March 23rd 2023
By Ari Parker
Learn which cancer treatments and supplies are covered under Medicare as well as how much they’ll cost (including chemotherapy & radiation).
By Ari Parker
Receiving a cancer diagnosis can be an overwhelming experience. If you or someone you love has been diagnosed, you're probably worried about health and well-being in addition to the high cost of cancer treatment. Fortunately, Medicare covers many of the expenses accrued during your treatment.
Medicare has comprehensive coverage for cancer treatment and services.
Cancer patients also often use Medicare coverage for durable medical equipment and home health care.
The best plan for managing cancer is generally a Medigap Plan G or Plan N stacked on top of Original Medicare.
Medicare doesn’t cover nutritional supplements or foods for cancer treatment.
If you only have Original Medicare (Part A & Part B), then Medicare will cover 80% of costs (once you’ve met your deductibles). Especially if you’ve been diagnosed with cancer, 20% of all your medical costs can add up. 90% of Medicare beneficiaries enroll in supplemental Medicare plans to reduce their healthcare expenses.
Depending on your supplemental Medicare insurance, some of your costs for cancer treatment and screenings may be significantly lower. Medicare Supplement (Medigap) plans will reduce or eliminate the 20% of costs of covered services that Original Medicare doesn’t pay. Medicare Advantage plans will limit your out-of-pocket expenses and sometimes provide coverage for additional services. Each Medigap and Medicare Advantage plan varies, and you can work with a Medicare agent to understand or change your plan to best meet your needs.
If you need help paying for your Medicare coverage, you can see if you qualify for any of the Medicare Savings Programs or the Extra Help program for your drug needs. People who qualify for a Medicare Savings Program will also qualify for Extra Help.
In terms of affordability, the best Medicare plan for managing cancer is often Original Medicare, paired with a Medicare Supplement plan and a prescription drug plan. Many Medicare Advantage plans require a 20% coinsurance for chemotherapy and radiation treatments. With the right Medicare Supplement plan and prescription drug plan, you can cut down on costs significantly. We’ll break down what coverage looks like with Original Medicare and Medicare Supplement vs. Medicare Advantage.
For cancer management and chronic care conditions, Original Medicare paired with a Medicare Supplement plan and a prescription drug plan is usually the most affordable option. If you only have Original Medicare you’ll have to pay for about 20% of the cost of services. With a Medigap Plan G, you’ll pay nothing for treatments once you meet your Part B deductible. Medigap Plan N is also a good option, but you may have to pay Part B excess charges in certain states.
All Medicare Advantage plans must provide the same coverage as Original Medicare. That said, they don’t have to standardize their costs in the same way as Original Medicare. Private insurance companies that offer Medicare Advantage plans set their own deductibles, coinsurance, and copays. Network restrictions can also make seeing certain providers more expensive.
In general, you’ll want to find a Medicare Advantage plan that has a low out-of-pocket maximum, because you’re likely to hit it if you’re receiving cancer treatment. Medicare Advantage plans often list copay and coinsurance amounts that you’ll have to pay in their Summary of Benefits. If you’re shopping for a Medicare Advantage plan, make sure you understand your out-of-pocket costs.
One important note about Medicare Advantage plans is that they often require prior authorization. These requests can delay your care, which can be detrimental for cancer treatment. If prior authorization is denied, you may have to cover the entire cost of services on your own.
Depending on the treatment plan you and your doctor choose, there are specific supplies and treatments you’ll need. Medicare Part B covers most supplies you’ll need during or after treatment. You'll need to get your supplies from a doctor or medical equipment company that accepts Medicare to get full coverage. If you have a Medicare Advantage plan, make sure to ask your provider if they take your specific plan. The following are standard cancer supplies that Medicare covers.
Many women with breast cancer will undergo a mastectomy (a surgical procedure that removes one or both breasts). You can get external or internal breast prostheses if you require or choose to have a mastectomy. External breast prostheses, including post-surgical bras, are covered by Medicare Part B. If you choose to have internal breast prostheses surgically implanted, you may be covered by either Part A or Part B. Learn more about how Medicare covers breast reconstruction surgery.
A colostomy, ileostomy, or urinary ostomy may be part of your treatment for colon cancer or other cancers that affect the digestive or urinary systems. Medicare Part B will cover ostomy supplies deemed medically necessary and ordered by your doctor from a company that accepts Medicare.
