Cancer is one of the most invasive and deadly conditions of all time. One of every two men and one of every three women will get cancer in their lifetime. The American Cancer Society reports over 4,500 people receive a cancer diagnosis daily. Fortunately, more people are living through and beating cancer. Medicare covers cancer treatment and procedures.

How Does Medicare Cover Cancer Treatments?

There are several cancer treatments available. Medicare will cover cancer treatments that have been proven to treat cancer. There is access to experimental cancer treatments. Generally, Medicare won’t cover experimental treatments.

Cancer treatments include surgery, chemotherapy, radiation therapy, immunotherapy, hormone treatment, stem cell transplant, bone marrow transplant, and targeted therapy.

Medicare Coverage For Cancer Surgery

Surgery is a standard cancer treatment. It involves surgically removing the cancerous tissues to get rid of cancer and stopping the spread. Depending on the location of the procedure, Medicare covers it as an inpatient or outpatient procedure.

Is Chemotherapy Covered by Medicare?

Chemotherapy is a cancer treatment that uses anti-cancer drugs as a standardized chemotherapy regimen. This type of treatment may cure cancer, prolong life, or reduce symptoms. Chemotherapy is performed as either an inpatient or an outpatient service.

There are newer prescription drug versions of chemotherapy available also. If you receive a chemotherapy pill, it’ll be covered by Medicare Part D.

Medicare Coverage For Radiation Therapy

Radiation therapy or radiotherapy is a therapy using ionizing radiation. Radiation therapy is provided as a cancer treatment to control or kill malignant cells.

A linear accelerator delivers this type of therapy. Medicare covers radiation therapy, and it’ll be provided as an inpatient or outpatient treatment.

Does Medicare Cover Cancer Immunotherapy?

Immunotherapy is a cancer treatment that helps your immune system fight cancer. Immunotherapy is a biological therapy that uses substances made from living organisms to treat cancer.

Your immune system detects and destroys abnormal cells and prevents the growth of many cancers. Immunotherapy is generally covered under Medicare Part B.

Does Medicare Cover Hormone Therapy?

Hormonal or endocrine therapy is a cancer treatment that may slow or stop the spread of cancer. It blocks the body’s ability to produce these particular hormones or changes how hormone receptors behave in the body.

Hormone therapy is available via pills, injections, or surgery. Hormone therapy surgeries remove hormone-producing organs, namely the ovaries in women and the testicles in men. It’s used alongside other cancer treatments.

Original Medicare does not cover hormone therapy treatment for cancer. Some Medicare Advantage or Part D drug plans may cover hormone replacement therapy drugs. You should check the plan’s drug formulary to see if the hormone replacement drug you need is covered.

Does Medicare Cover Stem Cell Transplants?

Stem cell transplants restore blood-forming stem cells in people who have lost theirs due to chemotherapy or radiation therapy used to treat certain cancers:

  • Blood-forming stem cells are important because they grow into different blood cells.
  • White blood cells are part of your immune system, and they help your body fight infection.
  • Red blood cells carry oxygen throughout your body.
  • Platelets help the blood to clot.

All three types of blood cells are needed to remain healthy. Most stem cell replacement is considered experimental, and Medicare does not cover experimental treatment.

FDA-approved stem cell cancer treatments can be covered by Medicare.

Does Medicare Cover Bone Marrow Transplants?

Bone marrow transplant is another name for stem cell transplant. There are 2 types of stem cell transplants covered by Medicare.

Autologous transplant stem cells come from your own body. For this type of stem cell treatment, doctors remove stem cells from your blood or bone marrow before beginning cancer treatment.

After chemotherapy, the stem cells are returned to your body. This restores your immune system and allows your body to fight infection and produce blood cells.

Allogeneic transplant stem cells come from another person. The patient receives the donor’s stem cells following chemotherapy or radiation therapy.

Medicare Coverage for Targeted Therapy

Targeted therapy targets proteins that control how cancer cells grow, divide, and spread. The most common target therapies are small-molecule drugs and monoclonal antibodies, the latter also being a treatment for COVID.

Small-molecule drugs use drugs that are small enough to enter cells.

Monoclonal antibodies or therapeutic antibodies are proteins produced in the lab. They attach to locations on cancer cells. Monoclonal antibodies can mark cancer cells so that the immune system can identify them and makes it easier to destroy them.

Additionally, monoclonal antibodies can directly stop cancer cells from growing or cause them to self-destruct or carry toxins to cancer cells.

Medicare covers targeted therapy for FDA-approved treatments.

Does Medicare Cover Breast Cancer?

While there are many different forms of cancer, breast cancer in women (and sometimes even for men) is one of the most common kinds. Three out of every 10 women who develop cancer each year will have breast cancer.

The good news in this fight is that both parts of Medicare cover it. Part A will deal with any hospital visits or long-term care pertaining to defeating this disease. Part B will be the aspect of Medicare that deals with treatment and visits to a doctor.

Either way, breast cancer is covered under Medicare, which might include the long list of medicines used to combat it.

How Much Do Cancer Treatments Cost on Medicare?

The treatment and location determine your Medicare costs. Most cancer treatments occur as inpatient or outpatient.

Inpatient procedures take place in the hospital, and Medicare Part A covers those services. On Medicare Part A, you can expect to pay your Part A deductible and any coinsurance or copays depending on the length of your inpatient stay.

Outpatient procedures happen at an outpatient facility or doctor’s office. Medicare Part B covers these services. You can expect to pay your Part B deductible and 20% of the cost.

If your provider doesn’t accept Medicare assignment, you can pay an additional 15% on top of the 20%.

Suppose your treatment includes prescription drugs from the pharmacy. In that case, you’ll be covered under Medicare Part D. Check your plan’s formulary to determine coverage for medicine. You’ll be responsible for any deductibles, copays, or coinsurance as outlined by your plan.

How Do Medigap Plans Cover Cancer Treatments?

Medicare Supplement plans fill the gaps in Parts A and B of Medicare. Depending on the plan letter you choose, you’ll have little to no money out of pocket for Medicare-approved cancer treatments covered by Medicare parts A or B.

Medicare Supplement plans don’t cover drug coverage. For Medicare-approved cancer prescription drugs, you’d refer to your drug plan.

How Do Medicare Advantage Plans Cover Cancer Treatments?

If you enroll in a Medicare Advantage plan, expect to pay the plan’s copays or coinsurance for covered cancer treatments.

You should expect to hit your maximum-out-of-pocket in a Medicare Advantage plan in many cases. Most Medicare Advantage plans include drug coverage.

You will pay the plan’s deductible, copays, or coinsurance. Check your plan to ensure coverage of a specific drug.

How are Prescription Drugs for Cancer Covered?

Medicare Advantage or a Part D prescription plan will cover you.

Check with your plan’s formulary to ensure coverage for your prescription. You can expect to pay the plan’s copay, coinsurance, or deductibles as applicable.

How to Get Medicare Coverage for Cancer

If you’re facing an unexpected battle with cancer, or you’re the loved one or caretaker of someone that is, you aren’t alone. We can assist you in figuring out your options for health coverage so that you can concentrate on dealing with cancer.

We have a team of licensed agents at your disposal to help find the best coverage for your individual needs. Fill out our online request form, or give us a call. We’ll be more than happy to connect you with the information you need and answer all of your questions.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.