Does Medicare Cover Cancer Treatment?
If you’re dealing with a diagnosis of cancer, you shouldn’t have to worry about how you are going to pay for your treatment. This is a time when all your focus should be on getting stronger and into recovery.
Today, cancer treatments have made great advances, but some are still very costly. That’s why it’s important to know how your Medicare benefits will help you. Medicare may help cover medically necessary treatments, supplies, services, and prescription drugs to help you get through this difficult time.
Does Medicare cover cancer treatment?
Medicare covers your cancer treatment if it is ordered by a physician who accepts Medicare assignment. Here’s a breakdown explaining what each part of Medicare covers:
Original Medicare Part A
Original Medicare Part A is inpatient hospital insurance. It covers hospital stays and cancer treatments while you are an inpatient in a hospital that accepts Medicare assignment. If you receive treatment in a hospital as an outpatient, this is covered by Original Medicare Part B.
Part A also covers the following services and supplies for cancer treatment and care:
- Skilled nursing facility care when it follows a related hospital stay of at least three days. The facility must accept Medicare assignment.
- Home health care services
- Some of the cost for clinical research studies conducted during hospital inpatient stays.
- Breast prostheses that you have surgically implanted (as an inpatient) after a mastectomy.
- Hospice care in a facility that accepts Medicare assignment.
Through Medicare Part A, you are responsible for deductibles and cost-sharing expenses.
Original Medicare Part B
Original Medicare Part B covers the following medically necessary outpatient services and treatments for cancer patients:
- Visits with health care providers/physicians/specialists who accept Medicare assignment.
- Chemotherapy drugs administered intravenously while you are an outpatient in a doctor’s office or other medical facility that accepts Medicare assignment.
- Non-laboratory diagnostic tests like CT or MRI scans, and X-rays
- Durable medical equipment
- Enteral nutrition equipment
- Outpatient surgeries
- External breast prostheses after a mastectomy like a post-surgical bra
- Surgically implanted breast prostheses when it is outpatient surgery
- A second opinion for surgery that isn’t an emergency (under some circumstances), and a third option if the first and second don’t agree.
- Mental health services provided as an outpatient
- Nutritional counseling for those with diabetes or kidney disease
- Some preventive and screening services
- Some costs for clinical research studies done as an outpatient
Original Medicare Part B pays 100 percent of the cost for some of the services above.For others, Part B pays 80 percent of the final approved cost, and you pay the remaining 20 percent after meeting your annual Part B deductible.
Medicare Advantage (Part C)
If you are enrolled in Medicare Part C, your Medicare Advantage plan is required to provide the same coverage as Original Medicare. However, you may need to use health care providers, physicians, medical facilities, hospitals, and medical suppliers that participate in your plan’s network of providers.
Before making any appointments, ask your plan provider for information about who you can visit for your care. Your out-of-pocket costs for coinsurance and deductibles depend on your individual Part C plan.
Medicare Part D
Medicare Part D prescription drug plans cover some chemotherapy treatments and drugs. It may also cover the following cancer medications:
- Oral prescription drugs for chemotherapy
- Anti-nausea medication
- Prescription drugs needed during cancer treatment, such as pain medication
Your costs depend on what your Part D plan charges for coinsurance and is based on the plan’s formulary and drug tiers.