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Medicare Coverage for Cancer Treatments


Medicare cancer coverage is a concern for beneficiaries. More than 4,500 people get a cancer diagnosis in the U.S. daily, according to the American Cancer Society. 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% coverage. Here are the facts on Medicare coverage for cancer treatments.

Does Medicare Cover Cancer Treatments

Medicare does cover cancer treatments. Your cancer coverage will work differently depending on if you’re in the hospital or an outpatient facility. Also, depending on your policy, you may need prior authorization for treatment.

In most cases, preventive services are available for people at risk for cancer.

Part A Cancer Coverage

Part A hospitalization coverage covers cancer Testing and treatment administered during a hospital stay. 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 your costs by paying your Part A deductible. It also provides expanded benefits for hospital stays and hospice care.

Part B Cancer Coverage

Part B covers cancer screenings and treatments at a doctor’s office or clinic. These preventive care benefits pay the full cost of some cancer screenings. Also, Part B pays 80% of the price of chemotherapy, radiation, and tests done on an outpatient basis or at a doctor’s office.

Does Medicare Advantage Cover Cancer?

Medicare Advantage plans give you Part A and B benefits through private insurance coverage. Although Advantage plans usually aren’t the best choice for cancer patients. This is because most plans’ benefits aren’t as good as Medicare plus a Medigap policy.

  • Advantage plans either require you to go to specific doctors within a network, or you will pay less if you use a network doctor. With Medicare plus Medigap, you can see any healthcare provider that accepts Medicare.
  • Many plans require you to pay coinsurance until you meet your annual out of pocket maximum.
  • 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.

Does Cancer Treatment Centers of America Accept Medicare?

Most Cancer Treatment Centers of America will work with Medicare or Part C Advantage plans. Since insurance is a challenge, it’s best to contact one of the Oncology Information Specialist to find out how your policy will work at the Cancer Treatment Center of America.

Does Medicare Cover Cancer Medications?

Part B covers some cancer medications, but others are not included unless you have a Part D prescription drug plan. Cancer drugs can be costly. This means that Medicare prescription drug coverage is an essential part of your cancer protection strategy. Part B covers 80% of the cost of intravenous cancer treatment and anti-nausea drugs. It also includes oral versions of these drugs if your doctor could have given you an intravenous dose but decided to provide you with a pill instead, and the medicine is taken within 48 hours of your cancer treatment.

Part D covers cancer drugs that are not covered by Part B, including anti-nausea medications that are only available in pill form, injections that you give yourself, and medicines 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.

Does Medicare Cover Keytruda?

No, for most people, Medicare won’t cover Keytruda. The medication can help slow the progression of cancer. Yet, Medicare will cover other medicines that can help with the treatment of cancer.

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 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 prescribe 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 are.

Does Medicare Cover Cancer Screenings?

Medicare covers 100% of specific cancer screenings as a preventive health service as long as your doctor accepts Medicare assignment.

Including:

  • 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 ten 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

Does Medicare Cover Chemotherapy?

Yes, Medicare covers chemotherapy cancer treatment for patients in a hospital setting, outpatient 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% 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 Breast Cancer?

Medicare pays 100% 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?

Part B. covers radiation administered at a doctor’s office or clinic. 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 Proton Therapy?

For the most part, Medicare will cover proton beam therapy. But, coverage will depend on the insurance company and the type of disease. If proton beam therapy is the treatment recommendation, the center where you get care will help you identify if health insurance will cover you.

Does Medicare Cover Lung Cancer Treatments?

Medicare pays the full cost of annual lung cancer screenings to your doctor if you between the ages of 50-77 and have a history of smoking.

If you have lung cancer, Medicare will cover:

  • surgery
  • lung transplant
  • chemotherapy
  • radiation treatments
  • and hospice care if you need it

Does Medicare Cover CAR T-Cell Cancer Therapy?

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 treatment.

Trump and Secretary Azar finalized the decision to cover the FDA-approved Chimeric Antigen Receptor T-Cell or “CAR T-Cell” Therapy, which is a form of treatment for cancer that uses the patient’s 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’ immunity cells for cancer treatment.

