Medicare & Radiation Oncology
Medicare covers most radiation therapy costs if you have cancer, but you will still be responsible for some out-of-pocket costs depending on your coverage. Medicare will cover treatment whether radiation is used by itself or in combination with other cancer treatments.
Does Medicare Pay for Cancer Radiation Treatments?
Original Medicare — Medicare Part A and Part B — covers radiation treatments for cancer that are performed in either a hospital or a freestanding clinic. Medicare Advantage plans are required by law to cover everything that Original Medicare covers, but Medicare Advantage plans may provide additional benefits.
You may still be responsible for out-of-pocket costs associated with your radiation treatment. A Medigap policy may help cover your out-of-pocket costs. Talk with your plan’s provider to find out exactly what benefits are available to you.
- Internal radiation
- Medicare covers this type of treatment in which radiation is delivered in a liquid or solid form, typically through an IV, pills or small pellets that are inserted inside your body.
- External beam radiation
- Medicare covers this type of treatment in which a machine directs beams of energy to a specific site on or inside your body in order to target a tumor while limiting exposure to the area around it.
- Proton beam therapy
- Medicare generally covers proton beam therapy. This is a more targeted treatment than external beam radiation because the proton beam stops after reaching the cancer. Proton beam therapy is a relatively new form of radiation treatment, and there may be certain requirements for coverage. Before committing to the treatment, make sure you check with Medicare or your Medicare Advantage plan provider to see that it’s covered in your case.
Radiation therapy may also be used in conjunction with other cancer treatments that Medicare covers such as chemotherapy.
Your Costs for Radiation Treatments on Medicare
While Medicare covers most of the cost of radiation treatment, you will still be responsible for a portion of the cost. Your responsibility will vary depending on the Medicare coverage you have. Each part of Medicare covers different costs associated with your cancer treatment.
- Medicare Part A hospital insurance
- Medicare Part A covers most of your radiation therapy costs if you are a hospital inpatient — meaning that you are formally admitted to a hospital. Your out-of-pocket costs in 2021 include:
- Part A deductible: $1,484 each benefit period
- $371 each day after 60 days in the hospital
- $742 each day after 90 days
- All costs after 150 days or after lifetime reserve days expire
- Medicare Part B medical insurance
- Medicare Part B covers most of your radiation therapy costs if you receive treatment in a freestanding clinic or other outpatient setting. Your 2021 out-of-pocket costs include:
- Part B deductible: $203
- In a hospital outpatient setting: Hospital copayment (varies depending on hospital)
- In a freestanding clinic: 20 percent of the Medicare-approved amount for the treatment
- Medicare Advantage (Part C) plans
- Medicare Advantage plans are sold by private insurers and must cover everything Medicare Part A and Part B cover, but these plans may include additional benefits. They also have limits on maximum out-of-pocket costs, unlike Original Medicare. Check with your plan administrator to find out exactly what benefits you have and what your maximum costs may be. Medicare Advantage plans may also cover the cost of prescription drugs you need for your treatment.
- Medicare Part D prescription drug plans
- Medicare Part D plans are sold by private insurers and may help with the cost of the medications you take at home as part of your cancer treatment. Different plans may cover different medications, so you will need to work with your medical team to find the best options for your situation. Check with your Medicare Plan D administrator to see which drugs are covered and what your out-of-pocket costs may be.
Medigap Coverage for Cancer Treatments
Medigap plans — also called Medicare Supplement insurance plans — are private policies that help you pay out-of-pocket costs that Original Medicare does not cover.
- Deductibles – the amount you have to pay before your Medicare coverage kicks in; both Medicare Part A and Part B have their own deductibles
- Copayments – a fixed amount you pay after you’ve reached your deductible
- Coinsurance – a percentage of the Medicare-approved cost of a service or item which you are responsible for paying after you meet your deductible
Medigap policies typically cost more than Medicare Advantage plans, and you cannot purchase both a Medicare Advantage and Medigap plan.
If you have a Medigap policy, Medicare will pay for its share of the costs before Medigap will pay its share.
Even with a Medigap policy, you may still have to pay a portion of your out-of-pocket costs. You should talk with your plan administrator to find out exactly what your Medigap policy covers and what your share will be.
8 Cited Research Articles
- U.S. National Institutes of Health. (2020, September 25). Cancer Statistics. Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics
- U.S. Centers for Medicare & Medicaid Services. (2020, September 18). CMS Announces Innovative Payment Model to Improve Care, Lower Costs for Cancer Patients. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-announces-innovative-payment-model-improve-care-lower-costs-cancer-patients
- Mayo Clinic. (2019, November 22). Proton Beam Therapy Program: Frequently Asked Questions. Retrieved from https://www.mayoclinic.org/departments-centers/proton-beam-therapy-program/sections/frequently-asked-questions/gnc-20187695
- 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
- U.S. National Institutes of Health. (2019, January 8). Radiation Therapy to Treat Cancer. Retrieved from https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Radiation Therapy. Retrieved from https://www.medicare.gov/coverage/radiation-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap