Medicare cancer coverage is an important concern for beneficiaries. More than 4,500 people get a cancer diagnosis in the U.S. daily according to the American Cancer Society, and the risk increases with age.
The good news is that Medicare does cover cancer treatment.
If you have a Part D prescription drug plan and a comprehensive Medigap plan, most of your treatment has 100 percent coverage.
Here are the facts on Medicare coverage for cancer treatments.
Medicare Coverage for Cancer Treatments
Medicare does cover cancer treatments. Your cancer coverage will work a little differently depending on whether you’re in the hospital or at a doctor’s office or outpatient center.
Part A Cancer Coverage
Cancer Testing and treatment administered during a hospital stay are covered by Part A’s hospitalization coverage. Before Part A begins to pay, however, you must meet a deductible.
If you have multiple hospital stays, you may end up paying the deductible more than once. Part A also pays the full cost of the first 20 days in a skilled nursing facility after cancer surgery, and it covers hospice care at a certified hospice facility.
A Medigap plan can reduce you out of pocket costs by paying your Part A deductible. It also provides expanded benefits for hospital stays and hospice care.
Part B Cancer Coverage
Medicare Part B covers cancer screenings and treatments at a doctor’s office or clinic. Part B’s preventive care benefits pay the full cost of some cancer screenings.
In addition, Part B pays 80 percent of the cost of chemotherapy, radiation, and tests done on an outpatient basis or at a doctor’s office. If you have a Medigap plan, your Medigap coverage takes care of the other 20 percent.
Advantage Cancer Coverage
Medicare Advantage plans give you Medicare Parts A and B benefits through private insurance coverage. Overall, though, Advantage plans usually are not the best choice for cancer patients. This is because most plans’ benefits aren’t as good as Original Medicare plus a Medigap policy.
- Advantage plans either require you to go to certain doctors within a network, or you will pay less if you use a network doctor. With Original Medicare plus Medigap, you can see any healthcare provider that accepts Medicare.
- Many MA plans require you to pay a coinsurance of up to 20 percent of the cost of covered services until you meet your annual out of pocket maximum. Medigap plans can pay this coinsurance for you.
- You can’t add a Medigap plan to your Advantage coverage. If you want better cancer coverage, you will have to buy a separate cancer policy.
Medicare Coverage for Cancer Medications
Medicare Part B covers some cancer medications, but others are not covered unless you have a Part D prescription drug plan. Cancer drugs can be extremely expensive. This means that Medicare prescription drug coverage is an essential part of your cancer protection strategy.
Part B covers 80 percent of the cost of intravenous cancer treatment and anti-nausea drugs. It also covers oral versions of these drugs if your doctor could have given you an intravenous dose but decided to give you a pill instead, and the pill is taken within 48 hours of your cancer treatment.
If you don’t have a Medigap plan to supplement your Part B coverage, you will be responsible for 20 percent of the cost of these drugs.
Part D covers cancer drugs that are not covered by Part B, including anti-nausea drugs that are only available in pill form, injections that you give yourself, and drugs designed to prevent cancer from recurring.
Your Part D prescription coverage offsets the high cost of cancer drugs. Your copays or coinsurance may be far less than what you would pay if you didn’t have drug coverage at all.
Healthcare Providers for Medicare Covered Cancer Treatment
If you have Original Medicare Parts A and B plus a Medigap policy, Medicare will pay for you to receive cancer treatment from any doctor or hospital in the country, as long as they take Medicare. This means you’re free to choose the very best healthcare provider for your condition.
If you have Medicare Advantage, your choices are more limited. If your plan is an HMO, you may need to choose from a limited network of doctors and hospitals. A PPO you will save money by choosing a doctor within your plan’s network. You will pay more for doctors outside the network.
Does Medicare Cover Wigs for Cancer Patients
Chemotherapy causes hair loss, so many cancer patients choose to wear a wig.
Unfortunately, wigs don’t have coverage through Original Medicare or Medigap.
Some Medicare Advantage plans or cancer insurance plans may offer coverage for wigs.
Managed care companies sometimes cover the cost of a wig if the doctor agrees to write a prescription for it.
Does Medicare Cover Cancer Treatment After Age 76
Contrary to rumors you may have heard, Medicare doesn’t limit your cancer coverage after age 76. Parts A and B pay for the same care no matter how old you’re.
Does Medicare Cover Cancer Screenings
Medicare covers 100 percent of certain cancer screenings as a preventive health service. As long as your doctor accepts Medicare assignment. This includes:
- A mammogram every year for women over 40.
- Pap smears and pelvic exams to screen for cervical and vaginal cancer, once every 24 months, or once every 12 months for women who are at increased risk.
- Colorectal cancer screening, including a colonoscopy every 10 years for anyone over 50, and additional screenings for people at increased risk.
- Annual lung cancer screenings for smokers or former smokers aged 55-77 whose doctors order a screening
- Prostate cancer screening once a year for men over 50
Other types of cancer screening may be covered 80 percent under your regular Part B coverage.
Does Medicare Cover Chemotherapy
Yes, Medicare covers chemotherapy cancer treatment for patients in a hospital setting, out-patient setting, or doctor’s office. If it’s administered during a hospital stay, you may have to pay the Part A deductible.
If done at a doctor’s office or clinic, you’ll be responsible for 20 percent of the cost under Part B. You can avoid having to pay either of these by signing up for a Medigap plan.