How to Find Medicare Plans for Cancer Patients

Whether you have Cancer or COPD, the best time to enroll is when you’re first Medicare-eligible. If you sign up during your Medigap 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 the best rates on a Medigap policy. Call or click to compare Medicare rates now.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

29 thoughts on “Medicare Coverage for Cancer Treatments

  1. I am about to undergo chemo for cancer.I’m thinking might be better of just dying rather than leaving a pile of bills for my spouse to pay.We have good insurance but the 15% left for use to pay is going to be in the tens or thousands.Is there any part of medicare to help cover our out of pocket expences

    1. Hi Tony! Are you on group coverage? Depending on what state you’re in, you may be eligible for Guaranteed Issue Rights to get coverage. Give us a call, we may be able to help you!

  2. Will Medicare cover chemotherapy infusion medications if given a day or two earlier than the prescribed frequency? Meaning, if the frequency for Keytruda is every 21 days, will Medicare pay if it is administered on day 19 or 20? Same question with Procrit?

    1. In most cases usually not. The injection must be given at the prescribed time. However, it comes down to your specific situation. Your doctor should be able to answer your question.

  3. My father has been receiving outpatient injections of Lupron at his doctor’s office as treatment to slow/avoid the spread of cancer. He is in a nursing & rehabilitation facility because his knee buckled under him and a lump in his leg previously diagnosed as a hematoma is actually a mass that is probably cancerous (we are awaiting biopsy results). My dad is now 15 days past the date of his next Lupron injection, and his nursing facility and prescribing doctor have both told him he has no coverage for Lupron while he is in the rehab facility because Medicare won’t pay for their treatment of a condition/disease that was diagnosed prior to his admission to the nursing facility. This makes no sense! How can my father get insulin at a nursing facility (which is unrelated to the back and knee issues that sent him into rehab) but he can’t get a shot that is supposed to keep non-metastisizing cancer from metastisizing. He can’t get he PSA levels checked in the rehab facility either. Any information you can provide would be very useful. Does denial of Medicare/Medigap benefits for outpatient cancer treatments while a patient in receiving in-patient care for an unrelated medical condition? To whom would we even appeal?

    1. Hi Liz! Your fathers Lupron injections are covered under Part B. Since the cost of his care while at the nursing and rehabilitation facility falls under Part A, they cannot bill Medicare for his injections. Unfortunately, yes, Medicare will deny treatment for outpatient cancer treatments while the patient is receiving inpatient care for an unrelated medical condition IF billed by the inpatient facility. I would contact the primary care physician who has been treating your father, more than likely they will find a solution to get him the injections he needs and bill Medicare accordingly under Part B for the treatment. I hope this helps!

    1. Hi Elizabeth! Prescriptions taken at home, such as Ibrance, are covered under Part D. Part D plans do cover Ibrance. If Faslodex is covered, it would fall under Part B since it’s an injection given in an outpatient setting. I would reach out to your doctor to confirm if this is covered or not. If administered at home, that would fall under Part D. At the moment, it does not look like any Part D plans provide coverage for Faslodex.

  4. Can I be billed for cancer drugs that are not covered by Traditional Medicare when I have them infused at a hospital clinic?

    1. Hi Kelly! As with any treatment given in a hospital setting, if your primary and/or secondary insurance doesn’t cover it, then the hospital would bill the patient. I hope this helps!

  5. Will Medicare cover a mastectomy if you don’t have breast cancer, but there is a strong family history. I have one sister who has had breast cancer and 2 first cousins, one died at age 60, I am 66 years old. Our mothers both died in their 50’s so we do not have any knowledge if they may have had breast cancer. Our mothers never had mammograms so we just don’t know. I have spent the past year researching information, the pro’s and con’s for having preventive surgery, so this is not something I take lightly. The only problem I have had is that I have not been able to find the answer to my question – will Medicare cover the procedure? I have Medicare and a Medigap policy with Cigna. If you can give me any information I would greatly appreciate it.

