Original Medicare Part A covers the radiation therapy someone receives as an inpatient in the hospital. Part B covers the radiation therapy a person receives as an outpatient in a clinic.

Under Original Medicare, coverage is available for both inpatient and outpatient radiation therapy with set out-of-pocket expenses.

Medicare Advantage provides radiation therapy coverage through parts A and B. However, out-of-pocket costs differ.

This article examines Medicare coverage of radiation therapy, out-of-pocket costs, and how to get help with the cost of radiation therapy.

Glossary of Medicare terms

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.
Woman Receiving a radiation therapy for Cancer Diagnosis cover by medicareShare on Pinterest
Credit: Mark Kostich/Getty Images

All parts of Medicare help with the costs of medically necessary cancer treatment, including radiation therapy.

Original Medicare

Original Medicare provides hospital insurance through Part A and medical insurance through Part B. Part A covers cancer treatment someone receives in the hospital, including radiation therapy.

Also, Part A covers skilled nursing facility care for a limited time following a 3-day stay at the hospital.

Part B covers radiation therapy in an outpatient clinic.

Medicare Advantage

Medicare Advantage, or Medicare Part C, is the alternative to Original Medicare.

It provides the coverage of parts A and B. This includes radiation therapy and other cancer treatments.

Medicare Part D

Those with original Medicare are eligible to purchase a Medicare Part D plan, which is prescription drug coverage the private insurance companies administer.

If Part B does not cover an individual’s oral cancer medication, their Part D plan may cover it.

Before buying a Part D plan, a person may wish to check the policy formulary. Formularies are lists of medications that a plan covers and often differ between providers.

Other cancer-related drugs that Part D may cover include medications for nausea and pain.

Medigap

Medigap is Medicare supplement insurance available for purchase by people with Original Medicare.

The plans cover 50% to 100% of out-of-pocket costs relating to parts A and B, including those for cancer treatment.

Each part of Medicare has out-of-pocket costs.

Part A

Part A costs for 2024 include:

  • $1,632 deductible for each benefit period
  • $0 coinsurance for the first 60 days of a benefit period
  • $408 per day coinsurance for days 61 to 90 of a benefit period

A benefit period starts the day a person enters the hospital and ends the day after they have been home from the hospital for 60 consecutive days.

Part B

Part B costs for 2024 include:

  • $174.70 monthly premium in most cases, though this may be dependent on income
  • $240 annual deductible
  • 20% coinsurance

If someone receives radiation therapy in an outpatient hospital setting, they may also owe a copayment.

Parts C and D

In Part C, to get lower costs, a person may need to use in-network providers. All Medicare Advantage plans have an annual cap on expenses.

Parts C and D costs include:

  • deductibles
  • copays
  • coinsurance
  • monthly premiums

These expenses vary among plans.

Medigap

The only Medigap cost is the monthly premium. The cost of the premium will depend on factors such as:

  • the insurance company
  • where the person lives
  • the specific plan

The following programs can help pay the costs for people with limited means:

  • Medicare savings programs: Medicare savings programs help pay some deductibles, copayments, coinsurance, and premiums. Each of the four programs has eligibility requirements that depend on someone’s income and resources.
  • Medicaid: Medicaid is a joint state and federal program that helps pay healthcare expenses for people who meet their income and resource requirements. It may also cover costs that Medicare does not cover, such as nursing home care.
  • Extra Help: Extra Help provides lower rates for prescription drugs. Individuals who qualify for the program pay no more than $4.50 for generic drugs and $11.20 for brand-name drugs.

Radiation therapy is a type of cancer treatment. It is sometimes called radiotherapy or X-ray therapy. It delivers high energy waves or particles to cancer cells.

A person’s cells usually grow and divide to form new cells. However, if someone has cancer, this process occurs faster.

Radiation causes small breaks inside cells’ DNA. This effect prevents cancer cells from growing and dividing, which leads to their damage or eradication.

Radiation can also affect the healthy cells that are near the targeted cancer cells, but most of them eventually recover.

Another form of radiation therapy involves taking radioactive substances by mouth or receiving them through a vein.

Although the substances travel throughout the body, they mostly collect in the area with cancer, so they have little effect on healthy cells.

According to the American Cancer Society, more than half of people with cancer receive radiation therapy. For some individuals who have cancer, it is the only treatment doctors recommend. However, for others, it is part of a regimen that involves several kinds of treatment.

Doctors advise radiation therapy for four purposes:

  • shrinking early stage cancer
  • lowering the risk that cancer will recur
  • reducing symptoms due to advanced cancer
  • treating cancer that has recurred

Medicare Part A and Part B cover radiation therapy and other cancer treatments. When a person with Original Medicare undergoes the treatment during a hospital stay, the out-of-pocket costs include a deductible. If their hospitalization extends past 60 days, they owe a coinsurance.

When someone with Original Medicare undergoes radiation therapy in an outpatient clinic or doctor’s office, their out-of-pocket costs include a deductible and a 20% coinsurance.

Out-of-pocket costs of Medicare Advantage plans are different. A person may wish to check their plan to get an idea of the expenses to expect.

Medicare Part D may help cover the costs of oral medications.

There are several programs to help cover out-of-pocket costs. These include Medicare savings programs, Medicaid, and Extra Help.