Does Medicare Cover Cancer Treatment?
Medicare Part A covers your hospitalization costs related to cancer. Medicare Part B covers most cancer-related medical services and treatments such as chemotherapy and radiation therapy. Original Medicare also covers preventive services such as tests and cancer screenings.
Is Cancer Surgery Covered by Medicare?
Original Medicare covers the cost of medically necessary cancer surgery.
Medicare Part A covers the costs of inpatient cancer surgery, other necessary treatments and care in a hospital setting. Medicare Part B covers outpatient cancer surgery.
Cancer surgery works by removing all visible cancer cells from your body. This involves surgically cutting out malignant tumors and nearby healthy tissue to prevent the cancer from spreading.
Medicare Part A also covers certain medical services you may need to recover from cancer-related surgery.
- Blood transfusions required during surgery
- Home health care services including occupational or physical therapy
- Hospice care
- Skilled nursing facility care following a minimum three-day stay in a hospital for cancer surgery
Medicare Part B covers surgery-related medical services and equipment provided outside a hospital setting.
- Outpatient cancer surgery, such as removal of polyps during colon cancer screenings or implantation of a chemotherapy port
- Biopsies and other procedures to diagnose or measure success of cancer treatments
- Outpatient implantation of breast implants following a mastectomy
- Doctors’ visits related to your cancer surgery
Does Medicare Cover Chemotherapy?
Original Medicare, Medicare Advantage plans and Medicare Part D prescription plans cover many of the costs associated with chemotherapy.
Chemotherapy uses chemical substances to treat cancer. It may be used along with surgery, radiation therapy or other procedures to treat cancer.
For treatments covered by Medicare Part B, Medicare pays 80 percent of the approved chemotherapy costs. You are responsible for the Part B deductible and the remaining 20 percent.
- Medicare Part A
- Medicare Part A hospital insurance covers chemotherapy if you are treated for your cancer as a hospital inpatient — admitted to a hospital with a doctor’s order.
- Medicare Part B
- Medicare Part B medical insurance covers your chemotherapy if you receive it as a hospital outpatient — receiving treatment in a hospital without a doctor’s order to admit you. Part B also covers outpatient chemotherapy treatment in a doctor’s office or a freestanding clinic or other chemotherapy facility.
- Medicare Part C
- Medicare Advantage plans — also known as Medicare Part C — are required to cover everything Original Medicare does and may also provide prescription drug coverage for chemo-related medicines. These plans are sold through private insurers, so you should check with your plan to see exactly what costs your plan covers.
- Medicare Part D
- Medicare Part D prescription drug plans may sometimes cover certain cancer drugs and oral chemotherapy-related medications. This often includes prescription cancer drugs that Medicare Part B does not cover. Part D may also cover drugs that counteract side effects of chemotherapy such as nausea.
How Much Does Medicare Pay for Radiation Treatments?
Medicare Part A covers radiation therapy you receive as a hospital inpatient. Medicare Part B covers it if you receive radiation therapy as an outpatient in a freestanding clinic or other Medicare-approved facility that provides the therapy.
Radiation therapy uses X-rays or similar forms of radiation to treat cancer. The radiation makes small breaks in the DNA inside cancer cells.
The breaks keep the cancer cells from dividing and growing. In successful radiation therapy, the cancer cells die. The therapy can also affect nearby normal cells, but most of those recover.
- Inpatient Radiation Therapy
- You pay the Medicare Part A deductible — $1,408 in 2020 — and any applicable coinsurance, usually a percentage of the Medicare-approved cost of the treatment.
- Outpatient Radiation Therapy
- You will have to meet your Medicare Part B deductible — $198 in 2020 — plus your copayment.
- Radiation Therapy at a Freestanding Clinic
- You have to meet your Medicare Part B deductible and 20 percent of the Medicare-approved cost of treatment. Medicare pays the other 80 percent after meeting your deductible.
Medicare and Cancer FAQs
9 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2019, November). Medicare Coverage of Cancer Treatment Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11931-Cancer-Treatment-Services.pdf
- American Cancer Society. (2019, May 13). Medicare Coverage for Cancer Prevention and Early Detection. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/medicare-coverage-for-cancer-prevention-and-early-detection.html
- American Cancer Society. (2019, May 13). Medicare Part D Prescription Drug Coverage. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/part-d.html
- American Cancer Society. (2019, May 13). Medicare Overview. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/medicare-overview.html
- Narang, A.K. and Nicholas, L.H. (2017, June 8). Out-of-Pocket Spending and Financial Burden Among Medicare Beneficiaries With Cancer. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441971/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Chemotherapy. Retrieved from https://www.medicare.gov/coverage/chemotherapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Clinical Research Studies. Retrieved from https://www.medicare.gov/coverage/clinical-research-studies
- U.S. Centers for Medicare & Medicaid Services. (n.d.). https://www.medicare.gov/coverage/radiation-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Radiation Therapy. Retrieved from https://www.medicare.gov/coverage/radiation-therapy