Often during the course of treatment, cancer patients require medical equipment to help with treatment or recovery. Durable medical equipment includes supplies like:
Walkers
Wheelchairs
Nebulizer machines
Nutrition equipment, like feeding pumps
Hospital beds
Oxygen equipment and accessories
Catheters for home IV infusions
For these supplies to be covered, they must be ordered by your doctor—and your doctor and the equipment company need to be enrolled and in good standing with Medicare.
Depending on the type of equipment you need, Medicare may require you to rent or buy the equipment. Medicare covers 80% of the cost of rented equipment for 13 months. Many times after 13 months, you automatically take ownership. Medicare may require that you purchase equipment that is not very expensive. You will only pay the 20% coinsurance on these items if you’ve met your Part B deductible.
Depending on the type of treatment you receive, and the location where you receive it, your cancer treatment may be covered by Original Medicare or Part D. You must be enrolled in a Part D (prescription drug) plan to obtain coverage for medications and treatments not covered by Original Medicare.
Medicare covers chemotherapy for cancer patients. How much you pay depends on your specific coverage.
There are limits to the number of treatments that Medicare will cover. Your doctor may want you to have more treatments than are covered by Medicare. If this is the case, you may be responsible for 100% of the cost of the additional treatments. Be sure to ask questions and find out what is covered before you get the treatment to avoid surprise medical bills.
Medicare Part A covers inpatient radiation treatment. Medicare Part B covers outpatient radiation treatments.
Medicare Part D covers most cancer medications that are taken at home. While most people think of chemotherapy as being administered by an IV, some chemotherapy drugs can be taken by mouth or applied topically. Topical chemotherapy medications are a common treatment or follow-up treatment for skin cancer. Other chemotherapy drugs can be taken by mouth or dissolved under the tongue.
Like other medications you pick up at your pharmacy, you must be enrolled in a Medicare Part D plan that covers the prescription drugs you need to receive coverage. Remember that even with your Part D plan, you may be responsible for a copay or a coinsurance charge.
Early detection for cancer cells can improve your chance of successful cancer treatment. Medicare Part B covers many preventative screening services, including cancer screenings. Most cancer screenings are simple outpatient scans or exams that can improve your chances of catching cancer earlier. Many screenings are covered at no cost to you, including:
Pap smears and HPV testing for women
Breast exams and mammograms
Bone density testing
Colon cancer screening, including fecal tests, colonoscopies, and flexible sigmoidoscopies
Lung cancer screening with low-dose CT scans
Prostate screening by digital rectal exam and PSA blood testing
Medicare also covers a few other services that can be beneficial for people with cancer. These include home health care services, LTACH care, and hospice care.
Medicare covers home health care services for a short period if your condition prevents you from leaving your home. If you’re recovering from surgery or otherwise eligible for home health services, you can receive the following benefits from a Medicare-certified home health agency.
Part-time skilled nursing care alongside a home health aide
Medical social services
Durable medical equipment
Medical supplies
Coverage doesn’t apply for meals, 24/7 care at home, homemaker services, or custodial care. If you qualify for home health care services, you’re only responsible for paying the coinsurance for durable medical equipment.
Your hospital insurance (Part A) also covers care at a long-term acute care hospital (LTACH). All of the costs for Part A also apply to stays at an LTACH.
Medicare Advantage plans also cover these services, but your out-of-pocket costs will depend on your plan. Take a look at your policy’s Summary of Benefits to understand your out-of-pocket costs.
While hard to think about, Medicare Part A covers hospice care if you have a life expectancy of six months or less. Medical services, social services, spiritual and grief counseling, and other relevant services are all covered. Your only out-of-pocket costs are a $5 copay for each prescription needed for pain and symptom management and a 5% coinsurance for inpatient respite care.
Medicare covers most supplies and services needed for cancer care, but a few are not covered. While feeding pumps and equipment are covered, medical food and nutritional supplements are generally not.
If you have questions about how you're covered under Medicare, schedule time to discuss the details with one of Chapter’s Medicare Advisors, or call us at 855-900-2427. We’ll help you understand how your current Medicare coverage works and help you enroll in a plan with better coverage if there’s an opportunity.
