Will Medicare pay for chemo and radiation?

Does Medicare cover cancer treatment? If you are a cancer patient or know that you are at risk of being diagnosed with cancer, then understanding how your Medicare health insurance plan will cover services is important.

Does Medicare cover chemo and radiation? Does Medicare cover immunotherapy? Does Medicare cover other cancer treatments and services? We’ll answer these questions and more below.

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Does Medicare cover chemo and radiation?

Chemotherapy is a way to describe many different medications for cancer. The type of chemotherapy that a cancer patient needs depends on the type of cancer they are diagnosed with and how advanced it is. Chemotherapy can be administered orally, intravenously, or by injection.

Does Medicare cover chemotherapy? Most Medicare plans cover chemotherapy treatment. Medicare Part A covers inpatient treatment, while Medicare Part B covers outpatient treatment. Medicare Part D covers prescription drugs.

Radiation treatment uses high doses of radiation to target and kill cancer cells. Medicare Part A and Part B cover radiation treatment for cancer patients. Most Medicare Advantage plans also cover chemo and radiation treatment, but you should contact your health care provider to double-check.

What other cancer treatments and services does Medicare cover?

Medicare insurance covers many other options for cancer treatment, depending on the type of Medicare plan you have.

Medicare Part A covers inpatient treatments, such as cancer treatment you receive in a hospital, skilled nursing facility expenses, home health care or hospice care, and surgically-implanted breast prostheses after a mastectomy as part of inpatient surgery (read our “Will health insurance pay for hospice?” for more information).

Medicare Part B covers outpatient treatments, such as doctors’ visits, chemotherapy, radiation therapy, diagnostic tests, durable medical equipment (DME), outpatient surgeries, mental health services, nutritional counseling, preventative and screening services, and more.

Does Medicare cover immunotherapy for cancer? Immunotherapy is a category of medications that trigger your immune system to fight cancer cells. If immunotherapy is medically necessary, your Medicare plan may cover it.

Can I get screened for cancer with Medicare?

Medicare provides coverage for various screenings to detect different types of cancers.

Women who are 40 years and older with Medicare can get one screening mammogram every 12 months along with a baseline mammogram between the ages of 35 and 39.

Medicare Part B covers one Pap test and pelvic exam every 24 months, or every 12 months if you are at high-risk for cervical or vaginal cancer or are of childbearing age and have had an abnormal Pap test within the previous 36 months.

Medicare covers colorectal screening in the following ways:

• Screening fecal occult blood tests once every 12 months for people 50 and older
• Multi-target stool DNA lab test once every three years for people between 50 and 85 who have no symptoms of colorectal disease but are at average risk of colorectal cancer
• Screening colonoscopy once every 24 months for people who are at high-risk for colorectal cancer
• Screening flexible sigmoidoscopy once every 48 months for most people who are 50 and older

Medicare Part B covers lung cancer screening with low-dose computed tomography (LDCT) once a year for people who are over 55 years old, do not have symptoms, smoke or have quit smoking in the last 15 years, have a smoking history of at least 30 “pack years,” and get a doctor’s order.

If you are a man over 50 years old, and you and your doctor decide that you should be screened for prostate cancer, your Medicare plan will cover a digital rectal exam (DRE) and prostate-specific antigen (PSA) blood test once per year.

Medicare for cancer patients under 65 provides good coverage for cancer treatments and screening services. The best Medicare plans for cancer patients may be Medicare Advantage plans, as they are likely to have coverage for a wider variety of services. To learn more about Medicare plans, check out this link.

However, Original Medicare does offer coverage for some treatments. If you need to buy health insurance for cancer patients, enter your ZIP code into our free quote comparison tool below to get affordable health insurance quotes from companies in your area.

1. https://www.ssa.gov/medicare

Case Studies: Medicare Coverage for Chemo and Radiation

Case Study 1: Sarah’s Breast Cancer Treatment

Sarah, a 68-year-old Medicare beneficiary, was diagnosed with early-stage breast cancer. Her oncologist recommended a treatment plan involving both chemotherapy and radiation therapy. Concerned about the costs, Sarah reached out to Medicare to inquire about coverage.

Medicare Part B, which covers outpatient services, including medically necessary chemotherapy and radiation, would cover Sarah’s treatments. She would be responsible for paying the Part B deductible and 20% coinsurance for the services received. However, if Sarah had supplemental insurance, such as a Medigap policy, it could help cover some or all of her out-of-pocket costs.

Case Study 2: John’s Lung Cancer Treatment

John, a 72-year-old Medicare enrollee, was diagnosed with advanced-stage lung cancer. His oncologist recommended a combination of chemotherapy and radiation therapy to target the tumor. Concerned about the potential financial burden, John sought clarity on Medicare’s coverage.

Medicare Part B would cover the medically necessary chemotherapy and radiation treatments for John’s lung cancer. As with Sarah’s case, John would be responsible for the Part B deductible and 20% coinsurance. It’s important to note that Medicare Part D, the prescription drug coverage, may also help cover certain oral or injectable chemotherapy drugs that John might need.

Case Study 3: Maria’s Prostate Cancer Treatment

Maria, a 75-year-old Medicare beneficiary, was diagnosed with localized prostate cancer. Her urologist recommended a treatment plan involving radiation therapy but not chemotherapy. Maria wanted to understand if Medicare would cover the radiation therapy costs.

Medicare Part B would typically cover radiation therapy for Maria’s prostate cancer, as it is considered a medically necessary treatment. Similar to the previous cases, Maria would be responsible for the Part B deductible and 20% coinsurance. If she had supplemental insurance, it could help mitigate her out-of-pocket expenses.