Does Medicare Cover Cancer Treatment?
This article was updated on: 11/16/2016
Medicare Part A and Part B may cover certain treatments for beneficiaries with cancer, including (but not limited to) chemotherapy and radiation therapy. Your Medicare costs will depend on whether you receive chemotherapy as an inpatient or outpatient. Make sure you get these treatments from Medicare-assigned health-care providers so that Medicare may cover its share of the costs.
You may be wondering how much chemotherapy costs under Medicare. 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 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.
Medicare Part B may also cover some cancer screenings, such as for breast cancer and prostrate cancer.
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.
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 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 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 anti-cancer 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
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. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
If you or someone you’re caring for has cancer, 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. Or, if you’re ready to speak with one of us, just call Medicare.com’s licensed insurance agents at 1-844-847-2660, TTY users 711; Monday through Friday, 8AM to 8PM ET.
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.
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