybe human services office to get specific questions answered.
That’s correct. Yeah. There are some resources where generally speaking some states have passed laws or signed agreements in which their Medicaid programs have to cover those routine care costs in Medicaid. And we can certainly make available those states. But even within those states, it’s important to look closely at the policies. For example, in Medicare, Medicare also covers any adverse events. So say, for example, while you’re being treated, you had to be admitted to an ICU for heaven forbid a heart attack or something like that. Medicare pays for all of those unexpected expenses. And that coverage may vary state by state in Medicaid.