Yes, you will likely have some out-of-pocket expense, depending on your insurance plan details. The exact amount can vary widely between patients because it’s influenced by factors like deductibles, co-insurance, and co-pays.
Here are the typical scenarios:
- If you have Medicare: Medicare Part B usually covers 80% of the approved cost of treatment. You are responsible for the remaining 20% (co-insurance), unless you have a Medigap supplemental plan or secondary insurance that covers that. If you have a supplemental plan, often it will pay the 20%. If not, you’ll be billed for that 20%. For example, if the total Medicare-approved cost for the whole course is, say, $2,000 (just an example), Medicare pays $1,600 and you would owe $400. Many patients have secondary insurance to cover this. Also, if you haven’t met your Part B annual deductible (around $226 in 2023), that would apply too.
- If you have private insurance (PPO/HMO): You may have:
- A deductible: an amount you pay out-of-pocket each year before insurance kicks in fully. If your deductible hasn’t been met, you’ll pay the treatment costs up to that amount.
- Co-insurance: after deductible, you might pay a percentage of costs (commonly 10-30%) and insurance pays the rest, until you hit an out-of-pocket maximum.
- Co-pay: some plans might have a fixed co-pay per visit (e.g., $50 per radiation session, which could add up if many sessions, but some plans treat the entire course as one “procedure” for billing, it varies).
The overall out-of-pocket can range from very little (if you have a great plan or already met your out-of-pocket max) to a moderate amount. For instance, patients with high-deductible plans might have to pay a couple thousand dollars until their insurance covers 100%. On the other hand, if you’ve already had other medical expenses that met your deductible and out-of-pocket max for the year, you might pay almost nothing.
From our experience, many insured patients end up paying a few hundred to a couple thousand dollars total for an IG-SRT course, but this is a broad generalization. It can be less, it can be more, purely based on plan structure. If cost is a concern, we can have our billing staff estimate your liability by verifying your benefits.
Also, note that if multiple lesions are treated, that can affect cost (though sometimes if done concurrently, they might be billed under same sessions, etc.). But focusing on one lesion, you’ll have some cost share.
Medicare Advantage and HMOs often mirror Medicare rules but might require co-pays per visit or referrals – we’ll get into referrals next but cost-wise, often similar co-insurance.
The key is: insurance covers the majority if you’re insured, but yes, expect to pay whatever your plan’s cost-sharing is. It could be as low as just co-pays each visit (e.g., 20 visits x $20 = $400) or as high as your out-of-pocket max if you haven’t paid anything that year yet.
We know cost is important, so our practice informs patients of expected out-of-pocket costs before starting. If, hypothetically, someone has no insurance, we’d discuss self-pay cost (which could be a few thousand dollars for a full course – see next question).
In summary, with insurance you will have some out-of-pocket costs, ranging from minimal to a few thousand depending on deductibles and co-insurance. Our office can provide an estimate once we know your plan details. Don’t hesitate to ask us to clarify what your plan covers – it’s part of our process to help you navigate that.
