Understand how your Medicare or Medicare Advantage plan benefits can help cover various parts of your cancer treatment plan.
Being diagnosed with cancer can feel daunting, but you’re not alone. Today, there are more treatment options than ever before, from advanced oral drugs and IV therapies to hospital facilities and dedicated outpatient clinics. If you’re enrolled in Original Medicare or Medicare Advantage, it’s important to know how your benefits cover various parts of your treatment plan.
Original Medicare and Cancer Treatment
Original Medicare benefits generally cover various services related to cancer diagnosis and treatment, including:
Medicare Part A is responsible for covering hospital care, including cancer care received in the hospital. For example, surgery to remove a tumor and diagnostic testing in the hospital are covered under your Part A benefits.
Medicare Part B, by contrast, covers outpatient medical care, including most types of treatment cancer patients receive. Visits with your primary care doctor and oncologists, intravenous chemotherapy treatments, and outpatient surgery fall under Medicare Part B cancer care coverage. Preventative and early-detection cancer treatments will also typically be covered by Medicare Part B.
By law, Medicare Advantage plans—also called Medicare Part C—must offer all the benefits included in Original Medicare at a minimum. If you have a Medicare Advantage plan, you have coverage for any cancer treatments that would be included in Part A and Part B.
Some Medicare Advantage plans also offer benefits beyond those offered by Original Medicare since the private companies that administer these plans want to be competitive in the marketplace. You may have access to a larger network of doctors or coverage for services Original Medicare doesn’t include without needing to purchase a separate Medigap supplemental plan.
Medicare does cover intravenous chemotherapy for cancer patients and some orally administered chemotherapy treatments. If you’re a hospital inpatient during chemotherapy, Medicare Part A covers the treatment. If you’re undergoing treatment at an outpatient clinic or doctor’s office, the treatment will be covered under Medicare Part B.
Part D prescription drug benefits can also cover some oral chemotherapy treatments, as well as pain and anti-nausea medications your doctor may prescribe to help with treatment side effects.
Medicare also covers radiation therapy as part of cancer treatment. If you have Original Medicare and are receiving inpatient radiation therapy, you will need to pay any applicable Part A deductibles and coinsurance.
Original Medicare beneficiaries receiving outpatient radiation therapy will pay a copayment after meeting the Part B deductible. Individuals on Medicare Advantage plans may have different deductibles and copayments than those with Original Medicare benefits.
Medicare may not cover all the necessary treatment for cancer patients. Generally, these plans exclude:
Be sure to check with your doctor whether Medicare covers the cancer treatments you need.
Also, check whether your doctor is a participating doctor that “accepts assignment.” This means that the doctor will take your standard deductible and copay plus the amount Medicare pays as full payment for your cancer treatments. This is applicable to those with original Medicare; those with a Medicare Advantage plan will want to confirm whether their doctor is in network by calling their practice.
Paying for cancer treatment can have a lot of variables, and the right support will help you ensure you’re getting the most out of your coverage. Keen’s experienced local Medicare agents are ready to answer your questions about benefits and choosing the right plan. Reach by phone or text at (888) 443-5336 (TTY: 711) or search our advisor directory to find assistance in your state.