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Does Medicare Cover Cancer Treatment?

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In 2018, over 1.7 million new cases of cancer will be diagnosed in the United States, according to the National Institutes of Health (NIH). The good news is that cancer mortality (deaths caused by cancer) is much lower than cancer incidence (new cases of cancer). Cancer incidence is 439.2 per 100,000 while cancer deaths are only 163.5 per 100,000 (based on 2011-2015 cases/deaths).  Some lives are saved through cancer treatment.

What are my options for cancer treatment?

What type of cancer treatment your doctor choses depends on what type of cancer you have and how advanced it is. In the United States there are many options for cancer treatment according to the NIH including:

  • Surgery to remove cancer cells from the body
  • Radiation therapy to kill cancer cells and shrink tumors
  • Chemotherapy which uses medications to kill cancer cells
  • Immunotherapy which can make it easier for the immune system to fight and destroy cancer cells

Does Medicare cover surgery for cancer treatment?

Surgery for cancer treatment may involve cutting out a tumor, surrounding healthy tissue, and nearby lymph nodes according to the National Institutes for Health. Surgery works best for solid tumors that are contained in one area. Surgery cannot be used for blood cancer nor for cancers that have spread. Often surgery is combined with other cancer treatments.

The cost of cancer treatment involving surgery includes costs for the surgeon, anesthesiologist, pathologist, operating room fees, equipment and medicines, according to the American Cancer Society. Medicare generally covers many medically necessary surgical procedures including surgery for cancer treatment. Inpatient surgery would be covered by Medicare Part A (hospital insurance) and outpatient surgery would be covered by Medicare Part B (medical insurance). Medicare Advantage plans also generally cover cancer treatment surgery. Medicare Advantage is Medicare coverage offered by private insurance companies contracted with Medicare. Medicare Advantage plans cover everything that Medicare Part A and Part B cover. You must continue to pay your Part B premium with a Medicare Advantage plan.

Does Medicare cover radiation for cancer treatment?

Radiation in small doses can be used in x-rays, such as x-rays of your teeth. Radiation in high doses can kill cancer cells and shrink tumors, according to NIH. Radiation cancer treatment damages the DNA of cancer cells, making them unable to divide and killing them. External beam radiation therapy treats a specific part of your body. Internal radiation therapy could be a local treatment or systemic therapy, traveling in the blood to tissues throughout the body. Medicare Part A generally covers radiation cancer treatment for hospital inpatients. Medicare Part B covers radiation therapy for outpatients of patients in freestanding clinics. Medicare Advantage plans also generally cover radiation.

Does Medicare cover chemotherapy for cancer treatment?

Chemotherapy is the use of medications to treat cancer, according to the American Cancer Society. Chemotherapy can be administered orally, through pills, capsules or liquids, according to the NIH. It can also be given intravenously through a vein or by injection into a muscle. There are many different chemotherapy medications, according to NIH. The type your doctor choses for you will depend on the type of cancer you have and how advanced it is and whether you have other health problems. Medicare generally covers chemotherapy cancer treatment if you’re a cancer patient in a hospital, outpatient clinic, or doctor’s office.

Chemotherapy cost may depend on how the chemotherapy medications are administered. If chemotherapy is administered by IV at a doctor office Medicare Part B may cover it and if it is administered by vein in a hospital, Medicare Part A may cover it. According to the American Cancer Society, oral chemotherapy cancer treatment costs a lot, sometimes many thousands of dollars each month. For help paying chemotherapy costs for prescription drugs you take at home, you may want a Medicare Part D Prescription Drug Plan. You can get Medicare Part D coverage through a stand-alone Prescription Drug Plan or a Medicare Advantage prescription drug plan.

Does Medicare cover immunotherapy for cancer treatment?

The immune system is made up of white blood cells and organs and tissues of the lymph system, according to the National Institute of Health. Immunotherapy helps your immune system fight cancer. Immunotherapy includes medications that cause an immune response which kills cancer cells. Immunotherapy also includes treatment vaccines which boost the immune system’s response to cancer cells. Medicare may cover immunotherapy cancer treatment if it determined to be medically necessary.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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