Medicare Coverage for Cancer

Man diagnosed with cancer receiving chemotherapy

Receiving a cancer diagnosis can be life-changing, and treatment may be costly. In 2018, over 1.7 million new cases of cancer were diagnosed in the United States, according to the National Institutes of Health (NIH). The good news is that cancer mortality is much lower than cancer incidence (new cases of cancer). That is very good news because it means that some lives are saved through cancer treatment.


There is no “one” approach to treating cancer. Cancer treatment is the result of the work of several doctors who need to come up with highly individualized treatment plan because approaches differ from person to person and from types of cancer, their stage, and threat to normal life functions. A comprehensive cancer treatment plan will include one or more of the following courses of treatment:


Surgery for cancer treatment may involve cutting out a tumor, surrounding healthy tissue, and nearby lymph nodes. Surgery works best for solid tumors that are contained in one area. Surgery cannot be used for blood cancer or for cancers that have spread over the body. The cost of cancer treatment involving surgery includes costs for the surgeon, anesthesiologist, pathologist, operating room fees, equipment, and medicines. Often surgery is combined with other cancer treatments.

Chemotherapy involves chemicals given orally or intravenously to kill cancer cells and stop cancer from spreading. Medicare generally covers chemotherapy cancer treatment if you’re a cancer patient in a hospital, outpatient clinic, or doctor’s office and costs may differ in the ways how the chemotherapy medications are administered.

Hormone therapy uses synthetic hormones and hormone blockers to target cancers that use hormones to grow. The cost varies from treatment to treatment.

Immunotherapy helps your immune system fight cancer. Immunotherapy includes medications that cause an immune response that kills cancer cells. Immunotherapy also includes treatment vaccines that boost the immune system’s response to cancer cells. Medicare may cover immunotherapy cancer treatment if it is determined to be medically necessary.

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.

Genetic therapy is the newest type of approach that typically deliver a virus to a cancer cell that will target and help destroy it.

Medicare Coverage of Cancer Treatment

Depending on the specific type of cancer a person has, Medicare covers some treatments from parts A and B. Still, in general, every part of Medicare covers some aspect of cancer treatment.

Medicare Part A may cover the following:

  • inpatient chemotherapy
  • inpatient hospital stay for surgery
  • blood transfusions
  • hospice care
  • skilled nursing facility care after a 3-day hospital stay
  • home healthcare (physical and occupational therapy)
  • surgically implanted breasts prostheses after a mastectomy (if the surgery takes place in an inpatient hospital)
  • some costs of clinical research in hospital settings

Medicare Part B may cover a variety of outpatient cancer services and treatments. It may cover the following:

  • outpatient chemotherapy
  • some oral chemotherapy
  • radiation therapy at an outpatient center
  • outpatient surgery
  • durable medical equipment (walker or supplemental oxygen)
  • equipment for external nutritional support at home (feeding tubes and pumps)
  • tests to diagnose and evaluate cancer treatment (CT scans and screenings)
  • some costs of medical research as an outpatient
  • external breasts prostheses after a mastectomy
  • breasts implants after a mastectomy, when the surgery takes place on an outpatient basis
  • doctor`s office visits

Medicare Part C plans give you all of the guaranteed Part A and B benefits through private insurance coverage. Although Medicare Advantage plans usually aren’t the best choice for cancer patients because most plans’ benefits aren’t as good as Medicare plus a Medicare Supplement policy. Part C requires you to go to specific doctors within a specific network, they require pay coinsurance until meeting the out-of-pocket maximum and you cannot add a Medicare Supplement plan to your Part C plan. But on the other hand, Part C plans may also bundle Part D into their coverage to cover the cost of prescription medications.

Part D or prescription drug coverage could provide coverage for oral chemotherapy medications, antinausea medications, and pain medications.

What Medicare does not cover regarding cancer?

Medicare won`t give coverage for any service, treatment, or medication that is not medically necessary. There are also limitations on coverage. And here lies the reason why you should have cancer insurance. For example, Medicare does not cover costs associated with:

  • room and board at an assisted living facility
  • services that help people with activities of daily living (such as bathing)
  • adult daycare
  • medical food or nutritional supplement
  • long-term nursing home care

Since Medicare does not cover all possible treatments, people should check with a doctor to ensure that their coverage includes the recommended treatment. If Medicare does not cover a recommended treatment, a doctor may be able to suggest an alternative treatment that Medicare does cover. Medicare does not cover all related expenses. For example, if a person loses their hair due to cancer treatment, Medicare will not cover the cost of a wig, as it is not medically necessary, but on the other hand, it will cover surgically implanted breast prostheses after a mastectomy.

Final Thoughts

Cancer treatment can be very costly. Every part of Medicare gives coverage for cancer treatments or drugs. However, a person will still be responsible for some of the cost. But there are some other programs that help limit those costs and help those with low income to have insurance. People’s total out-of-pocket expenses will vary. Before starting any suggested treatment, be sure that your doctor accepts the Medicare Assignment. The best option is that you talk with your doctor about every possible treatment to make sure that Medicare will provide coverage for at least some of the costs produced. If Medicare does not provide coverage for the treatment your condition needs, a doctor could recommend a different treatment option. With Texas Medicare Advisors you can buy special insurance for cancer diagnosis, the cancer insurance policy.

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