Cancer treatment can be costly—but Medicare can help you cover certain expenses.
Does Medicare fully cover chemotherapy? Some chemo drugs are covered under Medicare Part B, while others fall under Part D.
Medicare also covers most of the cost of a second opinion prior to undergoing cancer surgery.
Cancer is the second leading cause of death in the United States as well as globally. Millions of people today are living with cancer, have had it in the past, or are watching a loved one struggle with this disease.
Does Medicare cover cancer costs?
Managing a condition like cancer can be costly. But Medicare will help pay to diagnose and treat the cancer-related medical and mental health conditions you face. Specifically, Medicare covers these services:
- Doctor visits
- Certain medical items
- Ongoing medical treatment for your cancer diagnosis
- Hospital care
- Second opinions on surgery
- Chemotherapy or drugs taken orally or intravenously
- Medical treatment for other health conditions and side effects of your cancer treatment
- Prescription drugs for chemotherapy and to treat side effects such as nausea
- Healthcare services at home, such as a visiting nurse or rehabilitation therapist and home health aides
- Assistance with daily tasks, called rehabilitative care
- Mental health services
- Experimental treatments in clinical trials
- Short-term nursing home care
- Hospice or end-of-life care
Medicare may not pay for everything you need. It often does not cover these services:
- Services that help you bathe, eat, and do other activities of daily living that do not require skilled care
- Nutritional supplements
- Stays in assisted living facilities
- Adult daycare
- Long-term nursing home care
How to find a cancer treatment center
To get the best medical care possible for your cancer, choose your treatment center carefully. You may not be able to determine which hospital treats you in an emergency, but you can designate a center for your regular care.
The government has named some hospitals and healthcare organizations as excelling in treating certain conditions. These are called Centers of Excellence. The National Cancer Institute (NCI) has named the top centers for treating cancer in the United States. These are called NCI-designated cancer centers.
Drugs covered by Medicare Part B
It can be hard to understand why Medicare covers some drugs under Part B and others under Part D. But it is important to know the difference. How you get your drugs and what you pay will differ depending on whether Medicare Part B or Part D covers your drugs.
Does Medicare fully cover chemotherapy? Medicare Part B covers most chemotherapy drugs. These are cancer-treating medications that are given as a shot, through an IV tube, or by mouth.
There’s one important distinction to take note of. Medicare Part B covers cancer drugs that you take intravenously or by mouth. If your drug is only made to be taken by mouth, your Medicare Part D plan should cover it.
Medicare coverage for anti-nausea drugs
Many chemotherapy drugs can cause nausea and vomiting. This is why some cancer patients receive anti-nausea drugs. Anti-nausea drugs are covered the same way Medicare covers cancer drugs. If you can take your anti-nausea drug by mouth or intravenously, Medicare Part B will cover either one. But your doctor must give the medication to you within 48 hours of your cancer treatment. Otherwise, your Medicare Part D plan should cover it.
Medicare coverage for radiation therapy
You might be wondering, “Does Medicare pay for cancer radiation treatments?” Medicare Part B covers your radiation if you are an outpatient or in a freestanding facility. You will pay 20% coinsurance of the amount Medicare approves for the doctor visit. Medicare will pay the remaining 80%.
Medicare Part A covers your radiation therapy while you are a hospital inpatient.
Medicare coverage for second opinions
After you get your doctor’s diagnosis and cancer treatment plan, it’s a good idea to get another cancer doctor’s advice before you start treatment. This is especially true if your doctor suggests surgery. This is called a second opinion.
Medicare covers most of the cost of a second opinion before surgery. A second doctor might tell you to follow your first doctor’s treatment plan. Or they may suggest that you change the plan. A second opinion can give you peace of mind, knowing you’ve explored all of your treatment options. It will also give you a chance to get all your questions answered.
More questions regarding Medicare and cancer coverage?
How much does chemo cost with Medicare? What does Medicare pay for cancer screenings? Visit our Medicare guidance hub to learn more about coverage and benefits.