Cancer Treatment and Medicare
Medicare covers chemotherapy if you have cancer.
Medicare Part A (Hospital Insurance) covers it if you're a hospital inpatient. Medicare Part B (Medical Insurance) covers it if you're a hospital outpatient or a patient in a doctor's office or freestanding clinic.
Your costs in Original Medicare
You pay a copayment for chemotherapy covered under Part B in a hospital outpatient setting. For chemotherapy given in a doctor's office or freestanding clinic, you pay 20% of the Medicare-Approved Amount, and the Part B deductible applies.
Chemotherapy cost may depend on how the chemotherapy medications are administered. If chemotherapy is administered by IV at a doctor office Medicare part B may cover it and if it is administered by vein in a hospital, Medicare Part A may cover it. According to the American Cancer Society oral chemotherapy cancer treatment costs a lot, sometimes many thousands of dollars each month. For help paying chemotherapy costs for prescription drugs you take at home, you may want a Medicare Part D Prescription Drug Plan. You can get Medicare Part D coverage through a stand-alone Prescription Drug Plan or a Medicare Advantage prescription drug plan.
Medicare Part A
Medicare Part A covers hospital care. Most people don't pay a montly premium for Medicare Part A.
Cancer care and service Part A covers include:
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Cancer treatment
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Diagnostic testing you receive while you're in the hospital
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Inpatient Surgical Procedures to remove a cancerous mass
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Surgically implanted breast prostheses after a mastectomy.
Medicare Part B
Medicare Part B covers medically necessary outpatient care. Medicare Part B is what covers most types of cancer treatment.
Cancer care and service covered by part B include:
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Visits with you general practitioner
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Visits to your oncologist and other specialists
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Diagnostic testing, such as X-rays and blood work
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Outpatient surgery
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Intravenous and some oral chemotherapy treatments
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Durable medical equipment, such as walkers, wheelchairs, and feeding pumps
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Mental health services
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Certain preventive care screenings
Medicare Part C (Medicare Advantage)
Medicare Part C, also called Medicare Advantage, refers to private health insurance plans that bundle the benefits of Medicare parts A and B and sometimes part D.
These private health insurance plans are required to cover everything that original Medicare would cover. The premiums for Medicare Part C are sometimes higher, but things like covered services, participating doctors, and copays might provide better options for some people.
The annual enrollment period for
Medicare Part C and D begins October 15
and ends December 7 each year.
Medicare Part D
Medicare Part D covers prescription drugs. Medicare Part D may cover some oral chemotherapy drugs, anti-nausea medications, pain medications, and other medications you doctor prescribes as a part of your cancer treatment.
This coverage isn't automatically a part of Medicare or Medicare Advantage, and different plans have different restrictions on which drugs they'll cover.
Medicare Supplement (Medigap)
Medigap plans are private insurance policies that help cover your share of Medicare costs. You have to pay a premium for Medigap, and in exchange, the plan reduces or eliminates some copays and may lower your coinsurance and deductible amount.