Does Medicare Cover Chemotherapy?
- Does Medicare cover chemotherapy? Find out more about whether these cancer treatments are covered and under which plans, as well as what you might pay.
Cancer can be diagnosed in anyone at any age, and more than 4,500 people are diagnosed in the U.S. daily. There are a number of treatments for cancer; one of the most commonly prescribed is chemotherapy and related medication. This treatment can be costly, and Medicare beneficiaries have an interest in knowing whether Medicare covers chemotherapy and if they will be able to afford this treatment.
Does Medicare Cover Chemotherapy?
Chemotherapy is described by the American Cancer Society as certain types of medications that are used in the treatment of cancer. There are many types of medications that are used; the type used in any specific treatment is determined by the type of cancer a patient has and the degree to which it has spread at the time of diagnosis. Chemotherapy is available in pills, capsules, as a liquid and in injectable forms.
Medicare may cover chemotherapy if a doctor has diagnosed a beneficiary with cancer and has prescribed it as a treatment. It also may provide coverage for the administration of chemotherapy in a hospital or clinic setting or in a doctor’s surgery. Medicare may also cover these medications when administered in a beneficiary's home.
What Medicare Plans Cover Chemotherapy?
Medicare can cover chemotherapy for those with a cancer diagnosis and contributes towards the cost of chemotherapy through Medicare Parts A, B and D, depending on how the treatment is prescribed and administered.
Medicare Part A
Medicare Part A, which provides hospital coverage, may cover a variety of treatments such as chemotherapy for those requiring inpatient hospitalization.
Medicare Part B
Medicare Part B may cover a number of treatments for hospital outpatients and for patients in clinics and doctors’ practices. It might also cover oral and intravenous chemotherapy as well as assisting with the cost of medications. Hospitals conducting research on cancer treatments and Medicare can additionally cover many of the costs associated with these treatments for those participating in the studies.
Medicare Part D
Medicare Part D may cover chemotherapy if it is administered orally and under certain circumstances. It may also cover the cost of additional cancer medications as well as medications that treat the side effects of cancer treatments.
What Is the Cost of Cancer Treatment with Medicare?
The costs of cancer treatments can be covered for beneficiaries that have been prescribed medication by doctors that accept Medicare. Sometimes very particular criteria need to be met before coverage is provided for treatments. Coverage under Medicare Part B pays for 80 percent of the cost of enrollees’ allowed charges for cancer treatments, leaving the remaining 20 percent to be paid by the beneficiary.
How Much Is a Medicare Beneficiary's Chemotherapy Out of Pocket Cost?
Chemotherapy is one of the treatments that are prescribed most often for cancer and can cost beneficiaries anywhere between $1,000 and $12,000 per month. Those without health insurance can be responsible for paying chemotherapy costs that range from $10,000 to $200,000.
The amount charged for chemotherapy is also dependent on factors such as the type of cancer diagnosis, the type of chemotherapy prescribed, the number of treatments, the stage of cancer and the treatment setting.
Cancer Treatment Options
There are many kinds of cancer treatments, and the type a patient receives will largely depend on the type of cancer and its level of advancement. Some of the most commonly prescribed treatments include:
- Surgery to eliminate the tumor
- Chemotherapy medications to destroy cancer cells
- Radiation therapy to reduce the size of tumors and eliminate cancer cells
Immunotherapy to enhance the ability of the immune system to fight the cancer