Does Medicare Cover Cancer Treatment?
This article was updated on: 09/10/2018
Medicare coverage of cancer treatment
Medicare Part A and Part B may cover certain cancer treatments for beneficiaries with cancer, including (but not limited to) chemotherapy and radiation therapy. Your Medicare costs will depend on whether you receive the cancer treatments as an inpatient or outpatient. Make sure you get these cancer treatments from Medicare-assigned health-care providers so that Medicare may cover its share of the costs.
Medicare Part B may cover some cancer screenings, such as for breast cancer and prostate cancer.
Does Medicare cover the cost of chemotherapy for cancer treatment?
Chemotherapy cancer treatment can stop the growth of cancer cells, either by killing them or by stopping them from dividing, according to the National Institute of health. Chemotherapy can be administered in a variety of ways, including by mouth, injection, infusion, or on the skin, depending on the type and stage of cancer being treated. Medicare Part A covers chemotherapy and other cancer treatment that you get as a hospital inpatient, after you pay the Part A deductible. Read more details about Medicare costs.
Medicare Part B generally covers outpatient chemotherapy cancer treatments, such as in a freestanding clinic or doctor’s office. In this case, you’d pay 20% of the Medicare-approved amount, after paying the Medicare Part B deductible.
Similarly, Medicare also covers radiation therapy for cancer patients. If you’re covered under Medicare Part A, you’ll pay the inpatient deductible and any copayment that applies. If you get radiation therapy as an outpatient, you’ll typically pay 20% of the Medicare-approved amount, and the Medicare Part B deductible applies.
The cost of chemotherapy and radiation cancer treatment depends on a variety of factors, including how long you are treated for. If you receive many treatments, you may owe a significant amount of coinsurance payments, as Medicare has no out-of-pocket maximum.
Medicare Advantage plans for cancer treatment
Do you have a Medicare Advantage plan? If so, your Medicare coverage of cancer treatment is the same as described above. That’s because Medicare Advantage plans, offered by private, Medicare-approved insurance companies, include all your Medicare Part A and Part B benefits (except hospice care, which Part A still covers when you have a Medicare Advantage plan). Medicare Advantage plans often include extra benefits, such as prescription drug coverage and routine dental care that could be useful for a patient undergoing cancer treatment.
Medicare prescription drug coverage for cancer treatment
Medicare Part B may cover limited prescription drugs, including some cancer prescription drugs taken by mouth that may be administered to you. You also may be covered for anti-nausea drugs to treat symptoms caused by chemotherapy cancer treatment. In these situations, you usually pay 20% of the Medicare-approved amount, after the annual Medicare Part B deductible is applied. If you’re admitted to a hospital, Medicare Part A typically covers prescription drugs given to you as part of your inpatient cancer treatment.
For medications that aren’t covered under Original Medicare, you’ll need Medicare Part D coverage, or you may have to pay the full cost of those prescription drugs. You can get this optional coverage through a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Keep in mind that not every cancer treatment medication is covered by each Medicare Prescription Drug Plan or each Medicare Advantage Prescription Drug plan. Check the formulary (list of covered prescription drugs) of the plan you have or are considering to see if the medications you need are included. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
It’s important to review your prescription drug coverage every year, as Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans can make formulary and cost changes that affect how much you pay.
Medicare Supplement plans for cancer treatment
Original Medicare coverage for cancer treatment does come with costs you need to pay, such as the coinsurance and deductibles mentioned above. If you’re enrolled in Medicare Part A and Part B, you may be able to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs associated with your cancer treatment. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Does Medicare cover wigs for cancer patients?
According to the National Institute of Health (NIH), some types of chemotherapy cancer treatment cause the hair on the head and other parts of the body to fall out. You could wear a hat or scarf to cover your head, but some people may prefer a wig of natural-looking hair. Wig prices vary based on how long the wig is and whether the wig is made of synthetic materials or human hair, but they could cost hundreds of dollars and up to thousands of dollars. Unfortunately Medicare does not typically does not cover wigs for cancer patients who are undergoing cancer treatment. However, you may be able to get help from a non-profit to obtain a low-cost or free wig. Some non-profits, such as Friends Are by Your Side work with local salons to schedule wig consultations. You may have to provide documentation of your hair loss as a side-effect of chemotherapy and inability to independently afford a wig for organizations such as Lolly’s Locks. The American Cancer society may also accept and distribute new wigs at no cost through its local chapters.
If you or someone you’re caring for is undergoing cancer treatment, adequate coverage can help you manage your health costs and make sure you’re able to get the care you need. If you have any questions, we’re here to help. To get help over the phone or by email, use the links below to have me contact you. If you’d like to browse Medicare plan options on your own, just use the Compare Plans buttons on this page.
This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.