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Re: Does Medicare cover Proton Beam Radiation Therapy?

Terry,
I had proton beam therapy (PBT) in Oct 2011 at UFPTI. Medicare along with my Medicare supplement (Aetna) covered the 100% of the cost. If you contact the center where you want to have the procedure, they will put you in contact with their "insurance person" who will let you know what is covered and what your costs muight be. When I was down there at UFPTI, a couple of guys had a $30 co-pay required by their medicare supplement. Since each of the 39 "treatments" required a co-pay, they were required to pay money up front and each day's co-pay was subtracted from it. I'll bet 9wks in Florida would sound pretty nice to you guys in Minnesota about now....

Re: Does Medicare cover Proton Beam Radiation Therapy?

Terry,

I don't know the answer, which I think is "some do:some don't" but if you go the the RESOURCES page you will see a link to a site Fight Your Health Insurer and Win where you should get some current advice.

Good luck
Terry in Australia

Re: Does Medicare cover Proton Beam Radiation Therapy?

Terry, while I'm not of Medicare age, I had PBRT for Gleason 6 PCa at MD Anderson in Houston, and MANY of the men taking the treatment journey with me were there courtesy of Medicare and their Medicare supplement. I agree with the advice to contact your preferred treatment center directly, which will put you in touch with their insurance folks. They'll be able to give you a straight answer based upon the coverage you have.

One cautionary note: There's no doubt that despite excellent outcomes, PBRT for PCa is under assault by many in the health policy and oncology communities. They don't argue treatment safety and efficacy, but rather its cost, which is higher than for IMRT (i.e., photons). What they woefully fail to consider is TOTAL COST over the LONG RUN, since the majority of such critiques look narrowly at the comparison with IMRT and, in some cases, with bracytherapy. What's not in dispute is that with PBRT, the body receives a significantly lower integral dose of radiation, since the radiation can be precisely targeted to the gland (versus spread diffusely as with the other modes).

I remain pleased with my results and staunchly defend the total value, over time, delivered by PBRT. I would do it all over again. However, given the irrationality and inefficiencies seeping into U.S. healthcare as a result of Obamacare, I would not be surprised if short-term thinking spelled the demise of coverage for PBRT under Medicare. Let's hope that doesn't happen.

Re: Does Medicare cover Proton Beam Radiation Therapy?

Aloha R Scott,
It appears that you are repeating what you were told by the proton advocates and that is exactly what is in dispute in the saga of EBRT Vs. Protons. Both are radiation & both deliver a dose to the body. Where & how much that dose is depends on the doc prescribing the dose and those doc's do make mistakes (as in my case). The only difference between the two treatments is cost, and the Proton sellers make a bundle of cash. If a man is sold on proton treatment, he should be allowed to pay for it out of his pocket, not ours.
Joe

Re: Does Medicare cover Proton Beam Radiation Therapy?

Please do not start an argument for and against Proton Beam Therapy.

There can be no resolution to such arguments which tend to inflame men with very strong views one way or the other.

The fact of the matter is that there are no good, independent studies that demonstrate the superiority of Proton Beam Therapy. It may be better, it may have fewer side effects, but all evidence is anecdotal and not supported by good studies.

I will close down this thread if the argument continues, although posts answering Terry's original question about coverage will be welcomed.

Terry in Australia

Re: Does Medicare cover Proton Beam Radiation Therapy?

Terry:
Joe H's response appears to be "right on".
As part of your research effort I suggest you Google UFPTI then click on:

"University of Florida Proton Therapy Institute response to prostate cancer treatment comparison published Dec. 13, 2012 in the Journal of the National Cancer Institute" in the right hand column.

Best wishes Don O.

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