Will Medicare Pay For Cancer Treatment?

A cancer diagnosis can raise concerns about life, health, and the ability to afford treatments. Fortunately, Medicare can help pay for most qualifying treatments and services, such as doctor’s visits, screenings, and chemotherapy. You may face out-of-pocket costs, depending on your plan.

What cancer treatments does Medicare cover?

Different parts of Medicare cover cancer care. Medicare includes Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Coverage). Further, supplemental plans such as Part G and N can help cover gaps in coverage under Parts A and B (Original Medicare).

Does Medicare cover cancer prevention services?

Yes, Medicare covers certain preventive health care services and cancer screening tests. Some procedures are available at no cost, while others require a partial or full payment depending on:

• Where you receive your service or item
• The doctor’s fees
• The type of facility
• If your healthcare provider accepts assignment
• Other insurance you may have

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Colorectal cancer

People at an elevated risk for colorectal cancer can have a screening colonoscopy every two years. Otherwise, Medicare pays for the test every 10 years or four years after a previous flexible sigmoidoscopy.

Medicare will cover a follow-up colonoscopy if you receive a positive result from a non-invasive stool-based screen test.

Part B pays for a blood-based biomarker lab test for people:

• Between age 45 and 85
  
• At average risk of developing colorectal cancer
• Who show no symptoms of colorectal disease.

Lung cancer

Medicare Part B pays for yearly lung cancer screenings with low-dose computed tomography (LDCT). You must have an order from your healthcare provider and meet the following conditions:

• Age 50–77
• Asymptomatic
• Either a current smoker or have quit within the last 15 years
• Smoked at least an average of 20 cigarettes per day for 20 years.

Before the first lung cancer LDCT screening, you must have a counseling and shared decision-making visit, which covers beneficiary eligibility and the importance of yearly lung cancer LDCT screenings. Your healthcare provider will also discuss the impact of comorbidities and the urgency of smoking cessation and abstinence.

Breast cancer

Medicare covers one screening mammogram annually for all women with Medicare ages 40 and older. Women between the ages of 35 and 39 can get one baseline mammogram in their lifetime.

You pay 20% of the Medicare-approved amount for diagnostic mammograms after meeting the Part B deductible. Screening mammograms are free if a qualified healthcare provider accepts assignment.

Cervical cancer

Medicare Part B covers one Pap test and pelvic exam every two years. The pelvic exam includes a clinical breast screening for breast cancer. The Pap test includes tests for the Human Papillomavirus (HPV) every five years for asymptomatic women ages 30 to 65.

If your healthcare provider accepts assignment, you pay nothing for:

• The pelvic and breast exams
• The lab Pap test
• The Pap test specimen collection
• The lab HPV with Pap test

Prostate cancer

Medicare Part B covers prostate-specific antigen (PSA) blood test and digital rectal exams yearly for men over 50. If you get these services from a healthcare provider that doesn’t accept assignment, you may have to pay an additional cost. However, the test will be at no cost to you.

Digital rectal exams and related doctor’s services are cost-free.

Does Medicare cover chemotherapy?

If you have cancer, Medicare will cover your prescribed chemotherapy treatments. Part A covers hospital inpatient care. Part B covers hospital outpatient care and services in a doctor’s office or freestanding clinic.

In a hospital outpatient setting, you’ll be responsible for a copayment for chemotherapy. You’ll pay the Part B deductible and 20% of the Medicare-approved amount in a doctor’s office or freestanding clinic.

What are the out-of-pocket costs for cancer care?

While Medicare may pay a substantial portion of your cancer care expenses, you may still be responsible for handling some costs. Your income, the type of health provider you use, and your treatment location can influence what you pay. Moreover, Medicare out-of-pocket costs usually change every year.

Premiums

If you must pay a Part A monthly premium, you will continue to pay up to $506 each month in 2023. Most people have paid enough Medicare taxes while working, so their Part A is premium-free.

The standard Part B monthly premium is $164.90 in 2023. People with higher incomes pay more. Each provider sets premiums for Medicare Part C, Part D, or supplemental plans.

Deductibles

The deductible is the amount you must pay on top of the premium before Medicare starts to pay. Under Part A, you pay a $1,600 deductible per benefit period for hospital stays. The Part B deductible for 2023 is $226. There is no limit to how many benefit periods you can have in a year, so you might pay the deductible more than once a year.

Part B costs

After paying your deductible, you typically need to pay 20% of the cost for each Medicare-covered service. However, you pay nothing to cover clinical laboratory or home healthcare services.

Hospice care

You don’t pay for covered hospice care services, either. However, you might need to pay a copayment of $5 for drugs while you’re at home. You may also have to pay 5% of the Medicare-approved amount for inpatient respite care.

Deductibles, copayments, and other costs vary according to your Part C, Part D, or Medigap plans. Medicare pays for cancer screenings, surgeries, chemotherapy, and inpatient hospital stays. It may also cover the costs of clinical research and durable medical equipment needed for your cancer treatment. However, your doctor may recommend services that Medicare doesn't cover, so ask questions beforehand.