Does Medicare Cover Chemotherapy?
Original Medicare — Medicare Part A and Part B — covers most chemotherapy costs if you have cancer. But you are responsible for out-of-pocket costs if the treatment takes place in a hospital outpatient setting, a doctor’s office or a freestanding clinic.
Medicare Chemotherapy Coverage
Medicare covers most of the costs of chemotherapy cancer treatments. But you may still be responsible for out-of-pocket costs including deductibles, copayments or coinsurance depending on which parts of Medicare you have and where you receive chemotherapy treatments.
- Medicare Part A hospital insurance
- Medicare Part A typically covers chemotherapy treatment you receive after being formally admitted to a hospital. Part A also covers skilled nursing facility care after a three-day hospital stay, home health rehabilitation services, breast reconstruction surgery in a hospital following a mastectomy and hospice care.
- Medicare Part B medical insurance
- Medicare Part B covers different types of chemotherapy — oral, intravenous or injections — you receive at a doctor’s office, a freestanding clinic or a hospital outpatient center. It also covers drugs administered during your treatment in the treatment facility to control some of the side effects of chemotherapy. Part B also covers medical equipment such as a wheelchair or oxygen that you may need after your treatments. Part B also covers cancer screenings and preventive services.
- Medicare Advantage (Medicare Part C)
- These are plans sold by private insurers that are required by law to cover everything that Original Medicare — Medicare Part A and Part B — covers. It may also provide additional benefits such as prescription drug coverage not included in Original Medicare. But these plans typically require you to choose hospitals, doctors and other health care providers within your plan’s network or risk paying higher costs.
- Medicare Part D prescription drug plans
- Medicare Part D plans are sold through private insurers to help pay the cost of prescription drugs. Part D covers drugs you take on your own at home. These can include oral and injectable drugs you take yourself as well as drugs you take to control side effects of the chemo treatments. It does not cover drugs administered by health care professionals during your treatments.
- Medigap (Medicare Supplement insurance)
- Medigap plans are policies sold by private companies that help cover your out-of-pocket costs if you have Original Medicare. It can help cover your Original Medicare deductibles, copayments and coinsurance for chemotherapy treatments.
What Are Your Costs Under Medicare?
If you receive your chemotherapy in a hospital outpatient setting, you will have to pay the approved copayment fee —a fixed dollar amount set by the facility. If you receive chemo in a doctor’s office or freestanding clinic, you have to pay your Medicare Part B deductible and 20 percent of the Medicare-approved cost for the treatment.
Original Medicare will not cover some costs associated with chemotherapy treatments.
- Assisted living facilities
- Home caregivers to help with basic daily activities including meal preparation, bathing and dressing
- Long-term care facilities
- Room and board while receiving chemo treatments
- Treatments that are part of clinical trials
If you have a Medicare Advantage or Medicare Part D prescription drug plan, you should check with your plan’s administrator about the drugs you may be prescribed for chemotherapy and for dealing with the side effects of your treatment.
Each plan has its own formulary — a list of prescription drugs it covers. You should be aware of the drugs your plan covers. If your plan does not cover a particular drug you are prescribed, it is required to cover an alternative to that drug.
Work with your health care team to make sure you can be prescribed the version of the drug your plan will cover.
Ask Your Cancer Doctors About Chemotherapy Costs
When planning your chemotherapy treatments, it’s important to consider the costs of items and services Medicare does not cover.
For instance, if you live in a remote or rural area, you may need to travel to your chemo treatments and stay in a hotel. You may also need home care beyond what Medicare pays.
Talk with your doctor or other health care provider about what your treatment will require of you and exactly what kind of care you will need.
- Are there alternative treatments that Medicare will cover that will cost me less?
- How far will I have to travel to get my treatments, and will I have to stay overnight?
- How long will I need to receive chemo treatments?
- How much will my prescriptions cost?
- Is there a way to get help with my share of the treatment and medication costs?
- What are my total out-of-pocket costs for this treatment?
- What is my cost for each treatment?
- What is not covered by Medicare?
- Where will I receive my treatments — in a hospital, outpatient center, doctor’s office or clinic?
- Will I need to get prior authorization from my Medicare Advantage plan for any of this treatment? (Check with your plan administrator.)
Medicare Advantage plans differ from plan to plan and depending on where you live. You should also check with your plan’s administrator about specific benefits and limitations of your plan.
4 Cited Research Articles
- Johnson, E. (2020, June 24). Does Medicare Cover Chemotherapy? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-chemotherapy
- 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). Things to Know About the Cost of Your Cancer Treatment. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/managing-costs/the-cost-of-cancer-treatment.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Chemotherapy. Retrieved from https://www.medicare.gov/coverage/chemotherapy