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does Medicare cover chemo infusions

Does Medicare Cover Chemo Infusions?

One of the most common and effective ways of treating cancer is chemotherapy and chemo infusions. Chemotherapy treatment can either be taken orally or administered through intravenous means. Effective as it may be, chemotherapy is very expensive and not everyone who needs it can easily afford it.

So a common question many people have is, “Does Medicare cover Chemo Infusions?” In this article, we answer that question in clear, plain English. You will also find the average costs of chemotherapy infusions and other helpful info.

Does Medicare Cover Chemo Infusions?

The short answer is yes; Medicare will cover the cost of chemotherapy infusions. But not 100% of the time. As is often the case with Medicare, you must meet certain conditions in order for Medicare to pay for your chemotherapy infusions. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for chemotherapy infusions. Parts A and B provide coverage for many types of cancer treatments which include both oral and IV chemotherapy. For Medicare to cover various types of cancer treatment, it must be first prescribed by your healthcare provider.

Coverage for chemotherapy by infusion is provided by Medicare Part A when the patient needs it while he/she is staying in a hospital as an inpatient. Part A also provides coverage for hospital admissions to treat a patient dealing with cancer.

On the other hand, coverage for chemotherapy by infusion is provided by Medicare Part B if the patient receives it in an outpatient setting. This could be in a doctor’s office or a freestanding clinic. Medicare Part B provides coverage for many outpatient cancer treatments and they are often considered medically necessary. 

Medicare Part B covers 80 percent of the costs of chemotherapy by infusion. You will pay for the remaining 20 percent. 

Part C Coverage for Chemo Infusions

Medicare Advantage plans (Medicare Part C) also provide coverage for chemotherapy by infusion. Part C plans cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan. 

Part D Coverage for Chemo Infusions

Medicare Part D also provides coverage for both oral and IV chemotherapy. Medicare Part D plans provide coverage for chemotherapy medications that are not covered by Medicare Part B. Most Medicare Part D plans provide coverage for prescription drugs that are used in cancer treatment including medications to treat symptoms such as pain and nausea. 

How Much Does Chemotherapy Cost?

Chemotherapy may cost somewhere from $10,000 to $200,000 or higher. The type and stage of cancer you have will affect the overall costs of chemotherapy. The costs will also vary depending on if you receive oral or IV chemotherapy. Chemotherapy treatment also becomes more expensive if you require more doses.

What Are Some Ways You May Get Financial Help For Chemotherapy?

Aside from medical insurances such as Medicare, you may also get financial help through some organizations such as:

  • Cancer Financial Assistance Coalition
  • Patient Advocate Foundation
  • Patient Access Network Foundation

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover companion care?

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