Does Medicare Cover Cancer Treatments?

If you’ve been diagnosed with cancer and have Medicare, many of your treatments may be covered.

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Cancer is a leading cause of death for Americans in the traditional retirement age range (65+). In fact, a staggering 70% of cancer-related mortalities occur in individuals in the US aged 65 or older.

In the United States, 1.6 million people are diagnosed with cancer each year. But there is some good news for Medicare beneficiaries when it comes to cancer treatments.

Does Medicare Cover Cancer Treatments?

Yes, Medicare covers most types of cancer treatments, as much as 80 percent of what your doctor bills for until the deductible–the amount you pay for coverage out-of-pocket before your insurance starts paying–is met.

What Medicare Parts Cover Cancer Treatments?

Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance), but these aren’t the only parts that can help pay for cancer treatments.

Medicare Part A

Medicare Part A helps cover care in a skilled nursing facility, hospice care, and some home health care. Cancer treatments covered by Part A usually begin once the beneficiary is considered an inpatient at the hospital or health care facility. Medicare Part A covers the following when it comes to cancer treatments:

  • Inpatient chemotherapy
  • Semi-private rooms
  • General nursing
  • Meals
  • Medication

Medicare Part B

Medicare Part B helps cover health care provider and doctor services, outpatient care, home health care, some medical equipment, and many preventive services. Medicare Part B covers many chemotherapy drugs administered intravenously, in an outpatient setting. Medicare Part B also covers the following when it comes to cancer treatments:

  • Doctor’s visits
  • Intravenous chemotherapy drugs
  • Outpatient radiation treatments
  • Post-mastectomy breast prostheses
  • Diagnostic tests

Medicare Advantage (Part C)

Medicare Advantage, also known as Part C, is purchased through a private insurer and provides an alternative to Original Medicare (Part A, Part B). When enrolled in a Medicare Advantage Plan, the rules and costs may differ, but you must be given at least the same coverage as Original Medicare. Medicare Advantage covers the following when it comes to cancer treatments:

  • At least the same coverage provided by Original Medicare
  • Chemotherapy (with Part D)

Medicare Part D

Medicare Part D is an add-on to Original Medicare that helps the beneficiary pay for their prescription drugs. Part D’s formulary differs depending on the provider, so it’s important to check with them to ensure you get coverage for the medications you need. But Part D may help cover cancer treatment costs if it’s not covered by your Part B. Medicare Part D covers the following when it comes to cancer treatments:

  • Orally administered chemotherapy drugs
  • Anti-nausea medication
  • Pain medications

Medicare Supplement/Medigap

Medigap is a Medicare supplement that can be purchased from private insurance companies. It is intended to help policyholders pay their costs of Original Medicare, and does not provide additional coverage when it comes to cancer treatments. Medigap is sold by private insurers, so the type of coverage provided and its cost can vary depending on many factors. 

Types of Cancer Treatment Options

Medicare covers many different types of cancer treatments and preventive care. Below is a list of the most common treatments and preventive measures Medicare provides as coverable treatment options.

  • Surgery – Can be used to prevent, diagnose, stage, and treat cancer
  • Cancer screenings – An example of a preventive measure that Medicare covers 
  • Chemotherapy – Cancer-fighting chemicals are given orally or intravenously to kill cancer cells and halt their spread
  • Radiation Therapy – High-energy particles are used to kill cancerous cells
  • Immunotherapy – Uses drugs to enable your immune system to attack cancerous cells
  • Hormone Therapy – Synthetic versions of hormones and hormone blockers help halt the growth of cancerous cells

What Cancer Treatments Does Medicare Not Cover?

Medicare doesn’t cover all types of cancer treatments. If the treatment isn’t considered medically necessary, Medicare isn’t likely to cover it. For example, holistic cancer treatments aren’t covered.

Here are some of Medicare’s cancer care exclusions:

  • Room and board in assisted living facilities
  • Daily living activities, that don’t require skilled care
  • Medical food or nutritional supplements
  • Long-term nursing home care
  • Adult daycare

It’s important to note that Medicare coverage for tests, items, and services varies based on the state you reside in. You can find more information about what cancer treatments Medicare covers by visiting their official site.