Chemotherapy is one of the most common ways to treat cancer, especially for severe and late stages of the disease But it is very expensive. At its minimum, chemotherapy may cost tens of thousands of dollars without insurance.
If you or a loved one need this treatment, you are probably wondering “does Medicare cover chemo treatments?” In this article, we answer that question in clear, plain English. You will also find the average costs of chemo treatments for those who have to pay out of pocket.
Does Medicare Cover Chemo Treatments?
The short answer is yes. Medicare will cover the cost of chemo treatments. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your chemo treatments. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for chemo treatments. Parts A and B provide coverage for your chemo treatments if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Original Medicare provides coverage for many types of treatment for cancer. This includes chemotherapy.
Coverage for chemo treatments is provided by Medicare Part A if your chemo treatment takes place in an inpatient setting.
On the other hand, coverage for chemo treatments is provided by Medicare Part B when it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of chemo treatments. You will pay for the remaining 20 percent.
Part C Coverage for Chemo Treatments
Medicare Advantage plans (Medicare Part C) also provide coverage for chemo treatments. It’s a requirement for these plans to cover everything Original Medicare covers. Part C plans will also cover some treatments and services that Original Medicare does not cover. Exactly what these treatments and services are will vary depending on the plan that you have.
Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.
Medicare Part D plans provide coverage for oral chemotherapy medications. Part D also provides coverage for other prescription drugs for your cancer treatment. Medicare Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.
How Much Does Chemo Treatment Cost?
The cost of chemotherapy can range somewhere from $10,000 to $200,000. There are many factors that will affect the total cost. The type of cancer being treated and severity of it are two of the biggest.
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 oxygen in a nursing home?