Does Medicaid Cover Radiation Therapy?

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  • Does Medicaid cover radiation therapy? Find out how state and federal funding for radiation therapy works and how much the treatment costs out of pocket.

If your doctor recommends radiation therapy to treat cancer, the last thing you want to worry about is how to fund your care. Therefore, it's important to understand which plans are available to finance this life-saving treatment. 

So, does Medicaid cover radiation therapy? Below, you can find out which state and federal health care plans cover radiation therapy and how much the treatment costs out of pocket. 

Does Medicaid Cover Radiation Therapy?

Medicaid covers radiation treatment for eligible enrollees. Some states don't charge beneficiaries anything when they receive radiation therapy through Medicaid, but others charge a small copayment. 

States vary widely in the number of treatment episodes covered and the reimbursement amount paid. A recent study found that the reimbursement amount ranged between $2,945 and $15,218 per treatment episode for the 48 states with data available. You can find out how your state's Medicaid program covers radiation therapy by contacting your local Medicaid Agency

Does Medicare Cover Radiation Therapy?

Medicare Part A may cover medically necessary radiation therapy if you are admitted to a hospital as an inpatient. Enrollees receiving funding through Part A are liable for the deductible and coinsurance if your stay exceeds 60 days. As of 2021, the Part A deductible is $1,484, and coinsurance is charged at a rate of $371 per day between days 61 and 90. If your stay exceeds 90 days, you will be charged $742 for each lifetime reserve day, and you can claim up to 60 lifetime reserve days in total over your life. 

If you have treatment as an outpatient and are eligible for Medicare funding, you'll receive funding through Medicare Part B. All enrollees receiving treatment through Part B are liable to pay the Part B deductible, which is $203 as of 2021. You will also have to pay 20% of the Medicare-approved amount for your treatment. 

What Is Radiation Therapy?

Radiation therapy uses high-dose radiation beams to treat cancer. During treatment, doctors use a machine to direct radiation beams at the tumor. Radiation therapy is often used to cure cancer, but it is sometimes used as a palliative treatment to extend a beneficiary's life by slowing the cancer's growth or to reduce symptoms.

Doctors sometimes use radiation therapy in conjunction with other cancer treatments. For example, they may recommend radiation therapy to reduce the size of a tumor before performing surgery to remove it. 

Does Medicaid Pay for Cancer Treatment?

Medicaid pays for cancer treatment for many low-income enrollees, and it's estimated that around 2 million people with a cancer history receive their health care through Medicaid. States have leeway to choose which non-mandatory benefits to offer, but all must cover inpatient and outpatient hospital care and certain preventative screenings. 

Although prescription drugs are not a mandatory benefit, all states currently cover prescription drugs through Medicaid. Generally, Medicaid covers all approved drugs prescribed by a doctor to treat cancer, providing it is manufactured by a company with a Medicaid rebate agreement. The CMS has rejected applications from states wishing to limit the types of cancer treatment drugs funded through Medicaid because such limits could result in less effective treatment for beneficiaries.

How Much Does Radiation Treatment Cost?

Radiation therapy generally costs between $10,000 and $50,000 out-of-pocket, but the costs could be significantly higher. The overall costs per treatment episode depend on the type and location of the tumor, how many sessions are required and the type of radiation used. Stereotactic radiosurgery is generally more expensive than traditional radiation therapy treatment. 

The costs of radiation therapy generally include the use of X-ray or CT equipment to direct the radiation beam and the fees charged by the doctor to plan treatment. However, you may need to pay for regular follow-up appointments to monitor your condition for several years following successful treatment. 

Most people rely on Medicaid, Medicare or private health care insurance to pay for radiation therapy. All private health care insurers must cover cancer treatments such as radiation therapy, but insurers may limit the types of radiation therapy covered. If you have private health insurance or Medicare, you'll be liable to pay coinsurance and deductibles toward the cost of your treatment. You may be eligible to purchase supplementary insurance to help you cover your financial liabilities during cancer treatment.

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