After receiving a cancer diagnosis, many patients may find they are most concerned about how to pay for treatment. This can feel especially worrisome for older cancer patients who no longer receive employer-provided health insurance. Whether you've received a diagnosis or have a family history of cancer, you may be wondering, "Does Medicare cover cancer treatment?"
Understanding what cancer coverage you can expect from Medicare can help you feel more confident about handling the cost of your health care and enable you to focus on recovery. Here's what you need to know about Medicare's cancer coverage.
Can You Apply for Medicare With a Cancer Diagnosis?
If you've already gotten a cancer diagnosis, Medicare cannot turn you away because of your diagnosis. Specifically, cancer patients can enroll in Medicare during a 7-month period that includes the three months prior to their 65 birthday, the month of their birthday, and the three months after their birthday. Alternatively, you can enroll in Medicare after reaching age 65 during open enrollment, even if you've already received a cancer diagnosis.
Does Medicare Cover Cancer Treatment?
Medicare will pay for beneficiaries' cancer treatment. However, the way that Medicare pays for cancer treatment can vary depending on several factors.
To start, there is a distinction between what Medicare Part A, or hospital insurance, and Medicare Part B, or medical insurance, pay for. Together, these two parts of Medicare are referred to as Original Medicare.
What Does Medicare Part A Cover?
Medicare Part A generally has no out-of-pocket monthly premiums for beneficiaries, but offers more limited coverage: Only inpatient hospital care will be covered. This coverage can include a number of cancer-related treatments, such as:
- Inpatient chemotherapy treatment
- Inpatient radiation therapy
- Inpatient blood transfusions
- Recovery in a skilled nursing facility following a minimum 3-day inpatient hospital stay
- Hospice care
But even if you receive care at a hospital, that does not necessarily mean you are considered inpatient. Additionally, Medicare Part A does not cover prescription drugs, outpatient cancer therapies, doctor visits with your primary care physician or oncologist, or medical equipment you will need to use at home.
What Does Medicare Part B Cover?
Medicare Part B works more like employer-sponsored health insurance. You pay a monthly premium for Part B, which is $170.10 for most people as of 2022. Part B cancer coverage includes the following:
- Doctor visits with your primary care physician
- Oncologist and other specialist visits
- Diagnostic testing
- Outpatient surgery
- Chemotherapy treatments, including some oral chemotherapy
- Outpatient radiation therapy
- Durable medical equipment (like wheelchairs or feeding pumps)
- Outpatient physical therapy
- Mental health services
- Some preventive care screenings
There is a $233 deductible for Medicare Part B in 2022. Once you have reached that deductible, you can generally expect to pay 20% of the Medicare approved amount for any covered cancer treatment.
Does Medicare Cover Cancer Treatment Drugs?
Neither Medicare Part A nor Part B cover prescription drugs, which can be an expensive part of your cancer treatment plan. That's why many Medicare beneficiaries choose to enroll in a Medicare Advantage plan or add Medicare Part D to their Original Medicare.
Medicare Advantage Plans (also referred to as Medicare Part C) are private health insurance plans that combine the benefits of Medicare Parts A and B, along with prescription medication coverage. Though these plans are offered by private insurers, they are legally required to cover everything original Medicare would cover, which means you can count on the cancer treatment coverages outlined above. The monthly premiums for a Medicare Advantage plan are often higher than the Part B premiums, but these plans may offer more coverage of additional services and prescriptions, access to more participating doctors, or lower copays.
Medicare Part D is another option for beneficiaries who are concerned about paying for their cancer treatment drugs. This type of plan, which is offered through Medicare, provides prescription drug coverage. There are several different Part D plans, and some Part D plans are included in Medicare Advantage Plans. Each Part D plan has a list of covered drugs known as a formulary to help you determine if a plan covers the prescriptions you might need. These may include chemotherapy drugs, pain relief medications or anti-nausea medications.
The Bottom Line
Medicare will cover cancer treatment, but patients should familiarize themselves with the specific requirements, limitations, costs and expectations. Understanding what Medicare does and does not cover can help you prepare for any treatment costs you may have to pay out of pocket so that you can focus on recovery.