Cancer treatment can be expensive, but if you have Medicare, many of these costs are covered. This article explains how Medicare helps pay for cancer treatment and what you might need to pay out of pocket.
When Does Medicare Cover Cancer Treatment?
Medicare covers cancer treatment when it’s provided by a doctor or facility that accepts Medicare. Here’s how it works:
- Medicare pays 80% of the approved cost for cancer treatments.
- You pay the remaining 20% until you meet your annual deductible.
Medicare also covers:
- Second opinions: If you need surgery, Medicare pays for a second opinion. If the first two doctors disagree, Medicare will even cover a third opinion.
- Prescription drugs: If you have Medicare Part D, it covers medications used in cancer treatment, like chemotherapy drugs or pain relievers.
What Parts of Medicare Cover Cancer Treatment?
Medicare has different parts that cover various aspects of cancer care:
Medicare Part A (Hospital Insurance)
- Covers hospital stays and inpatient care.
- Includes:
- Cancer treatment in the hospital
- Diagnostic tests (like scans or blood work)
- Surgery to remove tumors
- Breast prostheses after a mastectomy
Medicare Part B (Medical Insurance)
- Covers outpatient care and doctor visits.
- Includes:
- Visits to your oncologist or other specialists
- Diagnostic tests (like X-rays or MRIs)
- Outpatient surgery
- Chemotherapy (IV and some oral medications)
- Medical equipment (like wheelchairs or walkers)
- Mental health services
- Preventive screenings (like mammograms or colonoscopies)
Medicare Part C (Medicare Advantage)
- These are private insurance plans that combine Parts A and B, and sometimes Part D.
- They must cover everything Original Medicare covers, but they may offer extra benefits like lower copays or more flexible doctor networks.
Medicare Part D (Prescription Drug Coverage)
- Covers prescription drugs, including:
- Oral chemotherapy
- Anti-nausea medications
- Pain relievers
- You need to enroll in a Part D plan separately.
Medigap (Medicare Supplement)
- These are private plans that help pay for costs Medicare doesn’t cover, like copays, deductibles, and coinsurance.
- You pay a monthly premium for Medigap, but it can reduce your out-of-pocket costs.
How Much Will I Pay for Cancer Treatment?
Your out-of-pocket costs depend on:
- The type of cancer and treatment
- Whether your doctor accepts Medicare assignment (meaning they accept Medicare’s approved amount as full payment)
- Your Medicare plan (Original Medicare, Medicare Advantage, or Medigap)
Average Costs
- A 2017 study found that out-of-pocket costs for cancer treatment ranged from 2,116to8,115 per year, depending on your insurance.
- In 2024, the Medicare Part B deductible is $240. After you meet this, you pay 20% of the cost for outpatient services.
Tips to Reduce Costs
- Check if your doctor accepts Medicare assignment: This ensures you won’t be billed more than Medicare’s approved amount.
- Ask about payment plans: Many hospitals offer payment plans or financial assistance.
- Compare Medicare Advantage plans: Some plans may offer lower copays or extra benefits.
What Cancer Treatments Does Medicare Cover?
Medicare covers a wide range of cancer treatments, including:
- Surgery: To remove tumors
- Chemotherapy: Both IV and some oral medications
- Radiation therapy
- Hormone therapy
- Immunotherapy
- Genetic therapy
Medicare does not cover alternative or holistic therapies, such as dietary supplements or natural remedies.
Frequently Asked Questions
What percentage of cancer treatment does Medicare cover?
Medicare covers 80% of the cost for approved treatments. You pay the remaining 20%.
What if I can’t afford cancer treatment?
- Talk to your hospital’s financial office about payment plans or financial assistance.
- Look into programs like Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
- The No Surprises Act protects you from being overcharged for out-of-network care.
Does Medicare cover stage 4 cancer?
Yes, Medicare covers cancer treatment at any stage, including stage 4.
How much does chemotherapy cost with Medicare?
- Without insurance, chemotherapy can cost 10,000to200,000 or more.
- With Medicare, you pay 20% of the cost after meeting your deductible.
Key Takeaways
- Medicare covers 80% of approved cancer treatment costs. You pay the remaining 20%.
- Medicare Part A covers hospital stays, Part B covers outpatient care, and Part D covers prescription drugs.
- Medicare Advantage (Part C) and Medigap can help reduce out-of-pocket costs.
- Always check if your doctor accepts Medicare assignment to avoid unexpected bills.
If you have questions about your coverage, call the Medicare Health Line at 800-633-4227. They can help you understand your costs and coverage options.