How Does Medicare Cover Cancer Treatment?

Cancer ranks as the second leading cause of death in the U.S., with over 600,000 fatalities each year, according to the CDC. This raises a crucial question: How does Medicare cover cancer treatment?

Discover how Medicare covers cancer treatment, including inpatient and outpatient services, prescription drugs, and preventive measures, to support your healthcare needs.

This article provides a detailed summary of Medicare’s cancer coverage, offering a thorough understanding to help you make informed healthcare decisions.

Understanding Medicare Coverage for Cancer Treatment

Navigating cancer treatment can be overwhelming, both emotionally and financially. Fortunately, Medicare enrollees can have many of these costs covered.

Medicare provides coverage for a broad range of diagnostic and treatment procedures essential in cancer care, including:

Diagnostic Procedures: These include colonoscopies, mammograms, X-rays, biopsies, and blood tests.

Treatment Options: After a cancer diagnosis, doctors often recommend a multidisciplinary approach. Medicare covers:

  • Surgery: Aimed at removing malignant tumors to prevent the spread of cancer cells.
  • Radiation Therapy: Uses high-energy particles to shrink and destroy tumors.
  • Chemotherapy: Utilizes powerful chemicals to target and kill cancer cells.
  • Immunotherapy: Strengthens the immune system’s response against cancer.

Medicare’s cancer coverage consists of several parts:

Original Medicare (Part A and Part B):

  • Part A (Hospital Insurance): Covers inpatient hospital stays, providing financial support during prolonged hospitalizations related to cancer care.
  • Part B (Medical Insurance): Covers outpatient services, preventive care, and consultations.

Medicare Advantage (Part C): Private insurance companies offer Part C plans as an alternative to Original Medicare. These plans must provide at least the same benefits as Original Medicare and often include additional services like dental, vision, and hearing.

Medicare Part D (Prescription Drugs): Covers specific cancer drugs and other essential prescription medications. For those under Original Medicare, a separate enrollment in a standalone Part D plan is necessary for prescription drug coverage.

Medicare Part A and Cancer Treatment

Medicare Part A provides essential care for cancer patients by covering a range of treatment-related expenses, including:

  • Inpatient Hospital Stays: Covers cancer treatments received during hospitalization.
  • Cancer Surgeries: Includes all costs from doctor’s fees to post-operative care, such as blood transfusions and reconstructive surgery.
  • Chemotherapy During Hospitalization: Covers the cost of hospital-based chemotherapy if prescribed by a physician.
  • Radiation During Hospitalization: Covers the costs of inpatient radiation treatment.
  • Skilled Nursing and Home Health Care: Provides coverage for skilled nursing care or home health care after a minimum three-day hospital stay.
  • Hospice Care: Covers end-of-life care for those diagnosed with terminal cancer.

Medicare Part B and Cancer Treatment

Medicare Part B provides comprehensive coverage for outpatient cancer care, addressing a range of essential services and treatments, including:

  • Doctor’s Visits: Regular check-ups, monitoring, and post-operative consultations.
  • Diagnostic Tests: Crucial tests such as X-rays and CT scans to enable early detection and effective treatment.
  • Preventive and Screening Services: Covers screenings and preventive services for individuals at risk.
  • Chemotherapy: Covers both intravenous and oral chemotherapy treatments administered in outpatient clinics or doctor’s offices.
  • Radiation Therapy: Covers radiation therapy received at outpatient clinics or Medicare-approved facilities.
  • Immunotherapy: Covers outpatient immunotherapy treatments in doctor’s offices or freestanding clinics. Immunotherapy vaccines deemed medically necessary may be covered under Medicare Part D.
  • Durable Medical Equipment (DME): Includes coverage for equipment like wheelchairs, walkers, feeding pumps, and enteral nutrition equipment prescribed for home use.
  • Mental Health Services: Covers cancer-related mental health services, both in clinics and hospital outpatient departments.
  • Nutritional Counseling: Available for patients with related complications such as diabetes or kidney disease.
  • Clinical Research Studies: If participating in a clinical trial, Part B may cover a significant portion of the costs.

For many treatments under Part B, Medicare typically covers 80% of the approved amount, with the patient responsible for the remaining 20% after meeting the Part B deductible.

Medicare Part C (Medicare Advantage) and Cancer Treatment

Medicare Part C, also known as Medicare Advantage, is required to provide all the benefits offered by Original Medicare (Part A and Part B). For cancer treatment, this means that Part C must cover essential services such as inpatient and outpatient treatments, chemotherapy, radiation, and surgeries, just like Parts A and B.

Many Medicare Advantage plans offer additional benefits not typically covered by Original Medicare, such as prescription drug coverage (Part D), dental, vision, and hearing services. However, coverage may vary depending on the specific plan you choose and whether your healthcare providers are in-network for your Medicare Advantage Plan.

It is important to examine your plan details carefully and check with your healthcare provider to ensure they accept your Medicare Advantage Plan.

Medicare Part D (Prescription Drug Coverage) and Cancer Treatment

Medicare Part D provides comprehensive coverage for various prescription drugs essential to cancer treatment, including oral chemotherapy drugs, anti-nausea medications, and pain relievers. Part D may also cover immunotherapy vaccines when deemed medically necessary.

While many Medicare Advantage plans include prescription drug coverage, the list of covered drugs may differ among plans. It’s crucial to review your plan’s formulary to ensure it covers your required medications.


Medicare provides extensive coverage for cancer treatment through its various parts, including inpatient and outpatient services, prescription drugs, and preventive measures. Understanding the scope of this coverage can significantly impact the management of cancer care.

Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.

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