The costs of treating cancer add up fast. If you have Medicare, many of those expenses are included in your coverage.
This article will answer basic questions about how to find out how much you will owe for your cancer treatment if you have Medicare.
If you receive a serious cancer diagnosis, you may want to call the Medicare Health Line at 800-633-4227. This line is available 24/7 and can give you specific answers about anticipating your costs.
When does Medicare cover cancer treatment?
Medicare covers cancer treatment prescribed by a doctor who accepts Medicare.
Medicare pays 80 percent of what your care provider bills for prescribed, approved cancer treatments. You’re responsible for 20 percent of the billed amount until you hit your annual deductible.
Some doctor’s visits and procedures must meet unique criteria to be approved by Medicare.
For example, if you need surgery, Medicare will pay for you to consult with a surgical oncologist and another surgical oncologist for a second opinion. Medicare will pay for you to get a third opinion, but only if the first and second doctors don’t agree.
If you have Medicare, it covers cancer treatment no matter how old you are. If you have Medicare Part D, prescription drugs that are a part of your cancer treatment are also covered.
What parts of Medicare cover cancer treatment?
Medicare is a federal program in the United States, governed by several sets of laws. These policies are the “parts” of Medicare. Different parts of Medicare cover different aspects of your cancer treatment.
Medicare Part A
Medicare Part A covers hospital care. Most people don’t pay a monthly premium for Medicare Part A.
Cancer care and services part A covers includes:
- cancer treatment
- diagnostic testing you receive while you’re in the hospital
- inpatient surgical procedures to remove a cancerous mass
- surgically implanted breast prostheses after a mastectomy
Medicare Part B
Cancer care and services covered by part B include:
- visits with your general practitioner
- visits to your oncologist and other specialists
- diagnostic testing, such as X-rays and blood work
- outpatient surgery
- intravenous and some oral chemotherapy treatments
- durable medical equipment, such as walkers, wheelchairs, and feeding pumps
- mental health services
- 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.
Medicare Part D
Medicare Part D covers prescription drugs. Medicare Part D may cover some oral chemotherapy drugs, antinausea medications, pain medications, and other medications your 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.
How do I find out my out-of-pocket cost for cancer treatment?
Before you go to any doctor for your cancer treatment, call their office and see if they “accept assignment.” Doctors who accept assignment take the amount that Medicare pays, as well as your copayment, and considers that a “full payment” for services.
Doctors who have opted out of Medicare may bill above the amount that Medicare will cover for your treatment, leaving you responsible for what’s leftover, in addition to your copay.
Average out-of-pocket costs for cancer treatment vary. The type of cancer you have, how aggressive it is, and the treatment type your doctors prescribe are all factors in how much it will cost.
One 2017 study found that the average annual out-of-pocket costs for cancer treatment ranged from $2,116 to $8,115 depending on what type of Medicare or insurance coverage participants had.
If you receive a diagnosis of any type of cancer, you’ll most likely meet your Medicare deductibles for Part B that year. In 2021, the deductible amount for Medicare Part B is $203.
In addition to your monthly premiums, you’ll be responsible for 20 percent of outpatient costs until you hit that annual deductible.
If your treatment includes hospital stays, inpatient surgery, or other types of inpatient treatment, it could start to run in the multiple thousands of dollars, even with Medicaid or other insurance.
What are your cancer treatment options?
Cancer treatment is highly individualized. Several types of doctors work together to come up with a treatment plan that addresses your needs. A comprehensive cancer treatment plan will include one or more of the following types of treatments, all of which can be covered by Medicare.
- Surgery. Surgery may be recommended for removing cancerous tumors.
- Chemotherapy. Chemotherapy involves chemicals given orally or intravenously to kill cancer cells and stop cancer from spreading.
- Radiation. Radiation therapy uses intense beams of energy to kill cancer cells.
- Hormone therapy. Hormone therapy uses synthetic hormone and hormone blockers to target cancers that use hormones to grow.
- Immunotherapy. Immunotherapy drugs use your body’s immune system to attack cancer cells.
- Genetic therapy. These newer therapies typically deliver a virus to a cancer cell that will target and help destroy it.
One kind of cancer treatment that isn’t covered by Medicare is alternative or holistic therapy. These treatments, which can include dietary changes, supplements, oils, and natural extracts, are not part of Medicare’s cancer coverage.
Cancer treatment can be very costly. Medicare absorbs much of this cost, but you’ll still need to pay a significant portion of it.
Before beginning any treatment, it’s important to be sure your doctor accepts assignment. Asking questions about cost and if there are less costly options available can also help minimize the cost of your care.