The Medicare-approved amount for chemotherapy is dependent on what type of treatment you’re undergoing. Your physician will be able to look up the amount.
Does Medicare Pay for Chemotherapy in a Skilled Nursing Facility
Yes, Medicare will pay for up to 100 days of care in a skilled nursing facility for each benefit period. Anything past 100 days becomes out of pocket costs for the beneficiary to pay.
Does Medicare Cover Immunotherapy for Cancer
Immunotherapy is a cutting-edge cancer treatment that stimulates your immune system to attack cancer cells.
Medicare will pay for immunotherapy in many cases, either under Part A or Part B.
Does Medicare Cover Clinical Trials
Medicare pays the cost of some clinical research studies, either in the hospital or while you’re an outpatient.
Does Medicare Cover Cancer Drugs
Medicare Part B does provide some coverage for cancer drugs, but not others. According to the American Cancer Society, drugs that are intravenous and in a doctor’s office or outpatient clinic have coverage.
If your doctor could have given the drug intravenously but decided to give it to you in pill form instead, it also has coverage.
This includes anti-nausea drugs, as long as they are within 48 hours of your cancer treatment.
For drugs covered under Part B, you’ll pay 20% coinsurance, unless you have a Medigap policy that picks up that cost. The Part B deductible may be applicable.
Drugs and injections that you administer yourself, or that are only available as pills, don’t have coverage through Part B. However, many of these drugs have coverage through Part D coverage.
You’ll usually pay a copay or coinsurance; however, the amount you pay is lower than the retail cost of the drug.
Part D anticancer drugs are part of the six protected classes.
Does Medicare Cover Breast Cancer
Medicare pays 100 percent of the cost of an annual breast cancer screening.
Part A pays for inpatient breast cancer surgery or breast implant surgery after a mastectomy.
Breast surgeries done at a doctor’s office or outpatient center are covered by Part B.
Part B also covers breast prostheses after a mastectomy.
Does Medicare Cover Radiation Treatments
Radiation administered at a doctor’s office or clinic is covered by Part B. This is because Part B covers outpatient services.
If you receive radiation treatment during a hospital stay, it’s covered under Part A. Inpatient services have coverage through Part A.
Does Medicare Cover Lung Cancer
Medicare pays the full cost of annual lung cancer screenings to your doctor if you between age 50-77 and have a history of smoking.
If you have lung cancer, Medicare will cover:
- radiation treatments
- and hospice care if you need it
CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries
The Trump administration has made the CAR T-Cell Cancer Therapy available to Medicare beneficiaries.
This means access to innovative new cancer therapy. CMS is working closely to monitor patient outcomes from the therapy.
Trump and Secretary Azar finalized the decision to cover the FDA-approved Chimeric Antigen Receptor T-Cell or “CAR T-Cell” Therapy, this is a form of treatment for cancer that uses the patients own genetically-modified immune cells to fight cancer.
This treatment is approved for people with certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.
Medicare covers CAR T-Cell therapy when it’s done in a healthcare facility enrolled in the FDA risk evaluation and mitigation strategies (REMS) for FDA-approved indications.
Medicare also covers FDA-approved CAR T-cell therapy for off-label use when CMS-approves compendia.
The manufacture of the therapy will be conducting post-market observational studies. This is to monitor potential risks when considering whether to approve new CAR T-cell products.
The FDA continues to work with CMS and the National Institute of Health’s National Cancer Institute (NCI) to help advance the availability of these new therapies to patients.
NCI started supporting the Cellular Immunotherapy Data Resource by the Center for International Blood and Marrow Transplantation Research 3 years ago to allow long-term stud of patients getting CAR T-cell therapy.
Recently there has been an increase in the development of CAR T-cell therapy and other treatment options that harness persons’ own immunity cells for cancer treatment.
Find Affordable Medicare Cancer Coverage
A cancer diagnosis is scary, and treatment is expensive if you don’t have good insurance coverage.
After helping thousands of people find good Medicare coverage, we know what policies work best.
- Original Medicare pays many of the costs of cancer, including hospital charges and 80 percent of costs that fall under Part B’s medical coverage.
- Medigap plans such as Medigap Plan F or G will pay hospitalization deductibles and coinsurance under Part A and Part B’s 20 percent coinsurance, meaning you may pay nothing out of pocket for medical and hospital services.
- Part D prescription plan will cover many prescription drugs that don’t have coverage by Part B.
- Supplemental cancer policies can give you additional coverage for things that may not be covered under Medicare and Medigap. Such as certain cancer drugs and room and board while traveling out of town for treatment.
If you have Medicare Advantage, you may not have optimal cancer coverage. You can switch from Medicare Advantage to Original Medicare with a supplemental Medigap policy during Open Enrollment Periods.
However, if you have already been diagnosed with cancer you may be turned down for Medigap coverage. For this reason, we recommend you buy a separate cancer policy if you have Medicare Advantage.
Best Medicare Plans for Cancer Patients
The best way to ensure that you can afford the best possible treatment for cancer is to sign up for a Medigap plan when you first become eligible.
If you sign up during your Open Enrollment Period, you can’t get coverage denials. Even if you already have cancer or have had cancer in the past.
At MedicareFAQ, we know how devastating a cancer diagnosis can be. We want you to have the right kind of coverage.
We’ll help you decide what coverage you need and search all the top carriers in your area. We can help you find you the best rates on a Medigap policy. Call or click to compare Medicare rates now.