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does Medicare cover chemotherapy

Does Medicare Cover Chemotherapy?

We always hear the word chemotherapy and cancer in the same sentence. And it is common knowledge that chemotherapy is one of the treatments that help battle cancer.

It remains one of the most effective treatments against cancer today. But it also remains a very expensive treatment. One that most people can’t afford to pay out of pocket.

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

Does Medicare Cover Chemotherapy?

The short answer is yes; Medicare will cover the cost of chemotherapy. 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 chemotherapy. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for chemotherapy costs.

Part A

Medicare Part A provides coverage for chemotherapy if you are staying in a hospital as an inpatient. Medicare Part A also covers chemotherapy if you have it in one of the following types of inpatient settings:

  • Skilled nursing facility care after a 3-day hospital admission
  • Hospice care
  • Home for rehabilitation services
  • inpatient breast reconstruction procedures after a mastectomy

Medicare Part A covers both oral and IV chemotherapy.

Part B

Medicare Part B provides coverage for cancer treatments in an outpatient setting. This includes chemotherapy. Other cancer treatment that Medicare Part B covers includes:

  • Cancer screening
  • Preventive services
  • Drugs to control the side effects of chemotherapy
  • Medical equipment needed after cancer treatment

Medicare Part B covers oral, IV, and injection chemotherapy. Medicare Part B will pay for 80% of the cost of chemotherapy.

Part C

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

Part D

Medicare Part D may also provide coverage for specific medications that Medicare Part B may not cover. Some Medicare Part D plans cover both oral and IV chemotherapy medications. Most Medicare Part D plans also cover the following:

  • Drugs to treat nausea
  • Prescription drugs for cancer treatment, which also includes pain medication
  • Medications to treat side effects of chemotherapy

Each Medicare Part D plan has a different list of approved medications and tier lists. The costs they cover/you pay also differ from plan to plan. So it would be wise to contact your plan provider when you are prescribed a new medication. That ‘s the best way to see where that medication falls in their tier system and how much you’ll have to pay.

How Much Does Chemotherapy Cost?

Chemotherapy treatment is expensive. It ranges from $10,000 to $200,000 or more. Several factors may decide for the chemotherapy’s cost, which includes:

  • Type of cancer that needed to be treated
  • Stage of the disease
  • Number of treatments
  • Duration of the treatments
  • Type of chemotherapy
  • Where you will have the treatment

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 septoplasty?

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