Does Medicare Cover Chemotherapy?
This article was updated on: 09/12/2018
According to the National Institutes of Health’s National Cancer Institute (NCI), 38.5% of all men and women in the United States will be diagnosed with cancer during their lifetimes. The median age at diagnosis is 66. Nearly 1.7 million new cases of cancer are diagnosed each year. However, in 2017, of the estimated nearly 1,700,000 new cancer cases, there were an estimated 600,000 deaths. This means that more than a million could be helped through life-saving treatments such as chemotherapy.
If you have cancer and are enrolled in Original Medicare (Part A and Part B), and your doctor recommends chemotherapy, Medicare will generally cover your treatment. Deductibles, copay and coinsurance amounts may apply.
Why did my doctor order chemotherapy?
According to the U.S. National Library of Medicine, doctors use chemotherapy, or cancer-killing drugs, to cure cancer, shrink the cancer or keep it from spreading, or to relieve other symptoms caused by the cancer.
Chemotherapy is given in several ways:
- Injections under the skin or into the muscles
- Directly into an artery or vein
- In pill form taken by mouth
- Injections into the fluid around the spine or brain
If you will need chemotherapy for a long period of time, your doctor may perform a minor surgical procedure to place a catheter called a central line into a vein near your heart.
Most chemotherapy is given in cycles, which can last anywhere from a day to several weeks. You’ll have a period of rest between cycles to give your body time to recover before the next cycle.
Where is chemotherapy given?
Chemotherapy can be given in the hospital as an inpatient or an outpatient, at a doctor’s office or an infusion center, or even at home in some cases, depending on the type of cancer and the chemotherapy agents you are given. No matter where you receive treatment, you will need to see your doctor before, during, and after chemotherapy to check for damage to your heart, lungs, liver, and blood, and to make sure the treatment is working properly. You may have blood tests and imaging studies such as CT scans, MRIs, and PET scans to help your doctor monitor your condition, according to the National Library of Medicine.
How does Medicare cover chemotherapy?
If you receive chemotherapy while you’re a patient in the hospital, Medicare Part A typically covers allowable charges for your treatment. If you get chemotherapy as an outpatient at the hospital, Medicare Part B usually covers the allowable charges; you are responsible for a copayment.
Part B also generally covers 80% of allowable charges for chemotherapy given in a doctor’s office or infusion clinic after you’ve met your Part B deductible.
If you have cancer and are concerned about your health care costs, a Medicare Supplement plan may help you manage your out-of-pocket expenses. Medicare Supplement plans pay all or part of your Part A and/or Part B deductibles and coinsurance amounts.
Medicare Advantage plans (Medicare Part C) may be another option to help you pay your health-care costs. Offered by private insurance companies approved by Medicare, Medicare Advantage plans provide the same coverage as Original Medicare (except hospice care, which is covered by Part A), but they may also offer extra benefits that may help people with cancer better manage their medical expenses.
Most Medicare Advantage plans include Part D coverage for prescription drugs, possibly including those that help with the side effects of chemotherapy. They may also include helpful benefits such as coverage for routine dental, vision, and hearing care. In addition, Medicare Advantage plans frequently have lower copayments and deductibles.
Not all plan types and benefit options may be available in every location. You also need to continue paying your Medicare Part B premiums plus any additional premiums required by your plan.
Looking for more information about Medicare and chemotherapy?
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