MD Anderson accepts Medicare, but you need to understand how it works there

Yes, MD Anderson Cancer Center accepts Medicare. However, Medicare coverage at MD Anderson works differently than it does at many other hospitals. MD Anderson is part of the University of Texas system and operates as both a teaching hospital and a research center. This means some services may be covered under Medicare Part A (hospital care) and Part B (doctor visits and outpatient services), but you will need to verify coverage for your specific treatment plan before you arrive.

The most important thing to know: MD Anderson requires you to have active Medicare coverage before scheduling treatment. If you are newly diagnosed and not yet on Medicare, you should contact MD Anderson's financial counseling office to discuss your options. They can tell you whether you should delay treatment to enroll or whether other payment routes exist for your situation.

Key Takeaways

  • MD Anderson accepts Medicare Part A and Part B, but you must be actively enrolled before treatment begins.
  • Your out-of-pocket costs depend on whether you have a Medigap policy, Medicare Advantage plan, or Original Medicare alone.
  • MD Anderson's financial counseling office can estimate your costs before treatment and discuss payment plans if you owe money upfront.
  • If you are traveling to MD Anderson from out of state, ask about lodging information programs — some are covered or subsidized for Medicare patients.
  • Preauthorization from Medicare is sometimes required for certain procedures, and MD Anderson's billing department handles this, but you should confirm it happened before your appointment.

How Medicare coverage works at MD Anderson

MD Anderson bills Medicare directly for hospital stays (covered under Part A) and for doctor visits, imaging, lab work, and outpatient procedures (covered under Part B). If you have Original Medicare with no supplemental coverage, you will owe a deductible, coinsurance, and copays. The exact amounts depend on the type of service and how long you stay.

If you have a Medigap policy (also called supplemental insurance), that policy covers some or all of your out-of-pocket costs after Medicare pays its share. If you have a Medicare Advantage plan instead of Original Medicare, your coverage and costs work differently — your plan's network, deductibles, and copays explore. Before your first appointment, call your insurance company to confirm that MD Anderson is in your plan's network and to ask what your costs will be.

MD Anderson is a teaching hospital, which means residents and fellows train there. This can affect your bill. If a resident performs part of your care under a doctor's supervision, Medicare may pay a different rate than it would for the attending physician alone. The financial counseling office can explain this before treatment starts.

What you need to do before your first appointment

Contact MD Anderson's financial counseling office as soon as you schedule your appointment. You can reach them through the main hospital line or through your oncologist's office. Have your Medicare card and any supplemental insurance information ready. The financial counselor will ask about your diagnosis, the type of treatment you need, and how long you expect to be in treatment.

Bring your Medicare card and insurance card to every appointment. MD Anderson's billing staff will verify your coverage at check-in. If your coverage has changed since your last visit — for example, if you switched from Original Medicare to a Medicare Advantage plan — tell the front desk when ready. Billing errors are easier to fix before treatment than after.

Ask the financial counselor for an estimate of your out-of-pocket costs. This estimate is not a may provide, because the actual cost depends on what treatment you receive and how long it takes. But it gives you a realistic range. If the cost is more than you can afford, ask about payment plans. MD Anderson offers payment plans for patients who owe money upfront, and some patients may be referred to financial information programs.

Preauthorization and what Medicare requires

Some cancer treatments and procedures require preauthorization from Medicare before MD Anderson can perform them. This means MD Anderson's billing department must contact Medicare and get approval before the procedure happens. If preauthorization is needed and MD Anderson does not get it, Medicare may deny the claim, and you could be billed for the full cost.

MD Anderson's billing department usually handles preauthorization, but you should confirm it happened. Ask your doctor's office or the financial counselor: "Does my treatment plan need Medicare preauthorization, and has it been submitted?" If it has not been submitted yet, ask when it will be. Preauthorization can take a few days to a few weeks, so do not wait until the day before your appointment to ask.

