Does Medicare Cover Cancer Treatment?
Key Takeaways
- Many cancer treatments are covered by Medicare.
- Part A of Original MedicareOriginal 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). covers hospital-related expenses; Part B covers medically necessary treatments, services and equipment.
- A Medicare Part D prescription drug plan covers medications that you take at home, which can be important to treat cancer and manage side effects.
- Medicare AdvantageMedicare 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). plans can substitute for Original Medicare and offer additional coverage options.
According to the National Cancer Institute, two of every five Americans will face a cancer diagnosis at some point in their lives.
If you or a family member age 65 or older is dealing with cancer, Medicare will cover many of the necessary treatments. You may need Part A and Part B of Original Medicare in conjunction with a Part D drug plan or a Medicare Advantage plan that bundles services to get coverage for the various aspects of your cancer treatment.
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“Cancer” ranks among the most dreaded words in the English language. Only heart disease claimed more lives in the United States in 2022.
The good news is that from 1991 to 2020, the death rate associated with cancer dropped 33%. Cancer is more treatable than ever, but treatment is often expensive.
Medicare can help with the financial burden brought on by a cancer diagnosis.
What Does Medicare Cover for Cancer Patients?
Medicare cancer coverage works in much the same way as medically necessary treatment of other conditions works.
- Medicare Part A covers inpatient hospital stays and surgical procedures related to cancer treatment and care in a skilled nursing facility, hospice care, and some home health care.
- Medicare Part B covers outpatient care for cancer like doctors’ visits and lab work; radiation, intravenous chemotherapy and oral chemotherapy (in some cases); durable medical equipment and mental health services.
- Having both Parts A and B, collectively known as Original Medicare, allows you to add a Part D prescription plan from a private insurance carrier, which helps with many drug costs that aren’t covered by Parts A and B.
- Having Parts A and B also gives you the option of switching to a Medicare Advantage plan from a private insurance carrier. A Medicare Advantage plan substitutes for Parts A and B and provides at least the same coverage. Medicare Advantage Prescription Drug plans include Part D drug coverage, and plans may offer a variety of other benefits.
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How Much Does Cancer Treatment Cost with Medicare?
Does Medicare pay for cancer treatment? Yes, although like coverage for other conditions, the patient faces some financial responsibility.
Costs for Part A cancer treatments include a benefit period deductible ($1,676 in 2025) that you must pay for every inpatient stay. After you pay the deductible, you don’t have to pay coinsurance for Days 1-60 of your stay but do pay coinsurance from Day 61 on.
The Part B cost model requires that you pay 20% coinsurance after you have paid your annual deductible ($257 in 2025). Medicare pays 80% of most covered services.
Are Cancer Drugs Covered by Medicare?
Original Medicare covers medications administered in a medical setting, such as a hospital or a doctor’s office. To get coverage for most prescription drugs you take at home, you need a Medicare Part D or a Medicare Advantage Prescription Drug plan.
For cancer-related medications covered by Part D, cost can vary widely based on the individual plan, the pricing within its drug tiers and where you are in the stages of the Part D cost model. Part D, like Part B (and Part A on rare occasions) usually requires a monthly premium; the projected average Part D premium in 2025 is $46.50.
How Much Will Medicare Pay for Cancer Treatment?
While Medicare helps with the financial burden of a cancer diagnosis, it doesn’t pick up all of the expenses associated with treatment. If you have Original Medicare, you can add a Medicare Supplement Insurance (Medigap) plan that can further assist with costs related to your treatment.
Medigap plans — offered by private insurance companies under federal guidance — help fill in the gaps when it comes to your costs.
All 10 of the standard Medigap plans pay 100% of Part A coinsurance, and all but one pays at least 50% of the Part A deductible. All 10 also pay at least 50% of Part B coinsurance and copayments.
Can You Enroll in Medicare if You Have Cancer?
While Medicare covers many cancer treatments, a cancer diagnosis doesn’t qualify you to enroll in Medicare. Most people first qualify for Medicare enrollment when they reach age 65. If you are eligible for Medicare and enroll in Parts A and B, you have the option to switch to Medicare Advantage. Keep in mind that if you try to add a Medigap plan more than six months after you first enrolled in Part B, you could be subject to an underwriting process that includes medical questions. The ability to add Medigap is only guaranteed during that initial six-month period when your health condition won’t impact your eligibility or your premium.Start your Medicare PlanFit CheckUp today.
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Sources
- US cancer death rate falls 33% since 1991. CNN.com
- Cancer Statistics. Cancer.gov.
- Leading Causes of Death. CDC.gov.
- Leading Cancer Cases and Deaths, All Races/Ethnicities, Male and Female. CDC.gov.
- Medicare Coverage of Cancer Treatment Services. Medicare.gov.
- Medicare Costs. Medicare.gov.
- Medicare Advantage and Medicare Prescription Drug Programs to Remain Stable as CMS Implements Improvements to the Programs in 2025 CMS.gov.