Medicare does provide coverage for cancer treatment, however Original Medicare alone doesn’t cover the costs entirely. How much of the bill you could be responsible for depends on the type of coverage that you have.
How Much Does Medicare Cover for Cancer Treatment?
While Medicare covers a significant portion of cancer treatment bills, it doesn’t pay for them in full. Medicare Part A and Medicare Part B together are referred to as Original Medicare, and they represent your inpatient and outpatient coverage. They each usually pay for up to 80% of your medical bills, after deductibles and copays. In addition, while Original Medicare covers most medications that you’re given in a medical setting, Original Medicare typically doesn’t cover your prescription medications.
In order to help control your out-of-pocket expenses, you have several options:
- Medicare Supplement Plans
- Medicare Advantage Plans
- Medicare Part D Prescription Drug Plans
Medicare Supplement Plans and Cancer
Medicare Supplement plans work secondary to Original Medicare, and how much they cover depends on the plan that you choose. For instance, Medicare Supplement Plan G covers all of the Medicare-approved copays or coinsurance, so you don’t pay out-of-pocket each time you visit the doctor. Because of this, it’s easy to predict your costs. As long as Medicare pays, your supplement plan will pay as well, and you can use them anywhere that accepts Medicare. Medicare Supplement plans don’t pay for your prescriptions, because Original Medicare doesn’t cover them.
Medicare Advantage Plans and Cancer
If you select a Medicare Advantage plan, it’s your primary coverage instead of Original Medicare. Advantage plans have to offer benefits that are at least as good as Medicare Part A and Part B, and some offer extra benefits like prescription drug coverage. Common risks of these plans are that the carrier can choose to decline your treatment even if your provider says that it’s medically necessary, and the doctors’ network isn’t as broad as Original Medicare’s. Depending on your plan, you may have high out-of-pocket costs through coinsurance and deductibles.
Part D Prescription Drug Plans and Cancer
Part D Prescription Drug plans are available to people who are on Original Medicare, or who don’t have a prescription plan through their Advantage carrier. These plans vary based on where you live, and cover prescriptions at different amounts.
What Services Does Medicare Cover?
Medicare has an extensive list of cancer-related treatments that it covers as long as your doctor says that it’s medically necessary, and it’s performed within Medicare’s guidelines. If you have a Medicare Supplement plan, your plan will pay its usual amounts as long as Medicare pays first. If the item or treatment isn’t covered by Medicare, the Medicare Supplement plan won’t pay either.
If you have a Medicare Advantage plan, you’ll need to check to see what’s covered according to your carrier. Medicare Advantage plans are forms of private insurance, so carriers may have different guidelines on the treatments they offer, and the qualifications you have to meet.
Does Medicare Cover Chemotherapy?
Injections and infusions delivered in a medical setting are typically covered under Medicare, while pills that are taken orally typically fall under your Part D Prescription Drug plan. For instance, chemotherapy delivered intravenously would be covered by Medicare (and your Medicare Supplement plan), and anti-nausea pills would fall under your prescription insurance.
Does Medicare Cover Wigs for Cancer Patients?
Because wigs aren’t considered medically necessary, they aren’t covered by Medicare. This means that they aren’t covered by Medicare Supplement plans either. Medicare Advantage plans may offer this benefit.
Does Medicare Cover Immunotherapy?
Yes, Medicare does offer coverage for immunotherapy. Keep in mind that your doctor needs to state that it’s medically necessary, and it must be performed within Medicare’s guidelines.
What Cancer Treatment Costs Doesn’t Medicare Cover?
The following treatments or services may be necessary as a result of cancer, however Medicare doesn’t typically cover them.
- Room and board in assisted living facilities
- Long-term nursing home care
- Services for activities of daily living (eating, bathing, etc.) that don’t require skilled care
- Medical food or nutritional supplements
- Adult daycare
Medicare covers a large amount of cancer treatment and related expenses. However, if you have Original Medicare alone, you risk facing large Medical bills. It’s essential that you consider your options for coverage so that you’re not left paying out-of-pocket.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.