If you are having an inpatient procedure that requires an overnight hospital stay, Medicare may require a three-day may have access to hospital stay before it will cover certain follow-up services. MD Anderson's financial counselor can explain whether this applies to your situation.

Travel and lodging costs if you live far away

MD Anderson is located in Houston, Texas. If you live far away, you may need to travel for multiple appointments or for a hospital stay. Travel and lodging are not covered by Medicare, but MD Anderson and other organizations offer programs that may help.

MD Anderson's Patient Relations office can refer you to lodging information programs. Some programs offer free or low-cost housing for patients and caregivers. The American Cancer Society and the National Association of Hospital Hospitality Houses also maintain lists of housing near major cancer centers. Ask about these programs when you call to schedule your appointment.

If you are traveling by air, some airlines offer discounted fares for medical patients. Ask MD Anderson's travel coordinator whether they have partnerships with airlines or hotels that offer discounts to patients.

What to do if MD Anderson is out of network for your plan

If you have a Medicare Advantage plan and MD Anderson is not in your plan's network, you have a few options. First, contact your Medicare Advantage plan and ask whether they will cover out-of-network care at MD Anderson. Some plans allow out-of-network coverage for specialized cancer treatment that is not available in-network.

If your plan will not cover out-of-network care, you can switch to Original Medicare during a special enrollment period. You have 60 days from the date you receive notice that MD Anderson is out of network to switch. You can also keep your Medicare Advantage plan and pay MD Anderson's out-of-network rates yourself, but this is usually very expensive. Talk to MD Anderson's financial counselor and your Medicare Advantage plan before making this decision.

If you are not yet on Medicare and you want to be treated at MD Anderson, you may be able to enroll in Medicare early if you have been diagnosed with cancer. Contact Social Security or Medicare to ask about early enrollment options.

Billing problems and what to do

If you receive a bill from MD Anderson that you think is wrong, contact their patient billing office. Bring the bill and your Medicare Explanation of Benefits (EOB) — the form Medicare sends you after it processes a claim. Compare the two documents to see what Medicare paid and what you owe.

If you think MD Anderson billed you for something Medicare should have paid, ask for an itemized bill. This shows every service, test, and procedure and what was charged for each one. You can compare this to your EOB to find the discrepancy. If you still disagree, you can file an appeal with Medicare. MD Anderson's patient advocate office can help you understand the appeal process.

Keep all your bills and EOBs in a folder. If you are in treatment for several months, you may receive many bills. Having them organized makes it easier to spot errors and to answer questions from your insurance company.

Frequently Asked Questions

Do I need to be referred to MD Anderson by my doctor, or can I call and make an appointment myself?

You can call MD Anderson directly to request an appointment. You do not need a referral from another doctor. However, if you already have an oncologist, they can send your medical records to MD Anderson before your appointment, which speeds up the process. Either way, have your pathology report and imaging results ready when you call.

What if I have Original Medicare and no supplemental insurance — how much will I owe?

Your costs depend on the type of care. For a hospital stay, you owe a deductible (currently $1,676 per benefit period for Part A) plus coinsurance. For outpatient services, you owe 20% of the Medicare-approved amount after you meet your Part B deductible. MD Anderson's financial counselor can give you a specific estimate based on your treatment plan.

Can I use a Medicare Advantage plan at MD Anderson?

Only if MD Anderson is in your plan's network. Call your Medicare Advantage plan and ask. If MD Anderson is not in-network, you can switch to Original Medicare during a special enrollment period, which gives you 60 days from the date you learn MD Anderson is out of network.

What happens if Medicare denies a claim for my treatment?

MD Anderson's billing department will notify you. You have the right to appeal. Ask MD Anderson's patient advocate office to help you understand why the claim was denied and what steps to take next. You can also contact Medicare directly at 1-800-MEDICARE to ask about the denial.

Does MD Anderson offer financial information if I cannot afford my out-of-pocket costs?

MD Anderson has a financial information program for patients who meet income requirements. Ask the financial counselor about this program when you call to schedule your appointment. You will need to provide income information and tax documents to explore.