Receiving a cancer diagnosis can be life changing, and treatment may be costly. Depending on the type of cancer a person has, Medicare covers some treatments from parts A and B.
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 of 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 parts A, B, C, and D can cover different aspects of cancer treatment.
Medicare Part A covers eligible cancer treatments that involve an inpatient hospital stay. For example, it may cover the following:
- inpatient chemotherapy
- inpatient hospital stays for surgery to remove or treat cancer
- skilled nursing facility care after a 3-day hospital stay
- home healthcare, such as physical and occupational therapy
- surgically implanted breast prostheses after a mastectomy, when the surgery takes place at an inpatient facility
- hospice care
- blood transfusions
- some costs of clinical research in hospital settings
Medicare Part B may cover a variety of outpatient cancer services and treatments, such as:
- outpatient chemotherapy, such as treatment at an infusion center
- radiation therapy at an outpatient center
- some oral chemotherapy
- outpatient surgery, such as the implantation of a port for chemotherapy
- durable medical equipment, such as a walker or supplemental oxygen
- tests to diagnose or evaluate cancer treatment, such as CT scans
- equipment for external nutritional support at home, such as feeding tubes and pumps
- some costs of medical research as an outpatient
- external breast prostheses after a mastectomy
- breast implants after a mastectomy, when the surgery takes place on an outpatient basis
- certain screenings
- doctor’s office visits
A person with Medicare Advantage, also known as Medicare Part C, must have at least the same coverage as a person with original Medicare, which comprises parts A and B. However, rates and rules may differ from original Medicare.
Medicare Advantage plans may also bundle Part D into their coverage to cover the cost of prescription medications. For example, if Medicare Part B does not cover a drug and 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.
Depending on the circumstances, a person may receive chemotherapy drugs orally, intravenously, or
Medicare covers chemotherapy for cancer treatment as long as the person’s doctor confirms that the treatment is medically necessary. Hospitals and clinics will usually administer chemotherapy, but some people also receive this treatment at home.
Medicare Part D sometimes covers chemotherapy if a person takes the medications orally. It also covers other cancer drugs.
Medicare Part B usually covers 80% of outpatient cancer-related services, such as radiation therapy and chemotherapy, after a $203 deductible. The insured person is responsible for paying the remaining 20% of the costs.
Medicare Part A covers inpatient expenses related to cancer treatment. A person needs to pay a $1,484 deductible for each benefit period. Costs then vary based on the number of days the person is in the hospital. For example, for the first 60 days, the person will pay nothing for coinsurance.
Costs may vary depending on the doctor, the type of facility, the person’s income, and the treatment location. According to one 2017 study, annual out-of-pocket costs ranged from
For people who need extra help with the costs, Medicare supplement plans, also known as Medigap plans, can help cover out-of-pocket expenses.
It can also be helpful to talk with a healthcare professional before a procedure to find out whether or not they “accept assignment.” If they do, they have already agreed to charge no more than the Medicare-approved amount for the service. This can help reduce a person’s out-of-pocket responsibility.
Typically, Medicare Part B covers cancer screening. However, several determining factors can affect coverage and costs, including:
- the person’s age
- their risk factors, such as a family history of a specific type of 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 when they do not take place in a hospital setting. Covered screenings may include:
- a mammogram to screen for breast cancer
- a Pap smear test to screen for cervical cancer
- a fecal blood test and colonoscopy to screen for colon cancer
- prostate-specific antigen tests and a rectal exam to screen for prostate cancer
- low-dose CT scans to screen for lung cancer
People with a Medicare plan should talk with a doctor to determine their cancer risk and which screenings they need.
Medicare does not cover any service, treatment, or medication that is not medically necessary. There are also limitations on coverage. For example, Medicare does not cover costs associated with:
- room and board in assisted living facilities
- services that help people with activities of daily living, such as eating or bathing, that do not require skilled care
- adult daycare
- medical food or nutritional supplements
- long-term nursing home care
A person should talk with a doctor and ask questions about the services, treatments, and medications they are recommending.
Since Medicare does not cover all possible treatments, people should check with a doctor to ensure that their coverage includes the recommended treatment. If Medicare does not cover a recommended treatment, a doctor may be able to suggest an alternative treatment that Medicare does cover.
Medicare does not cover all related expenses. For example, if a person loses their hair due to cancer treatment, Medicare will not cover the cost of a wig, as it is not medically necessary. However, Medicare will cover surgically implanted breast prostheses after a mastectomy.
A person can check Medicare’s website for a list of all covered medical treatments.
The different parts of Medicare cover cancer treatments, medications, and some types of cancer screening. A person will still be responsible for some of the cost, however. People’s total out-of-pocket expenses will vary.
People should talk with a doctor about all recommended treatments, screenings, and medications to make sure that Medicare will cover some of the associated costs. If Medicare does not cover a recommended treatment, a doctor may be able to recommend a different treatment option.