Does Medicare cover testicular cancer care? Screening and more


All types of Medicare plans provide coverage for treatment and services relating to cancer care, including testicular. Out-of-pocket expenses usually apply.

Both original Medicare and Medicare Advantage plans have benefits that can help those with testicular cancer.

A person may still have to pay some out-of-pocket expenses, including deductibles, copayments, and coinsurance.

This article discusses the different types of testicular cancer, the most common treatments for the disease, and details of the benefits that Medicare provides.

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.

Medicare provides coverage for testicular cancer treatment, including surgery, chemotherapy, and radiation.

Medicare Part A, which is inpatient insurance, covers treatment that someone receives during a hospital stay, including:

  • cancer treatments in the hospital
  • skilled nursing facility care after a 3-day hospital stay
  • hospice care
  • blood tests
  • home health care such as physical therapy

When a person is not required to stay in the hospital, Medicare Part B, outpatient insurance, covers many cancer-related services and treatments a person receives, such as:

  • doctor visits
  • chemotherapy
  • radiation treatment
  • imaging such as X-rays and CT scans
  • mental health services
  • durable medical equipment (DME), such as a wheelchair or feeding pump
  • a second opinion for non-emergency surgery

The testicles are organs that produce sperm and the hormone testosterone. More than 90% of testicular cancers start in the cells that make sperm, according to the American Cancer Society (ACS). Another name for these cells is germ cells.

Testicular cancer usually occurs in young or middle-aged adults, with an average age at diagnosis of 33, says the ACS. However, testicular cancer can develop in people of any age.

Individuals who are older than 55 make up approximately 8% of cases.

Testicular cancer is usually curable, especially when someone has detected it early, according to the American Society of Clinical Oncology (ASCO).

Types of tumors

The two types of germ-cell tumors in testicular cancer include seminomas, which often occur in individuals in their 40s and 50s and are usually slower to grow and spread. Non-seminomas typically develop in people who are in their late teens to early 30s and often contain more than one type of cell.

Within each type of tumor are subtypes. The type of tumor and its stage will indicate how much the disease has spread. A doctor will base treatment on these factors.

Treatment usually includes surgery, and a doctor might also recommend radiation or chemotherapy after the surgery has taken place.

Testicular cancer has no standard screening test, according to Physician Data Query, a service of the National Cancer Institute.

People with testicular cancer often discover a lump on their testicle themselves. Sometimes a doctor finds the tumor during a routine physical examination.

Some doctors recommend a self-exam of the testicles every month between ages 15–55, the ASCO said.

According to the ACS, in almost all testicular cancer cases, treatment starts with surgery to remove the testicle with the tumor. Doctors examine the removed testicle to see whether the tumor is cancerous.

Doctors might also recommend surgery to take out lymph nodes in the abdomen, to see whether the disease has spread to other parts of the body.

Medicare covers surgery for testicular cancer under Part A if it is an inpatient operation. Part B covers the costs of outpatient surgery.

Radical inguinal orchiectomy

This procedure is a standard treatment for testicular cancer, according to the ACS. During an orchiectomy, a surgeon removes one or both testicles.

The surgeon pushes the testicle up from the scrotum and takes it out through a lower abdominal cut.

Inguinal refers to the location of the surgical incision, which is just above the pubic bone.

Doctors use an orchiectomy to both diagnose and treat testicular cancer, the ASCO said.

Retroperitoneal lymph node dissection (RPLND)

This procedure removes lymph nodes at the back of the abdomen to see whether they contain cancer.

The surgeon gets to the lymph nodes by making a large incision along the middle of the abdomen.

Laparoscopic surgery

In some cases, a surgeon can remove lymph nodes in the abdomen through laparoscopic surgery, which uses several small incisions and special surgical tools.

Recovery is often quicker than in RPLND, as there is no large incision.

Another name for this procedure is minimally-invasive RPLND.

Reconstructive surgery

Some people may decide they want surgery to implant an artificial testicle after an orchiectomy.

The weight and texture of a prosthetic testicle are similar to that of a real testicle, but some people may find the implant uncomfortable, the ACSO said.

Individuals might want to wait until their treatment has finished before deciding on reconstructive surgery.

Medicare Part B covers prosthetic devices to replace a body part when a healthcare provider orders it, according to Medicare.gov.

Out-of-pocket costs during testicular cancer treatment may include deductibles, copayments, and coinsurance.

Someone with Medicare Part A has a $1,408 deductible in 2020.

The copayment is $0 for the first 60 days of a hospital stay. For days 61–90 of a hospital stay, the copayment cost is $352 per day.

In 2020, the deductible for Part B is $198. After a person pays the deductible, the coinsurance is 20% of the Medicare-approved amount.

Out-of-pocket costs may differ for people with Medicare Advantage plans. The plans can provide information on their expenses.

Medicare supplement insurance, also known as Medigap, can pay for some of the out-of-pocket costs in testicular cancer treatment.

Private insurance companies administer Medigap policies, but the plans are available only to those with original Medicare parts A and B.

The Testicular Cancer Society provides online forums and one-on-one support to individuals with testicular cancer. The group also helps connect people with financial resources.

The ASCO provides a list of national organizations that can help with the financial impacts of cancer treatment.

The ACS runs the National Cancer Information Center, which is available 24 hours a day to answer questions about cancer and offer support.

Medicare will cover many of the costs associated with testicular cancer treatment. Out-of-pocket costs usually apply.

Because treatment may affect a person’s quality of life, including sexual health and fertility, people with testicular cancer should discuss with their doctors which treatment plan is best for them.

Help and support are available through the Testicular Cancer Society, the ACOS, and the ACS.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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