Does Medicare Cover Radiation Therapy?

Let’s look at the different parts of Medicare and what they’ll cover when it comes to radiation treatments, including proton therapy.

Medicare Part A

Medicare Part A will cover costs related to an inpatient hospital stay and treatment. If you’re in the hospital and receive any type of radiation therapy, it’s usually covered.

Part A will also cover costs for any medications needed during your hospital stay, as well as meals you have while in the hospital.

Medicare Part B

Your Medicare Part B plan covers costs for cancer treatments and visits at outpatient medical centers like doctors’ offices and freestanding clinics. Services and treatments for cancer that may be covered under Part B include:

• cancer screening and prevention services
• radiation therapy
• medications to manage side effects (anti-nausea, pain relievers), when given by a healthcare provider in an outpatient setting

Medicare Part C

Your Medicare Part C (Medicare Advantage) plan covers all the things included in parts A and B. It may also cover extra items and services.

Your amount of coverage will depend on which plan you choose and whether you’re using an in-network provider, hospital, and pharmacy.

Medigap

Medigap (Medicare supplemental insurance) is a type of private insurance plan that helps cover your share of Medicare costs if you have parts A and B. Parts A and B together are known as original Medicare.

With a Medigap plan, you will most likely have no out-of-pocket expenses for appointments, treatments, and prescription drugs related to cancer.

Note that Medigap plans can only be used with original Medicare. If you have Medicare Advantage, you won’t be eligible to sign up for a Medigap plan.

Part A costs

The deductible amount for Medicare Part A is $1,408 per benefit period in 2020.

A benefit period starts the day after you’re admitted to a hospital. It ends after you haven’t had any inpatient care for 60 days following that hospital stay.

You may have more than one benefit period within a calendar year. You’ll owe the deductible amount for each benefit period. If you’re in the hospital for longer than 60 days, you’ll owe a coinsurance amount.

The coinsurance amounts for 2020 are:

• $352 per day for hospital stays lasting 61 through 90 days
• $704 per day for hospital stays that are 91 days and longer (for up to 60 extra lifetime reserve days)

Part B costs

The typical monthly premium for Part B is $144.60. But this may be higher depending on your income.

The deductible for 2020 for Medicare Part B is $198. After you’ve met your deductible, you’ll pay 20 percent of the costs for all other Medicare-approved treatments and services.

Part C costs

For Medicare Part C, the cost will vary depending on which plan you have. Each plan may have different copays, coinsurance, and deductibles.

Many plans have 20 percent coinsurance costs until you reach the out-of-pocket maximum (the highest possible is $6,700). After you hit that amount, 100 percent coverage should kick in.

Remember, these costs all depend on what kind of plan you have. Check your specific plan to see what’s covered.

Medigap costs

A Medigap plan is generally a little more expensive than a Part C plan and doesn’t include prescription drugs. But it may be the most stress-free way to ensure that all cancer treatment costs are handled through your coverage.

Radiation therapy involves using high-intensity beams of energy to destroy cancer cells by destroying their DNA. This then prevents them from multiplying and traveling throughout the body.

There are two types of radiation therapy: external beam and internal. Here’s how they work:

• External beam radiation. This type of radiation is given through a machine that directs energy beams to a specific site. For example, if you have a brain tumor, external radiation can target just the tumor without affecting other areas of your brain.
• Internal radiation. This type of radiation is placed inside your body in either liquid or solid form. In liquid form, it’s typically given through an IV. The radiation will travel throughout your body, seeking out any cancer cells. Solid forms include pills that you take or small particles placed at or near the site of your cancer.

A new, emerging type of external radiation treatment is called proton therapy. With proton therapy, the energy beams stop after reaching their target. This means that it’s less likely you will have any damage to healthy tissues surrounding your tumor.

Radiation therapy is often given in conjunction with other cancer treatments, like chemotherapy or surgery. It can also be used to help with pain or other symptoms in late-stage cancers.

What to expect with radiation treatments

If you and your doctor have decided that radiation therapy is right for your type of cancer, you’ll begin with a radiation simulation. During the simulation, you’ll lie on a table and a CT scan or X-ray will be done to see where your cancer is and where the energy beams should focus.

After the images are taken, your treatment team will mark the area where radiation is needed. This will help the team direct the radiation precisely to the right place.

During radiation therapy, you’ll likely have treatments 5 days per week for up to 10 weeks. How much radiation you receive and for how long will depend on the extent and type of your cancer.

Depending on the kind of treatment you get, you may experience side effects such as:

• fatigue
• nausea and vomiting
• skin changes
• diarrhea

Tell your treatment team if you’re having side effects. Your oncologist may be able to prescribe medications to help with any side effects of your radiation treatments.

• Medicare covers radiation therapy costs.
• You may still be responsible for some out-of-pocket expenses; these will depend on the type of coverage you have.
• Radiation therapy can be used as a stand-alone cancer treatment or in conjunction with other cancer treatments, like surgery or chemotherapy.