Chances are you’ve experienced cancer in some way—whether it was your own struggle or that of someone you care about. Cancer has been among the top two leading causes of death in the U.S. for more than 75 years. While the mortality rate has decreased in recent years, this devastating disease still claims the lives of more than half a million Americans each year.1
Older adults face unique risks and challenges when confronting a cancer diagnosis. If you’re 65 or older and have Medicare, you may be wondering, “How much does cancer treatment cost with Medicare?” or “Does Medicare cover chemotherapy or cancer surgery?”
Keep reading to learn more about Medicare’s cancer coverage and what it means for you.
Does Medicare cover cancer costs?
Managing a condition like cancer can be costly. But Medicare will help pay to diagnose and treat the cancer-related medical and mental health conditions you face. Specifically, Medicare covers these services:
Under Part A:
- Hospital care
- Health care services at home, such as a visiting nurse or rehabilitation therapist and home health aides
- Skilled care in a nursing facility following a hospital stay
- Some costs related to clinical research studies during a hospital stay
- Surgically implanted breast prostheses following a mastectomy (in an inpatient setting)
- Hospice care
Under Part B:
- Doctor visits
- Diagnostic tests (e.g., X-rays)
- Chemotherapy or drugs taken orally or intravenously
- Radiation treatments in an outpatient setting
- Certain outpatient surgeries (e.g., surgically implanted breast prostheses)
- Durable medical equipment (e.g., wheelchairs, walkers)
- Second opinions on surgery (and in some cases, a third opinion)
- Enteral nutrition equipment (feeding pump) for use at home
- Medical treatment for other health conditions and side effects of your cancer treatment
- Prescription drugs to treat side effects such as nausea
- Mental health services (outpatient)
- Certain preventive services and screenings
- Nutrition counseling if you have diabetes or kidney disease
- Some costs related to clinical research studies while you’re an outpatient
Medicare may not pay for everything you need related to cancer care. It often does not cover the following:
- Services that help you bathe, eat, and perform other activities of daily living that do not require skilled care
- Nutritional supplements or medical food
- Room and board in assisted living facilities
- Adult day services
- Long-term nursing home care
How to find a cancer treatment center
To get the best medical care possible for your cancer, choose your treatment center carefully. You may not be able to determine which hospital treats you in an emergency, but you can designate a center for your regular care.
A good place to start is asking your doctor for a cancer center recommendation—and talking to friends, family, and neighbors with firsthand experience with cancer treatment. In addition, the National Cancer Institute (NCI) has named the top centers for treating cancer in the United States. These are called NCI-Designated Cancer Centers. Find one near you.
Does Medicare cover expensive cancer drugs?
It can be hard to understand why Medicare covers some drugs under Part B and others under Part D. But it is important to know the difference. How you get your drugs and what you pay will differ depending on whether Medicare Part B or Part D covers your drugs.
Does Medicare fully cover chemotherapy? Medicare Part B covers most chemotherapy drugs. These are cancer-treating medications that are given as a shot, through an IV tube, or by mouth.
There’s one important distinction to take note of. Medicare Part B covers cancer drugs that you take intravenously or by mouth. If your drug is only made to be taken by mouth, your Medicare Part D plan should cover it. For example, Medicare Part D may cover these cancer drugs:
- Chemotherapy drugs (only if taken by mouth)
- Anti-nausea drugs
- Other prescription drugs used during your cancer treatment (e.g., pain medication)
Medicare coverage for anti-nausea drugs
Many chemotherapy drugs can cause nausea and vomiting. This is why some cancer patients receive anti-nausea drugs. Anti-nausea drugs are covered the same way Medicare covers cancer drugs. If you can take your anti-nausea drug by mouth or intravenously, Medicare Part B will cover either one. But your doctor must give the medication to you within 48 hours of your cancer treatment. Otherwise, your Medicare Part D plan should cover it.
Medicare coverage for radiation therapy
You might be wondering, “Does Medicare pay for cancer radiation treatments?” Medicare Part B covers your radiation if you are an outpatient or in a freestanding facility. You will pay 20% coinsurance of the amount Medicare approves for the doctor visit. Medicare will pay the remaining 80%.
Medicare Part A covers your radiation therapy while you are a hospital inpatient.
Medicare coverage for second opinions
After you get your doctor’s diagnosis and cancer treatment plan, it’s a good idea to get another cancer doctor’s advice before you start treatment. This is especially true if your doctor suggests surgery. This is called a second opinion.
Medicare covers most of the cost of a second opinion before surgery. A second doctor might tell you to follow your first doctor’s treatment plan. Or they may suggest that you change the plan. A second opinion can give you peace of mind, knowing you’ve explored all of your treatment options. It will also give you a chance to get all your questions answered.
In certain cases, Medicare will also cover a third opinion if the first and second opinions differ.
More questions regarding Medicare and cancer coverage?
How much does cancer treatment cost with Medicare? What does Medicare pay for cancer screenings? Visit our Medicare for Older Adults resource center to learn more about coverages and benefits.
What is the best Medicare plan for cancer patients?
You have many choices when it comes to Medicare—and trying to sort through it all can feel overwhelming. NCOA has partnered with Medicare brokers who can help you make informed decisions and won't pressure you into buying a specific plan. Speak to an NCOA Partner today.
“Being actively engaged in your health coverage is necessary to age well," said Jen Teague, NCOA Associate Director of Health Coverage and Benefits. "It will help with your financial stability, mental health, mobility and everything else.”
Sources
1. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics. Cancer Deaths. Found on the internet at https://www.cdc.gov/nchs/hus/topics/cancer-deaths.htm
