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.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

    Read More
  • Edited By
    Lee Williams
    Lee Williams, senior editor for RetireGuide.com

    Lee Williams

    Senior Financial Editor

    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

    Read More
  • Published: May 12, 2021
  • Updated: November 1, 2022
  • 4 min read time
  • This page features 4 Cited Research Articles
Fact Checked
Fact Checked

Our fact-checking process starts with vetting all sources to ensure they are authoritative and relevant. Then we verify the facts with original reports published by those sources, or we confirm the facts with qualified experts. For full transparency, we clearly identify our sources in a list at the bottom of each page.

Cite Us
How to Cite RetireGuide.com's Article

APA Turner, T. (2022, November 1). Does Medicare Cover Chemotherapy? RetireGuide.com. Retrieved December 7, 2022, from https://www.retireguide.com/medicare/treatments/cancer/chemotherapy/

MLA Turner, Terry. "Does Medicare Cover Chemotherapy?" RetireGuide.com, 1 Nov 2022, https://www.retireguide.com/medicare/treatments/cancer/chemotherapy/.

Chicago Turner, Terry. "Does Medicare Cover Chemotherapy?" RetireGuide.com. Last modified November 1, 2022. https://www.retireguide.com/medicare/treatments/cancer/chemotherapy/.

Why Trust RetireGuide.com
Why You Can Trust Us

Content created by RetireGuide and sponsored by our partners.

Key Principles

RetireGuide’s mission is to provide seniors with resources that will help them reach important financial decisions that affect their retirement. Our goal is to arm our readers with knowledge that will lead to a healthy and financially sound retirement.

We’re dedicated to providing thoroughly researched Medicare information that guides you toward making the best possible health decisions for you and your family.

RetireGuide LLC has partnerships with Senior Market Sales (SMS) and GoHealth.

Our partners are able to be reached through the phone numbers and/or forms provided on our website.

The content and tools created by RetireGuide adhere to strict Medicare and editorial guidelines to ensure quality and transparency.

Editorial Independence

While the experts from our partners are available to help you navigate various Medicare plans, RetireGuide retains complete editorial control over the information it publishes.

We operate independently from our partners, which allows the award-winning RetireGuide team to provide you with unbiased information.

Visitors can trust our inflexibility regarding our editorial autonomy. We do not allow our partnership to influence RetireGuide’s editorial content whatsoever.

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.

What Parts of Medicare Cover Chemotherapy?
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.
Advertisement

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.

Items and Services Not Covered by Medicare
  • 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.

Advertisement

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.

Questions to Ask Your Doctors About Your Cancer Treatment Costs
  • 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.

Last Modified: November 1, 2022

4 Cited Research Articles

  1. U.S. Centers for Medicare & Medicaid Services. (2022, January). Medicare Coverage of Cancer Treatment Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11931-Cancer-Treatment-Services.pdf
  2. Johnson, E. (2020, June 24). Does Medicare Cover Chemotherapy? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-chemotherapy
  3. 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/managing-costs/the-cost-of-cancer-treatment.html
  4. U.S. Centers for Medicare & Medicaid Services. (n.d.). Chemotherapy. Retrieved from https://www.medicare.gov/coverage/chemotherapy