After you’ve met your deductible, the various parts of Medicare will cover immunotherapy costs. You may be responsible for some out-of-pocket expenses, depending on your type of coverage.
Each part of Medicare covers a different portion of immunotherapy treatment, but you can expect some out-of-pocket expenses.
Your coverage may vary depending on where you receive the medication and what type of medication it is.
Part A is hospital insurance. It covers inpatient immunotherapy during a hospital stay and limited stays in skilled nursing facilities.
Here are the basic costs for Part A in 2024:
- $278 to $505 monthly premium, if you have one
- $1,632 deductible for each benefit period
- 20% of all Medicare-approved costs during your stay
- $0 coinsurance for days 1 to 60 of treatment after you pay your deductible
- $408 coinsurance per day for days 61 to 90 of treatment
- $816 coinsurance per day for days 91 to 150 of treatment while using your 60 lifetime reserve days
- 100% of the treatment costs for days 151+
Part B is medical insurance. It covers visits to outpatient centers like doctor’s offices or freestanding clinics. When you’re receiving cancer treatments, Part B will cover a variety of therapies, including:
- immunotherapy (specifically the CAR-T form)
- chemotherapy
- radiation treatments
Here are the basic costs for Part B in 2024:
- $174.70+ monthly premium, if you have one
- $240 deductible
- 20% of all Medicare-approved costs during your treatment
- any copayment or coinsurance fees
Part C, or Medicare Advantage, bundles hospital and medical insurance with prescription drug coverage (Part D).
Costs vary depending on the plan and provider you choose. Each plan has a different premium, deductible, copayment, and coinsurance amount.
Staying within your plan’s “network” of healthcare professionals, pharmacies, and other providers ensures you receive the maximum coverage at the lowest out-of-pocket cost.
Once you pay your plan’s out-of-pocket maximum, your plan will cover 100% of all Medicare-approved costs.
Part D covers prescription drugs that you take outside of a healthcare facility.
The amount of coverage each plan provides depends on its formulary and tier system. A formulary is a list of medications the plan covers. Those medications are then divided into groups or tiers, typically based on cost.
Part D costs and coverage for individual immunotherapy drugs can vary based on the medication.
Let’s look at the cost of Keytruda as an example.
In 2024, a single 200-milligram (mg) dose costs $11,337.36 without insurance and is administered every 3 weeks. A 400-mg dose costs $22,674.72 without insurance and is administered every 6 weeks.
According to a 2022 analysis of commercial and Medicare claims for 200-mg Keytruda in 2020:
- About 80% of people with Original Medicare without supplemental Medigap insurance paid $1,200 to $2,100 per 200-mg infusion.
- 38% of people with a Part C plan had no out-of-pocket costs. About 80% paid $0.01 to $925 per 200-mg infusion.
What is Medigap?Medigap can help cover some costs associated with parts A and B, such as premiums, deductibles, and copays. You can only enroll in Medigap if you have an Original Medicare plan.
You can’t enroll in Medigap if you have a Part C plan.
Immunotherapy is covered under the various parts of Medicare. You’ll need to meet your plan’s deductible and then pay some coinsurance or copayment costs.
Talk with your plan provider to get a better understanding of how much coverage you’ll receive before you start your treatment.