    1. Hi Linda, this is a great question! This surgery is called a prophylactic mastectomy. Most companies will cover the cost of this surgery for women with a BRCA1, BRCA2, or other inherited mutation linked to increased breast cancer risk. Some state laws require coverage for prophylactic mastectomy, but coverage varies state to state. Your best bet is to contact Medicare directly and ask them if it’s covered and what the guidelines are. If it is covered, then your Cigna Medigap plan will also cover it. If you enrolled in your Cigna plan through us, call our Client Care Team and they can help you find the answer to this question.

  6. If a person with bladder cancer is undergoing Immunotherapy trial,can he transfer the trial interstate for a holiday period. The trial is under compassionate grounds. Would there be a cost involved? Currently no cost is incurred.

    1. Hi Peggy! It really depends on your specific condition. If the treatment is considered medically necessary, then Medicare will pay for it. Some radiofrequency ablation requires prior authorization, and specific criteria must be met. Your doctor should know what CPT codes are considered medically necessary to know if Medicare will cover the treatment.

  7. Is Keytruda covered under medicare? I am a nurse at a hospital trying to do pre-authorizations and the medicare website is of no help. I have called 3 different numbers and they all give me a different number. I honestly am at the end of my rope.

  8. I am 75 years old and am working full time with good insurance, I have ovarian cancer since last June and will have my last chemo treatment January 31st. I will have addl. avastin treatments after that date. My insurance has approved that drug, I will then be treated with oral drugs, my question is: I would like to retire. I will have to get Medicare part b and a media gap plan plus a prescription plan. As I have had continuous coverage at my job I believe this makes open enrollment for me when I retire. I need to be sure that I will be covered under a medigap plan and an addl. prescription plan because I already have cancer can I be sure of this.

  9. Hi.. I am in Arizona and am 53 on SSDI due to cancer… There are NO medigap policies available in Arizona for disabled ppl under 65!! I have reg medicare 80/20 but cant afford my $1700 a month copay for cancer meds… Am thinking about the different Advantage plans list cancer @ 20% (ppo) on plan details but most don’t list Cancer under its plan details… If I choose an Advantage Plan with a 5K deductible..would this put me at catastrophic after the 5K and would have the Cancer Meds covered for the rest of yr. I am married and we are over the Medicaid income allowed!

    1. Hi Anna! If there is a Medicare Advantage Special Needs Plan available in your area, I would look into that first. Specifically, a Chronic Condition SNP, or C-SNP. There are so many factors that come into play with your question, the best thing to do is give us a call so we can go over all your options. We would need to know your location, income, medications, etc, to provide you with what your plan options are.

  10. All of the Part D drug plans in Florida say that they do not cover chemotherapy drugs. I thought the Federal government required them to cover these drugs.

    1. The federal government requires that all Part D plans cover drugs that fall into six specific classes – known as the six protected classes. When I use the Medicare Plan Finder Tool, I can see that many of the top cancer medications are in fact covered in Florida. Those that are not, have an equivalent generic that is covered. If you share what specific medications you’re trying to find coverage for, we can help you more.

    1. Hi Steven! Rituxan is covered under Part B and Part D of Medicare. You would need to check with your prescribing doctor and/or Medicare to determine your out of pocket costs.

  11. I have a friend who is 64, has retiree insurance through his former employer and has Medicare due to End Stage Renal Disease and is on dialysis and has also developed lung cancer and is on chemotherapy. He was called by his hospital and told that both medicare and his retiree’s insurance say they are primary so neither one has paid anything on his chemotherapy. How can this be straightened out as far as who is primary for this situation so his bills can be paid? TWho can he call ? Thank you. I have tried to find out for him but not having any luck.

    1. Hi Terrie! What you should do first is contact your group plan’s benefits administrator. They should be able to tell you if it is primary to Medicare or secondary. If they are primary then they should have the bill submitted to them first then to Medicare for them to pick up their portion based on the contract. If they are secondary then you need to contact Medicare to find out why they are not listed as primary and get it straightened out.

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