Medicare covers most cancer treatments, but the amount you pay depends on which part of Medicare you have and what type of treatment you need

Medicare Part A covers inpatient hospital stays for cancer treatment, including surgery and chemotherapy given while you are admitted. Medicare Part B covers outpatient services: doctor visits, lab tests, imaging scans, radiation therapy, and chemotherapy given in a clinic or doctor's office. If you have Original Medicare (Part A and B together), you will pay a deductible and coinsurance for each service. If you have a Medicare Advantage plan (Part C), your coverage and costs work differently — you pay copays instead, and your plan sets its own rules about which hospitals and doctors you can use.

The key difference is timing and setting. A treatment given in a hospital bed is Part A. The same treatment given while you sit in an outpatient chair is Part B. Both are covered, but you pay different amounts.

Key Takeaways

  • Medicare Part A covers cancer treatment during hospital stays; Part B covers outpatient visits, scans, chemotherapy, and radiation therapy.
  • With Original Medicare, you pay a deductible and coinsurance; with Medicare Advantage, you pay copays, and your plan decides which providers you can see.
  • Prescription cancer drugs are covered under Part D (prescription drug plans) if you enroll, or under Part B if given by injection in a doctor's office.
  • Clinical trials for cancer treatment may be covered by Medicare if the trial meets certain standards, but you should confirm coverage before enrolling.
  • Costs can add up quickly; ask your doctor's office or hospital for an estimate before treatment starts, and contact Medicare directly if you have questions about a specific drug or procedure.

What Part A covers during a hospital stay

If you are admitted to the hospital for cancer surgery, chemotherapy, or other inpatient treatment, Medicare Part A pays the hospital's charges after you meet your deductible. For 2024, the Part A deductible is $1,632 per hospital stay (this amount changes each year). After you pay the deductible, Medicare covers the full cost of your hospital room, meals, nursing care, and most procedures and tests done while you are there.

You do not pay extra per day for the first 60 days. From day 61 to day 90, you pay a daily coinsurance amount. If you stay longer than 90 days, costs rise further. Most cancer treatments do not require stays longer than a few weeks, so most people pay only the deductible and then nothing more for that hospital stay.

What Part B covers for outpatient cancer care

Most cancer treatment happens outside the hospital. Part B covers doctor visits, oncologist consultations, lab work, CT scans, PET scans, X-rays, chemotherapy infusions in a clinic, radiation therapy, and related services. You pay 20 percent coinsurance after you meet your Part B deductible (for 2024, that is $240 per year). Once you reach your deductible, Medicare pays 80 percent of the approved amount for each service, and you pay 20 percent.

If your doctor orders a scan or test, Medicare covers it if it is medically necessary for your cancer diagnosis or treatment. If your doctor prescribes a chemotherapy drug to be given by injection in the office, Part B covers it. If the drug is a pill you take at home, it falls under Part D instead.

Prescription cancer drugs and Part D coverage

Cancer medications you take by mouth — such as targeted therapy pills or hormone therapy — are covered under Medicare Part D, the prescription drug plan. You must enroll in a Part D plan during your initial enrollment period or during the annual open enrollment period (October 15 to December 7 each year). If you do not enroll when you are first may be able to access, you may pay a penalty for late enrollment.

Part D plans vary widely in which drugs they cover and how much you pay. Some cancer drugs are expensive, and your plan may require you to try a cheaper drug first or get approval from the plan before it will pay. This is called prior authorization. Ask your oncologist's office to check your plan's formulary (the list of covered drugs) before you start treatment, so you know what your out-of-pocket cost will be.

If a drug is very expensive or your plan does not cover it, you may be able to get help from the drug maker's patient information program. Your doctor's office or a social worker at the cancer center can help you find these programs.

Medicare Advantage plans and cancer treatment

If you have a Medicare Advantage plan (Part C), your coverage works differently. You pay a copay for each doctor visit, lab test, or scan — usually $20 to $50 per visit. You do not pay coinsurance. However, your plan has a network of doctors and hospitals, and you usually must use providers in that network. If you want to see an oncologist outside the network, you may have to pay more or get prior authorization first.

Medicare Advantage plans also set annual out-of-pocket maximums. Once you reach that limit, the plan pays 100 percent of covered services for the rest of the year. This can be helpful if your cancer treatment is extensive and costs are high. However, you need to understand your specific plan's rules before treatment starts. Call your plan's customer service number (on your insurance card) and ask what your copays will be for oncology visits, chemotherapy, radiation, and imaging.

Cancer clinical trials and Medicare coverage

Medicare covers routine care costs for cancer patients in approved clinical trials. This means Medicare pays for doctor visits, lab tests, imaging, and standard treatments you receive as part of the trial. However, Medicare does not pay for the experimental drug or device itself — the trial sponsor (usually a pharmaceutical company or research institution) pays for that.

Not all clinical trials are covered. The trial must meet Medicare's standards for research quality and safety. Before you enroll in a trial, ask the trial coordinator whether Medicare will cover your routine care costs. You can also contact Medicare at 1-800-MEDICARE to confirm coverage for a specific trial.

Costs to expect and how to plan ahead

Cancer treatment costs vary widely depending on the type of cancer, the treatment plan, and how long treatment lasts. With Original Medicare, your main costs are the Part A deductible (if hospitalized), the Part B deductible, and 20 percent coinsurance for all Part B services. With a Medicare Advantage plan, your costs are copays and any out-of-pocket maximum you have not yet met.

Before treatment starts, ask your oncologist's office or hospital billing department for an estimate. They can tell you which procedures and tests are planned and what Medicare will likely pay. If you are worried about costs, ask to speak with a social worker or financial counselor at the cancer center — many centers have staff who help patients understand their bills and find financial resources.

If your out-of-pocket costs are very high, you may be able to get help from nonprofit organizations that information cancer patients with medical bills. Your social worker can point you toward these resources.

Frequently Asked Questions

Does Medicare cover cancer screening like mammograms or colonoscopies?

Yes. Medicare Part B covers preventive cancer screenings at no cost to you: mammograms for breast cancer, colonoscopies for colorectal cancer, and Pap tests for cervical cancer. You pay nothing if your doctor orders the screening as prevention. If the screening finds something and a biopsy or follow-up test is needed, that follow-up may have a copay or coinsurance.

What if my oncologist prescribes a drug that Medicare does not cover?

Contact your Part D plan or your oncologist's office to ask about prior authorization — sometimes the plan will cover the drug if your doctor provides medical justification. If the plan still refuses, ask your doctor about alternative drugs the plan does cover. You can also ask the drug maker about patient information programs that may reduce your cost.

Do I need supplemental insurance (Medigap) if I have cancer?

Supplemental insurance can help pay the coinsurance and deductibles you owe under Original Medicare, which can add up during cancer treatment. However, you can only enroll in Medigap during certain windows, and you cannot switch plans once you have cancer without restrictions. Talk to a Medicare counselor before making this decision.

Will Medicare cover a second opinion from another oncologist?

Yes. Medicare Part B covers a second opinion visit just as it covers any other doctor visit. You pay your Part B coinsurance (20 percent after your deductible). Many cancer patients get a second opinion, and it is a normal part of cancer care.

What happens to my Medicare coverage if I need treatment out of state?

Original Medicare works nationwide, so you can see any doctor or hospital that accepts Medicare, anywhere in the United States. If you have a Medicare Advantage plan, check whether your plan covers out-of-state care, because some plans limit coverage to their network. Call your plan before you travel for treatment.