Medicare Coverage of Cancer Treatment
Close to 40% of men and women will be diagnosed with cancer at some point in the lifetimes, according to that National Cancer Institute’s 2015 data. Depending on the stage and type of cancer, your doctor may prescribe surgery to remove cancer or radiation and chemotherapy to kill cancer cells. You may receive some of this treatment as an outpatient and you may be admitted to the hospital for several nights or more. If you have a cancer diagnosis, your first question may be “Does Medicare cover cancer treatment?”
What are the costs of cancer treatment?
When you receive cancer treatment, you may incur costs for:
- The services of medical professionals such as surgeons, anesthesiologists, and oncologists
- Prescription drugs, including prescription drugs to kill cancer and prescription drugs to help you with side effects, such as nausea or pain
- Operating room fees and equipment fees
- Lab tests such as blood tests and imaging tests such as x-rays
- Hospital stays
- Home care
Does Medicare cover cancer treatment?
Medicare generally covers all medically necessary health care services needed to diagnose or treat an illness or disease, including many types of cancer treatment.
- Medicare Part A (hospital insurance) generally covers cancer treatment you receive as an inpatient. This may include skilled nursing facility care following a 3-day hospital stay, hospice care, and some home health care including rehabilitation services.
- Medicare Part B (medical insurance) generally covers cancer treatment you receive as an outpatient including doctor visits, radiation treatments given in an outpatient clinic and some oral chemotherapy treatments. Medicare Part B may also cover outpatient surgeries, diagnostic tests, and durable medical equipment like wheelchairs and walkers.
- If you need coverage for prescription drugs to treat cancer or side effects of cancer treatment, you can opt to get Medicare Part D coverage for prescription drugs.
- Medicare Supplement plans may cover some out-of-pocket costs that Medicare Part A and Part B generally don’t
Medicare Advantage plans also generally cover all types of cancer treatment that Original Medicare (Part A and Part B) covers. Medicare Advantage is Medicare coverage offered by private insurance companies contracted with Medicare. Most Medicare Advantage plans also include prescription drug (Medicare Part D) coverage. You must continue to pay your Part B premium with a Medicare Advantage plan.
What does cancer treatment cost me if I have Medicare coverage?
You may be responsible to pay copayments, coinsurance, and deductibles for your cancer treatment. A deductible is a set amount you must pay before your insurance begins to pay. A coinsurance could be a percentage, for example, 20% of the allowable charges that you are responsible for. It may be difficult to predict a dollar amount you may owe because you may not know what the allowable charges are. That’s where a Medicare Supplement plan comes in. Medicare Supplement plans may cover:
- Your Medicare Part A coinsurance and hospital costs up to 365 additional days after Medicare benefits are used up
- Your Medicare Part B coinsurance or copayment
- Your Medicare Part A hospice care coinsurance or copayment
- Your skilled nursing facility care coinsurance
- Your Medicare Part A deductible
- Your Medicare Part B deductible
To find a Medicare Advantage or Medicare Supplement plan that can help you pay for cancer treatment, enter your zip code on this page.