A cancer diagnosis can be life changing, and treatment may be costly. Medicare covers some cancer treatments from parts A and B depending on the specific type.
Medicare Part A covers in-hospital treatments, such as surgery, and Medicare Part B covers medical care, such as consultations and outpatient visits. Different out-of-pocket costs may apply depending on which part of Medicare is funding the care.
Medicare also pays for some chemotherapy drugs through Part D.
This article will explain Medicare’s coverage for different cancer treatments and screening methods.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare covers chemotherapy for cancer treatment, as long as the doctor confirms that it is medically necessary.
Hospitals and clinics will usually administer chemotherapy, but some people also receive this treatment at home.
Depending on their circumstances, a person may receive chemotherapy drugs orally, intravenously, or through an implanted port.
Medicare Part A or Part B will cover the cost, depending on the location of administration. Part A covers inpatient chemotherapy, during which a person stays in the hospital overnight. Part B covers outpatient infusions.
Cancer treatment varies. It can take place on both an inpatient and outpatient basis, depending on the type of cancer and the person’s healthcare needs.
Some people need additional services as part of their cancer treatment, including care that supports recovery from surgery.
Medicare Part A covers eligible cancer treatments that involve an inpatient hospital stay. For example, it may cover the following:
- inpatient hospital stays for surgery to remove or treat cancer
- inpatient chemotherapy
- skilled nursing facility care after a 3-day hospital stay
- home healthcare, such as physical and occupational therapy
- hospice care
- blood transfusions
Medicare Part B covers several outpatient cancer services and treatments.
Some treatments may include medications, radiation therapy, and surgery. However, cancer treatment may also include other services, such as medical equipment at home, prosthetics, and care at home.
Cancer treatment covered by Medicare Part B may include:
- outpatient chemotherapy, such as treatment at an infusion center
- radiation therapy at an outpatient center
- outpatient surgery, such as the implantation of a port for chemotherapy
- necessary medical equipment, such as a walker or supplemental oxygen
- tests to diagnose or evaluate cancer treatment, such as a CT scan
- equipment for external nutritional support at home, such as a feeding tube and pump
- external breast prostheses after a mastectomy
- breast implants after a mastectomy, when a doctor performs this as outpatient surgery
- doctor’s office visits
Usually, Medicare Part B also covers some costs related to participating in a clinical research study on cancer treatment.
The hospital performing the study typically covers many of the costs of such a study. However, Medicare parts A or B may cover specific elements of the study, such as the treatment of any side effects.
Medicare Part D sometimes covers chemotherapy if a person takes the medications orally. It also covers other cancer drugs.
For example, if Medicare Part B does not cover a drug but a person has Medicare Part D, this portion may cover the costs.
Medicare Part D may also cover medications that counter the side effects of cancer treatment, such as antinausea drugs.
According to the American Cancer Society, Medicare funds some types of cancer screening and prevention. Cancer screenings are an essential part of diagnosing cancer early and improving a person’s outlook.
Typically, Medicare Part B covers cancer screenings. However, there are several determining factors, such as:
- a person’s age
- their risk factors, such as a family history of a specific cancer
- symptoms that may have links to cancer, such as a lump on the breast
Restrictions also include the frequency of screenings.
Benefits for cancer screenings come from Medicare Part B, including:
- a mammogram, for breast cancer
- a Pap smear test, to screen for cervical cancer
- a fecal blood test and colonoscopy, to check for colon cancer
- prostate-specific antigen tests and a rectal exam, to screen for prostate cancer
- low dose CT scans, for lung cancer
People with a Medicare plan should talk with their doctor to determine their cancer risk and which screenings they need.
Medicare Part B usually covers 80% of outpatient cancer-related services, such as radiation therapy and chemotherapy. The insured person is responsible for a 20% coinsurance.
Although it may vary, people might have to fund deductibles, copayments, or coinsurance for some costs of the cancer treatment.
These may vary depending on the doctor, the type of facility, and the treatment location. For example, the price of a CT scan may vary between one city and the next, or between an outpatient facility and a hospital.
It can be helpful to talk with a healthcare provider to find out what a test or procedure costs. Medigap, or Medicare supplement plans, will usually cover out-of-pocket expenses.
Medicare may exclude costs related to some elements of cancer treatment. For example, Medicare does not cover holistic or alternative cancer treatments, such as herbal remedies.
Although Medicare may cover some costs associated with participating in a clinical trial, it does not cover everything. For instance, Medicare also does not cover tests administered during a clinical study to gather data.
However, the hospital should clarify whether or not they will fund these costs.
Other cancer exclusions include the cost of a wig. For example, certain types of cancer drug can lead to hair loss as a side effect. This can contribute to emotional distress in some people. Medicare does not deem a wig to be medically necessary, however, so they will not cover the cost.
Medicare also excludes certain other costs, such as long-term home nursing care and nutritional supplements other than tube feeding. For example, Medicare does not cover vitamins and protein drinks.
Services that are not medically necessary are also excluded. For example, a treating healthcare provider may prescribe a medication or procedure outside of what Medicare deems necessary.
People with a Medicare Advantage plan may have different coverage for certain aspects of cancer care, such as wigs. Private insurers administer Medicare Advantage plans.
Private insurers must provide the same coverage as Medicare parts A and B. However, in some cases, Medicare Advantage plans offer additional benefits and coverage. Since these plans vary by location and policy, it is best to check with the insurance provider for specific details.
Medicare covers cancer treatment and some types of cancer screening. Different parts of Medicare cover different aspects of treatment.
Medigap plans may cover the out-of-pocket costs of Medicare parts A and B. Medicare Advantage plans also cover cancer treatment, and some cover additional services that original Medicare does not, such as wigs.