Medicare Coverage for Radiation Therapy?
Key Takeaways
- Radiation therapy is often used as a cancer treatment to fight tumors
- Radiation therapy comes in three forms: internal, external and systemic
- Radiation therapy can be covered by Original Medicare’sOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). Parts A and B, and Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). .
- How Medicare covers your radiation therapy depends on the type of plan you have. You may also need to factor in how you receive it.
Yes; if you need radiation therapy, Medicare Parts A and B will help cover your costs, depending on your situation. Medicare Advantage (Part C) will also offer at least the same level of benefits for radiation therapy.
With its ability to fight tumors more directly than traditional treatment options, radiation therapy has emerged as an effective tool in the fight against cancer. It can be given internally or externally, and can be used on its own or alongside medications. If you have cancer and are a Medicare beneficiary, one question probably stands out above all others in your mind: Does Medicare cover radiation therapy?
Here’s what you need to know about radiation therapy and Medicare.
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Is Radiation Therapy Covered by Medicare?
If you have one of the many conditions that can be treated with radiation therapy, Medicare will generally cover it. Like other treatments covered by Medicare, your doctor must certify in writing that it is medically necessary. That doctor must also accept Medicare assignment, as well as the provider who performs your radiation therapy.
Do you have to pay for radiation treatment?
Yes — even though Medicare will help cover your radiation treatments, it won’t pay 100% of your radiation therapy cost. Exactly how much you’ll pay comes down to what kind of radiation therapy you receive and where. So, how does it work?
How does Medicare cover radiation therapy with Part A?
Medicare Part A will typically cover radiation therapy when it’s an inpatient service.
How does Medicare cover radiation therapy with Part B?
Medicare Part B helps cover outpatient radiation therapy. This is a therapy that doesn’t require a stay in the hospital.
How does Medicare cover radiation therapy with Medicare Advantage (Part C)
Medicare Advantage (Part C) replaces Original Medicare (Part A & B) but offers the same Part A and B benefits or coverage as Original Medicare. That means Part C will help cover both inpatient and outpatient radiation therapy.
What Kind of Radiation Therapy Does Medicare Cover?
Radiation therapy uses radiation to disrupt the DNA inside cancerous cells, causing them to shrink or die. It can be prescribed on its own or as part of a larger care plan that can include surgery and chemotherapy. No matter the situation, all radiation therapies fall into one of three categories: internal, external or systemic.[i]
External radiation therapy
With this treatment, a doctor uses a machine to focus beams of radiation directly into the affected site. This traditionally meant the radiation passed through the tumor but also affected surrounding areas of your body. Newer advancements such as proton therapy can target cancerous tissue even more accurately.
Internal radiation therapy
Instead of beaming radiation into the tumor, a radioactive source is placed inside your body to deliver a steady stream of radiation therapy. The source may be implanted temporarily or left inside your body permanently. This is based on the type and severity of the condition it is treating.
Systemic radiation therapy
You may also receive radiation therapy through a pill or IV. When taken internally, the radiation travels through your body similar to other treatments like chemotherapy. This radiation, though, finds the affected area of your body and gathers there. This allows the radiation to concentrate on tumors and other treatment areas without harming other areas of your body.
What doctors perform radiation therapy?
If you need radiation therapy, you’ll probably need a doctor other than your primary care physician. Radiation therapy is a precise treatment that needs to be administered by a Medicare-approved provider. To find one in your area, ask your doctor. Radiation therapy is typically performed by one or more of the following:
- Radiation physicist
- Radiation oncologist
- Dosimetrist
- Radiation therapist
- Radiation therapy nurse
- Radiation therapy technician
Is radiation therapy harmful?
The term “radiation” certainly brings up some scary images. But radiation has been used by doctors for decades. In small doses, it’s used to create x-rays. In larger applications, it can be dangerous, but radiation therapy allows physicians to vastly limit the damage it causes to cancer cells and tumors. The radiation impacts the cells’ DNA and stops them from multiplying.
Here are some of the ways doctors use radiation therapy to treat cancer:
- To kill or shrink cancer cells
- To shrink cancer cells before surgery
- To remove traces of cancer cells after surgery
- Alongside medications that allow the radiation to be more effective
- In support of other cancer medications
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Does Medicare Pay for Cancer Radiation Treatments?
If you’re living with cancer and your doctor prescribes radiation therapy, Medicare will generally cover a portion of your care. As with other benefits and services, your doctor must certify that it’s medically necessary to be covered by Medicare, whether covered by Medicare Part A, Part B, or Medicare Advantage (Part C). And like other services or benefits, Medicare will cover that care at different levels based on how you receive it.
What does Medicare pay for radiation treatments?
Inpatient radiation therapy: Medicare Part A typically kicks in to help cover your inpatient radiation therapy cost. Part A will cover the first 60 days of your treatment after you’ve paid your deductible. Daily coinsurance charges will kick in on Day 61.
Outpatient radiation therapy: If you receive your radiation therapy at an outpatient facility or home, Part B generally covers a portion of your treatment. Like Part A, you’ll need to pay your deductible first. After that, Medicare typically picks up 80% of your Medicare-approved radiation therapy cost. You’ll pay the remaining 20% coinsurance.
Medicare Advantage (Part C) helps cover both inpatient and outpatient radiation therapy. While the coverage it offers must provide at least the same benefits as Parts A and B above, you may pay different amounts. To see what your Medicare Advantage plan covers, give your plan provider a call.
Is radiation therapy the same thing as chemotherapy?
No, while both are used to fight cancer, radiation therapy and chemotherapy are two different treatments. Radiation therapy uses radiation to shrink or kill cancerous cells and tumors. Chemotherapy has the same goal but uses medications and chemicals to do it. Unlike radiation therapy, chemotherapy is often less targeted, causing the medication to spread throughout the body. This can make the side effects more widely felt.
Radiation therapy and chemotherapy are often used together to treat some kinds of cancer.
How Much Does it Cost for Radiation Therapy?
As we’ve pointed out, your radiation therapy cost will come down to the kind of therapy you need and what kind of Medicare you’re enrolled in. If you have Original Medicare, Parts A and B can be useful in helping cover your care. They can also leave you with high out-of-pocket costs at a time that’s difficult to make financial ends meet.
That doesn’t mean Parts A and B are your only options. Instead, many Original Medicare beneficiaries look at other options. These can include Medicare Supplement Insurance and Medicare Advantage (Part C). Here’s how they can help Medicare beneficiaries who need radiation therapy.
Medicare Supplement (Medigap): This is a group of policies that Original Medicare beneficiaries can add separately. Medigap plans bolster Parts A and B by helping cover their high out-of-pocket costs. If you’re receiving radiation therapy, whether it’s inpatient or outpatient, a Medigap plan may be able to help cover your Part A and B deductibles, copays and coinsurance.
Medicare Advantage (Part C): Part C must offer at least the same coverage as Original Medicare’s Parts A and B. Many Part C plans have different payment structures, including flat-rate copays. Because of this, some Medicare Advantage (Part C) plans may offer a more cost-effective solution for Medicare enrollees who need radiation therapy.
Sources
- What is radiation therapy? American Cancer Society.
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