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does Medicare cover immunotherapy for cancer

Does Medicare Cover Immunotherapy For Cancer?

Immunotherapy is a new way of boosting a person’s immune system. This treatment helps the body to recognize and fight cancer cells. However, the cost of immunotherapy for cancer is very expensive, and not everyone who needs it can easily afford it. 

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

Does Medicare Cover Immunotherapy For Cancer?

The short answer is yes; Medicare will cover the cost of immunotherapy for cancer. 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 immunotherapy for cancer. 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 immunotherapy for cancer. Medicare provides coverage for most cancer treatments which include immunotherapy for cancer. 

Medicare Part A provides coverage for immunotherapy if it takes place in an inpatient setting such as a hospital or a skilled nursing facility. Original Medicare covers the following for immunotherapy for cancer:

  • Inpatient stay
  • Medications and/or therapies that you receive in your inpatient stay
  • Meals
  • Other related expenses

On the other hand, Medicare Part B provides coverage for immunotherapy for cancer if it takes place in an outpatient setting such as a doctor’s office or outpatient clinics. Medicare Part B provides coverage for the following for immunotherapy for cancer: 

  • Immunotherapy itself (specifically the CAR-T form) 
  • Chemotherapy
  • Radiation therapy

Medicare Part B will cover 80 percent of the costs of your immunotherapy. You will pay for the remaining 20 percent. 

Part C Coverage for Immunotherapy for Cancer

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

Medicare Part D provides coverage for prescription drugs including immunotherapy medications. 

How Much Does Immunotherapy For Cancer Cost?

Immunotherapy often costs $100,000 or more. If therapies are used in combination, the overall costs may even double or triple. For example, CAR-T treatment may cost somewhere from $350,000 to $500,000. The good thing is that Medicare provides coverage for this kind of treatment.

What Happens During CAR-T Therapy?

Our immune system has cells called T-cells which fight infections. During CAR-T therapy, the T-cells are removed from our bodies and brought to a laboratory. There, the T-cells are turned into chimeric antigen receptors, or CAR. The new CAR-T cells are then returned to our bodies where they will recognize and destroy cancer cells. This is one type of immunotherapy. 

Other types of immunotherapy include:

  • Monoclonal antibodies
  • Oncolytic virus therapy
  • Cancer vaccines

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 root canals?

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