Does Medicare Cover Proton Therapy?

Christian Worstell
In this article...
  • Does Medicare cover proton therapy? Find out who is a candidate for proton therapy through Medicare and how much you'll need to pay with and without insurance.

Medicare may cover proton beam therapy to treat cancer if it is the most appropriate treatment for your condition and health status. You will need to meet various eligibility criteria to qualify for proton beam therapy funding through Medicare. Generally, Medicare will pay up to 80% of your approved costs if you're eligible. 

Qualifying beneficiaries will be required to pay Medicare Part A and/or Part B deductibles, coinsurance and copayments.

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Who Is a Candidate for Proton Therapy Through Medicare?

Medicare may consider funding proton beam therapy for certain types of cancer where there is a strong body of evidence to support its efficacy, such as solid tumors in children and central nervous system tumors.

For types of cancer with limited evidence available, Medicare may provide funding if the beneficiary is enrolled in a clinical study. Medicare will not consider paying for treatment unless the therapy delivery system is FDA-approved.

Your doctor must provide evidence that there is a strong rationale for using proton beam therapy to treat your cancer instead of more conventional treatments.

If you're being treated for a primary lesion, your medical team must certify that you can have a reasonable expectation of being cured using the protocol.

If you have secondary lesions, you will need to provide evidence that proton beam therapy would likely either eliminate your lesions or make them significantly easier to control, resulting in at least 2 years of added life expectancy.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

How Much Does Proton Therapy Cost Without Insurance?

As of 2017, a course of proton beam therapy costs between $30,000 and $120,000. However, exact costs will vary depending on various factors, including the size and location of the tumor and the treatment duration.

What Is Proton Therapy?

Proton therapy is a form of radiotherapy that uses protons to kill cancer cells. Protons are particles with a positive charge that can penetrate deep into the body to target cancerous lesions. Unlike regular radiotherapy, proton therapy minimizes the exposure of the surrounding tissues to radiation. 

Proton beam therapy is often performed as an outpatient treatment. During treatment, the affected individual is positioned carefully and a proton beam is directed accurately towards their tumor. Physicians may take medical images such as X-rays during treatment to ensure that the person adopts exactly the same position each time. It's important to stay still during proton beam therapy so that the beam penetrates the correct area. 

Proton beam therapy doesn't hurt at the point of treatment, but the surrounding skin may feel sore and irritated for a while afterward. Proton beam therapy is often used in conjunction with other cancer treatments, such as chemotherapy and radiotherapy, which may cause further side effects.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at

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