We often get asked questions by prospective patients and other physicians about the cost of proton therapy. Is it expensive? Does insurance cover it? How much is it if insurance doesn’t pay? All of these are important questions worth addressing.
Does Insurance Cover Proton Therapy?
All of the major insurance companies cover proton therapy treatment. This list includes Blue Cross, UnitedHealthcare, Aetna, Cigna, Humana, TriCare, and many more. Additionally, Medicare and Medicare Replacement plans offer broad coverage for proton therapy.
The coverage offered by commercial payers can vary depending upon the payer and the patient’s specific insurance plan. At Oklahoma Proton Center, nearly 80% of patients with commercial insurance get approved by their insurance plan for treatment at the facility. We work with each patient prior to treatment to determine what their benefits will be for their diagnosis and treatment regimen.
Medicare approves treatment for proton therapy at Oklahoma Proton Center; thus, patients with Medicare can be confident that their treatment will be paid for. By law, Medicare Replacement plans have to offer the same coverage as Medicare, so patients with these plans will also have coverage, although a referral may be required.
How much does proton therapy cost?
As is often the case in healthcare, this question depends on the payer. Medicare pays about $1,000 per treatment; thus if a patient has a 20% co-pay, they would owe about $200 per treatment.
The various commercial payers all pay a different amount that can vary from just a little bit more than Medicare up to about $2,000 a treatment. The amount owed by these patients will depend upon their plan.
Most patients have a plan that caps their out-of-pocket to a maximum dollar amount regardless of their deductible or co-insurance percentage. The financial counselors at Oklahoma Proton Center can help patients interpret the nuances of their plan so that they know exactly how much they will owe before treatment starts.
Oklahoma Proton Center is a not-for-profit healthcare provider with a generous charitable care policy. The center can provide need-based discounts or grants as well as structure payment plans that can help patients afford treatment. We do not want the cost of treatment to be a burden that prevents patients from receiving the care that they need.
Is proton therapy more expensive than other treatment options?
This depends on a number of factors, including where the other treatment is being provided and what treatment or treatments are being included. For example, Oklahoma Proton Center is a free-standing, independent facility, so the cost of proton therapy here can actually be less than traditional radiation treatment at a hospital that charges much higher rates.
Chemotherapy, Immunotherapy, and other targeted therapies can often cost into the hundreds of thousands of dollars. The average cost of a course of proton therapy at Oklahoma Proton Center is about $45,000. So this is much less expensive than some of these other options.
Additionally, the “cost” burden of treatment isn’t just the cost of the treatment itself but also the cost of treating the side effects of the treatment. While proton therapy can be more expensive upfront than other types of radiation treatment, in the long run, the cost is often less due to the reduction in treatment-related side effects.
In fact, a study from MD Anderson did in conjunction with the State of Texas employee health benefit plan showed that over a 6-month period, the total cost of caring for a proton therapy patient was less than the cost for a comparable patient receiving IMRT (photon based radiation treatment). This was due to the reduction in treatment related complications for the proton therapy patients.
What else should I know?
Ultimately what is most important is that a patient receives the best possible treatment regardless of where that is or what that is, or what the cost is. That is why it is so important for patients to be their own advocates and do their research. Every patient should explore all possible treatment options before making a decision.
If you have a question about proton therapy, the cost, your insurance plan, or how proton therapy can work for your cancer, please call us at (405) 773-6700.