Original Medicare (Part A and Part B) covers medically necessary treatments and services for bladder cancer.

If you or a loved one have been diagnosed with bladder cancer, you might be wondering what Medicare will cover.

Original Medicare covers approved treatments and services for bladder cancer that your healthcare team deems medically necessary. There are some limitations and requirements you must meet.

Read on to learn exactly what’s covered — and what’s not.

In the case of bladder cancer, medically necessary treatments and services for outpatients (not admitted to a hospital), Medicare Part B covers:

  • visits with your doctor (including oncologists and other specialists)
  • diagnostic testing (lab tests, ultrasound, etc.)
  • many chemotherapy drugs administered through an IV at your doctor’s office or a clinic
  • some chemotherapy drugs administered orally
  • outpatient clinic radiation treatments
  • durable medical equipment, such as feeder pumps and wheelchairs

It’s a good idea to confirm coverage before receiving treatment. Talk with your doctor to better understand your treatment plan and coverage. If Medicare doesn’t cover your doctor’s recommended treatment, ask whether you can try any covered alternatives.

Medicare Part A covers inpatient hospital stays, including cancer treatments and diagnostics you receive as an inpatient. Part A also offers:

  • some coverage for care at home, such as skilled nursing and physical therapy
  • limited coverage for care in a skilled nursing facility after 3 days in the hospital
  • care in a hospice

While Medicare covers some medications, such as chemotherapy drugs administered at your doctor’s office, it may not pay for others. These include:

Always confirm coverage and expected costs before receiving treatment. If Medicare doesn’t cover the treatment you need, discuss payment plans or other options with your doctor.

Does Medicare cover BCG treatments for bladder cancer?

Bacillus Calmette-Guerin (BCG) is the standard immunotherapy drug for bladder cancer. Immunotherapy uses your own immune system to attack cancer cells.

In this case, a catheter is used to insert BCG directly into your bladder. BCG is typically used for noninvasive and minimally invasive bladder cancers, and it may be covered by Medicare if it’s deemed medically necessary by your doctor.

Bacillus Calmette-Guerin (BCG) is the standard immunotherapy drug for bladder cancer. Immunotherapy uses your own immune system to attack cancer cells.

In this case, a catheter is used to insert BCG directly into your bladder. BCG is typically used for noninvasive and minimally invasive bladder cancers, and it may be covered by Medicare if your doctor deems it medically necessary.

To help with out-of-pocket costs such as copayments, you may consider a Medigap (Medicare supplement) plan, Medicare Medicare Part C (Medicare Advantage) plan, or Medicare Part D (prescription drug) plan.

Medigap plans can help you cover costs for copays and deductibles. You can choose from 10 different plans, depending on factors like your location and coverage needs.

Medicare Advantage plans may also offer additional coverage. These plans must offer at least as much coverage as Part A and Part B of Original Medicare.

Be aware, though, that you can’t have both a Medigap plan and a Medicare Advantage plan at the same time.

Medicare Part D is an add-on that can help cover the costs of prescription medications not covered by Original Medicare. These include:

  • certain oral chemotherapy medications
  • pain relievers
  • anti-nausea medications

Medigap, Medicare Part C, and Medicare Part D plans are all sold by private companies vetted by Medicare.

Several factors affect the cost of treating bladder cancer, including:

The starting point for managing your medical expenses is making sure that your doctor accepts Medicare assignment. This means they’ll accept the Medicare-approved treatment price as full payment.

Next, talk with your doctor about treatment recommendations, including medications. Discuss whether they’re considered medically necessary and accepted as such by Medicare.

If you have purchased a Medigap, Medicare Part C, or Medicare Part D plan, you might want to speak with the insurance company that manages those plans to learn what they cover from the treatment plan your doctor has planned.

Medicare covers treatment and services for bladder cancer; however, you may still have significant out-of-pocket costs depending on factors like recommended treatment or the stage of your cancer.

You can work with your doctor to develop a treatment plan that maximizes your Medicare coverage.

If you have additional coverage, such as a Medicare Part D (prescription drug) plan or a Medigap (Medicare supplement) plan, many of your out-of-pocket costs will be covered.