Does Medicare Cover Chemotherapy?

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.

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.

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.

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.

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.