Does Medicare Cover Immunotherapy for Cancer?
- Immunotherapy uses the body's own immune system to fight cancer. Learn whether Medicare covers immunotherapy for cancer and what you can expect from treatment.
Immunotherapy is a treatment that uses the body’s own immune system to fight cancer. Although this treatment isn’t as common as chemotherapy or radiation, your oncologist may recommend a course of immunotherapy if you’ve received a cancer diagnosis. For Medicare beneficiaries who want to know, “Does Medicare cover immunotherapy for cancer treatment?” the answer is yes. Keep reading to learn more about this up-and-coming treatment, including Medicare’s coverage rules.
What Is Immunotherapy?
Immunotherapy is a biological therapy that helps the body’s immune system fight cancer and certain other diseases. Immunotherapy can boost natural immunity, enhance your body’s immune response and teach your immune system to recognize and attack cancer cells. Treatments may come in a variety of forms, including:
- Cancer vaccines
- Targeted antibodies
- Tumor-infecting viruses
- Checkpoint inhibitors
- Adoptive cell transfer
When immunotherapy is used to suppress cancer, it may also be referred to as immuno-oncology. It may be combined with surgery, radiation, chemotherapy or other therapies, and it’s sometimes used as a last resort when these other therapies are no longer effective.
What Types of Cancer Does Immunotherapy Treat?
Immunotherapy can potentially be used to treat any type of cancer in any area of the body, including those that are inoperable. Common types of cancer treated by immunotherapy techniques include:
- Bladder cancer
- Brain tumors
- Breast cancer
- Ovarian cancer
- Prostate cancer
- Lung cancer
- Colorectal cancer
How Are Immunotherapy Treatments Administered?
Depending on the individual therapy and the type of cancer being treated, immunotherapy treatments may be administered several ways:
- Oral drugs, which are swallowed
- Intravenous drugs or infusions, which are administered into a vein
- Topical medications, which are applied directly to the skin
- Intravesical drugs, which are inserted into the bladder
Most immunotherapy treatments are given in an outpatient setting such as a doctor’s office or clinic. The frequency and duration of treatments vary depending on the type of medication and the cancer being treated.
How Can Immunotherapy Benefit People Undergoing Cancer Treatments?
Although immunotherapy isn’t the right choice for everyone undergoing cancer treatment, it may lead to better outcomes for some people diagnosed with this disease. That's because it's designed to work with the body's own immune system, which continuously learns and adapts to effectively fight illness.
Immunotherapy may have the following benefits:
- It’s precise enough to target cancer cells while sparing healthy tissue
- It can launch new attacks on tumors that may have escaped initial detection.
- It can target cancer if it returns, providing ongoing protection from new occurrences of tumors
- It can target cancer anywhere in the body, including tumors that are deemed inoperable
Does Medicare Cover Immunotherapy for Cancer?
Yes. Both Original Medicare and Medicare Advantage plans cover immunotherapy as a cancer treatment if it's deemed medically necessary by a Medicare-approved doctor. If you have Original Medicare, treatment may be covered under Part A if the therapy is administered in an inpatient setting and under Part B if it’s received on an outpatient basis.
How Much Does Medicare Pay for Immunotherapy?
If you’re receiving immunotherapy in an outpatient setting, Medicare Part B typically pays 80% of treatment costs after you’ve met your $203 deductible. Beneficiaries are then responsible for paying the 20% co-insurance. Because there’s no annual limit for co-insurance costs, ongoing treatment can become expensive.
If you’re receiving immunotherapy during an inpatient hospital stay, it’s covered under Medicare Part A, which has a deductible of $1,484 per benefit period in 2021. After a beneficiary meets this deductible, they’re responsible for paying the plan’s co-insurance, which varies depending on the length of the inpatient stay.
Because Medicare Advantage plans are administered by private health insurance companies, coverage may vary by policy and insurer. However, Medicare Advantage plans are generally required to cover at least as much as Original Medicare.
Does Medicare Cover Keytruda?
Medicare Part B generally covers Keytruda if it’s deemed medically necessary by a Medicare-approved doctor. The medication, which is usually administered by infusion every three weeks in an outpatient setting, is currently FDA-approved to treat certain types of cancers, including lung cancer and melanoma. Medicare Part B typically pays 80% of the cost of the drug and any related expenses after your Part B deductible has been met.
Keytruda is also reimbursable under Medicare Advantage plans, although out-of-pocket costs may vary by insurer and individual policy.
Can Medigap Help With Immunotherapy Costs?
Medicare Supplement Insurance, which is also referred to as Medigap, may be purchased from private insurance companies to help pay for the out-of-pocket expenses remaining after Medicare coverage. These optional policies, which work alongside your Medicare plan, may cover some or all of the costs of co-insurance, co-pays and deductibles for immunotherapy treatments. Coverage specifics vary by plan and carrier.
Does Private Insurance Cover Immunotherapy?
Although coverage through private health insurance varies widely from plan to plan, most policies cover medically necessary cancer treatments such as immunotherapy.
Where Can I Find Help With the Cost of Cancer Care?
Cancer treatments are expensive and the cost of care can add up quickly. Financial help may be available through several national service organizations:
- Cancer Financial Assistance Organization: CFAC offers practical and financial resources to help cancer patients address their financial challenges. The organization maintains a database of resources and offers tips for finding assistance in your own community.
- CancerCare: This organization may be able to help cover expenses related to cancer care, including medical transportation and home care. It also maintains a database of organizations that may be able to provide additional financial support.
- The HealthWell Foundation: The HealthWell Foundation's mission is to help cancer patients afford medications and essential treatments and to provide financial assistance for other cancer-related costs.
- The Leukemia & Lymphoma Society: LLS offers financial assistance programs for anyone diagnosed with an eligible blood cancer. Funds are designed to help pay for treatment-related expenses.
Because bills can add up quickly, most organizations recommend seeking financial help soon after diagnosis.