Does Medicare Cover Chemotherapy?

Yes, Medicare covers chemotherapy. If you have been diagnosed with cancer and your doctor prescribes chemotherapy, Original Medicare (Part A and Part B) will help pay for your treatments. How it is covered - and what you will pay out of pocket - depends on where you receive the treatment and how the medication is administered.

If you receive chemotherapy as an inpatient in a hospital, Medicare Part A covers the cost of the treatment as part of your hospital stay. You will be responsible for the Part A deductible, but the chemotherapy itself is covered.

If you receive chemotherapy in an outpatient clinic or doctor's office, Medicare Part B covers the treatment. Part B covers both the chemotherapy drugs and the administration of the drugs. For outpatient chemotherapy, you will pay the Part B deductible and a 20% coinsurance for the Medicare-approved amount of the treatment.

Because chemotherapy can be expensive, that 20% coinsurance can add up quickly. There is no annual limit on your out-of-pocket costs with Original Medicare alone.

This is where the rubber meets the road. A cancer diagnosis is hard enough without having to worry about whether you can afford the treatment that could save your life. You've worked hard, paid into the system, and you deserve to know exactly how your coverage works so you can protect what you've earned.

If you have a Medicare Supplement (Medigap) plan, it will help cover the 20% coinsurance that Part B leaves behind. Depending on the Medigap plan you choose, your out-of-pocket costs for outpatient chemotherapy could be reduced to zero after you meet your Part B deductible.

If you choose to enroll in a Medicare Advantage plan instead of Original Medicare, your chemotherapy will still be covered, but the costs and rules will be different. Medicare Advantage plans are required to cover everything that Original Medicare covers, but they can set their own copayments and coinsurance for chemotherapy. You may also be required to use doctors and facilities within the plan's network, and you may need prior authorization before your treatment can begin.

The choice between Original Medicare with a Medigap plan and a Medicare Advantage plan is the most important decision you will make regarding your healthcare coverage. The supplement decision comes AFTER you choose Traditional Medicare - it's a component of the Traditional path, not an alternative to Advantage.

When you're facing a serious illness, you need straight answers, no surprises. We can walk you through every option and help you understand exactly how your coverage will work when you need it most. We're on your side of the table, and we'll help you compare your options free, with no obligation.