Medicare covers cancer treatment when provided by an in-network provider. Part A covers hospitalization, Part B covers outpatient treatment, and you should get similar coverage through Medicare Advantage (Part C). Part D will pay for some prescription drugs.

The costs of treating cancer add up fast. If you have Medicare, many of those expenses are included in your coverage.

This article will answer basic questions about how to find out how much you will owe for your cancer treatment if you have Medicare.

If you receive a serious cancer diagnosis, you may want to call the Medicare Health Line at 800-633-4227. This line is available 24/7 and can give you specific answers about anticipating your costs.

Medicare covers cancer treatment prescribed by a doctor who accepts Medicare.

Medicare pays 80% of what your care provider bills for prescribed, approved cancer treatments. You’re responsible for 20% of the billed amount until you hit your annual deductible.

Some doctor’s visits and procedures must meet unique criteria to be approved by Medicare.

For example, if you need surgery, Medicare will pay for you to consult with a surgical oncologist and another surgical oncologist for a second opinion. Medicare will pay for you to get a third opinion, but only if the first and second doctors don’t agree.

If you have Medicare, it covers cancer treatment no matter how old you are. If you have Medicare Part D, prescription drugs that are a part of your cancer treatment are also covered.

Medicare is a federal program in the United States governed by several laws. These policies are the “parts” of Medicare, which cover different aspects of cancer treatment.

Medicare Part A

Medicare Part A covers hospital care. Most people don’t pay a monthly premium for Medicare Part A.

Cancer care and services Part A covers include:

  • cancer treatment
  • diagnostic testing you receive while you’re in the hospital
  • inpatient surgical procedures to remove a cancerous mass
  • surgically implanted breast prostheses after a mastectomy

Medicare Part B

Medicare Part B covers medically necessary outpatient care. Medicare Part B covers most types of cancer treatment.

Cancer care and services covered by part B include:

  • visits with your general practitioner
  • visits to your oncologist and other specialists
  • diagnostic testing, such as X-rays and blood work
  • outpatient surgery
  • intravenous and some oral chemotherapy treatments
  • durable medical equipment, such as walkers, wheelchairs, and feeding pumps
  • mental health services
  • certain preventive care screenings

Medicare Part C (Medicare Advantage)

Medicare Part C, also called Medicare Advantage, refers to private health insurance plans that bundle the benefits of Medicare Parts A and B, and sometimes Part D.

These private health insurance plans are required to cover everything Original Medicare would cover. The premiums for Medicare Part C are sometimes higher, but things like covered services, participating doctors, and copays might provide better options for some people.

Medicare Part D

Medicare Part D covers prescription drugs. Medicare Part D may cover some oral chemotherapy drugs, anti-nausea medications, pain medications, and other medications your doctor prescribes as a part of your cancer treatment.

This coverage isn’t automatically included in Medicare or Medicare Advantage, and different plans have different restrictions on which drugs they’ll cover.

Medicare Supplement (Medigap)

Medigap plans are private insurance policies that help cover your share of Medicare costs. You have to pay a premium for Medigap, and in exchange, the plan reduces or eliminates some copays and may lower your coinsurance and deductible amount.

Before you go to any doctor for your cancer treatment, call their office and see if they “accept assignment.” Doctors who accept assignments take the amount that Medicare pays, as well as your copayment, and consider that a “full payment” for services.

Doctors who have opted out of Medicare may bill above the amount that Medicare will cover for their treatment, leaving you responsible for what’s left in addition to your copay.

Average out-of-pocket costs for cancer treatment vary. The type of cancer you have, how aggressive it is, and the treatment type your doctors prescribe are all factors in how much it will cost.

One 2017 study found that the average annual out-of-pocket costs for cancer treatment ranged from $2,116 to $8,115, depending on what type of Medicare or insurance coverage participants had.

If you receive a diagnosis of any cancer, you’ll most likely meet your Medicare deductibles for Part B that year. In 2024, the deductible amount for Medicare Part B is $240.

In addition to your monthly premiums, you’ll be responsible for 20% of outpatient costs until you hit that annual deductible.

If your treatment includes hospital stays, inpatient surgery, or other types of inpatient treatment, it could start to run in multiple thousands of dollars, even with Medicaid or other insurance.

Cancer treatment is highly individualized. Several types of doctors work together to come up with a treatment plan that addresses your needs. A comprehensive cancer treatment plan will include one or more of the following types of treatments, all of which can be covered by Medicare.

Alternative or holistic therapy is one kind of cancer treatment that isn’t covered by Medicare. These treatments, which can include dietary changes, supplements, oils, and natural extracts, are not part of Medicare’s cancer coverage.

What percentage of cancer treatment does Medicare cover?

When your treatment is provided by an in-network provider that accepts assignment, Medicare will pay 80% of the cost.

What happens if you can’t afford cancer treatment?

If you have health insurance, it’s a good idea to speak with the finance manager in your hospital about setting up a payment plan or finding financial resources that can help cover your medical costs. If you don’t, try talking with the hospital staff about negotiating costs before receiving any services.

You may also qualify for discounts or assistance programs. Remember, the No Surprises Act protects you from being overcharged for out-of-network care. You can also seek help from government programs such as Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or Employee Assistance Program (EAP) programs.

Does stage 4 cancer qualify for Medicare?

Regardless of the stage of your cancer, Medicare should pay 80% of the cost of your treatment.

How much does chemo cost with Medicare?

A 2021 Meta-Analysis suggests that the average hourly cost of chemotherapy worldwide is around $125-150. Without insurance, depending on how much chemotherapy you need, this can add up from $10,000 to as high as $200,000 or more. That said, under Medicare, you should only have to pay 20% of this cost.

Cancer treatment can be very costly. Medicare absorbs much of this cost, but you’ll still need to pay a significant portion.

Before beginning any treatment, it’s important to be sure your doctor accepts the assignment. Asking questions about cost and if there are less costly options available can also help minimize the cost of your care.