MD Anderson accepts Medicare, but coverage depends on which part you have and how your plan is structured
MD Anderson Cancer Center in Houston, Texas accepts Medicare as payment for cancer treatment and related care. However, "accepts Medicare" does not mean all your costs are covered the same way. If you have Original Medicare (Part A and Part B), MD Anderson will bill Medicare directly for services. If you have a Medicare Advantage plan (Part C), your coverage and out-of-pocket costs depend entirely on your specific plan's network and rules — some Medicare Advantage plans cover MD Anderson in full, others require you to pay out-of-network rates, and some do not cover it at all.
Before scheduling treatment at MD Anderson, you need to know which type of Medicare you have and whether MD Anderson is in your plan's network. This matters because the difference between in-network and out-of-network care can be thousands of dollars.
Key Takeaways
- MD Anderson accepts Original Medicare (Part A and Part B) and bills the center directly for inpatient and outpatient cancer care.
- If you have a Medicare Advantage plan, you must check with your plan first to confirm MD Anderson is in your network and what your out-of-pocket costs will be.
- MD Anderson's financial counselors can help you understand your coverage and discuss payment options if you have high out-of-pocket costs.
- You should call MD Anderson's insurance verification line before your first appointment to confirm what Medicare will cover for your specific situation.
How MD Anderson works with Original Medicare
If you have Original Medicare (Part A and Part B), MD Anderson is a participating provider, which means it has agreed to accept Medicare's approved amount as payment. When you receive care at MD Anderson, the center bills Medicare Part B for outpatient services like chemotherapy, radiation, and office visits. Medicare Part A covers inpatient hospital stays if you need admission.
You will still have out-of-pocket costs: a Part B deductible (which resets each year), coinsurance of 20 percent for most services after you meet your deductible, and any costs for services Medicare does not cover. If you have a Medigap or Medicaid policy, those may cover some or all of these costs, but MD Anderson does not bill them automatically — you need to provide that information when you register.
Medicare Advantage plans and MD Anderson coverage
Medicare Advantage plans (also called Part C) are sold by private insurance companies and have their own networks of doctors and hospitals. MD Anderson may or may not be in your plan's network. If it is in-network, your costs are typically lower and the plan handles billing. If it is out-of-network, you may pay much more or the plan may not cover the care at all.
Some Medicare Advantage plans have agreements with MD Anderson as a specialty cancer center, even if most of your other care is through a different network. Others require you to use cancer centers within their network. The only way to know is to contact your Medicare Advantage plan directly and ask whether MD Anderson is covered and at what cost. Your plan's member services number is on your insurance card.
If your Medicare Advantage plan does not cover MD Anderson, you have options: you can switch to Original Medicare during the annual open enrollment period (October 15 to December 7 each year), or you can ask your plan about exceptions or appeals if MD Anderson is the only center that offers a specific treatment you need.
What to do before your first appointment
Call MD Anderson's insurance verification department before you schedule treatment. Have your Medicare card and any supplemental insurance cards ready. Tell them your diagnosis or the type of care you expect to receive, because coverage can vary by service. They will tell you what Medicare will cover, what your deductible and coinsurance will be, and whether there are any services that require prior approval from Medicare.
MD Anderson's financial counselors can also discuss payment plans if your out-of-pocket costs are high. The center offers financial information programs for patients with financial hardship, though these are separate from insurance coverage and have their own requirements.
Prior authorization and coverage decisions
Some cancer treatments, especially newer drugs or clinical trials, require prior authorization — meaning MD Anderson must get approval from Medicare before providing the service. If prior authorization is needed, MD Anderson's billing team usually handles the request, but the process can take one to two weeks. If you are in urgent need of treatment, tell your care team when ready so they can expedite the request or discuss alternative treatments that do not require authorization.
Medicare may deny coverage for a specific treatment if it considers it experimental or not medically necessary. If this happens, MD Anderson can appeal the decision on your behalf, and you have the right to appeal as well. Ask MD Anderson's financial counselor to explain the denial and what your options are.
Out-of-pocket costs and financial information
Even with Medicare, cancer treatment at a major center like MD Anderson can be expensive. You may owe a deductible, coinsurance, copays for medications, and costs for services Medicare does not cover. MD Anderson has a financial information program for patients who cannot afford their out-of-pocket costs, though you will need to provide financial information to be considered.
The center also has social workers and patient advocates who can help you understand your bills, negotiate payment plans, and connect you with other resources like pharmaceutical information programs (which drug makers offer to help patients afford medications) and nonprofit organizations that help cancer patients with costs.
Transferring your care to MD Anderson
If you are already being treated for cancer elsewhere and want to transfer to MD Anderson, your current doctors can send your medical records directly. MD Anderson will review your case and let you know whether it can take you on as a patient. This process usually takes one to two weeks. During this time, confirm with MD Anderson's insurance team that your Medicare coverage will explore to care at the new center.
If you are switching from a Medicare Advantage plan to Original Medicare to access MD Anderson, make sure the switch is complete before your first appointment. Changes to Medicare take effect on the first of the month following your request, so plan ahead.
Frequently Asked Questions
Will MD Anderson bill my Medicare Advantage plan directly?
If MD Anderson is in your plan's network, yes — the center will bill your plan and you will pay your plan's copay or coinsurance. If MD Anderson is out-of-network, the center may bill your plan, but you will likely owe a higher percentage of the cost. Contact your plan to confirm before scheduling.
What if Medicare denies coverage for my treatment?
MD Anderson can file an appeal with Medicare on your behalf, which usually takes two to four weeks. You also have the right to appeal independently. Ask MD Anderson's financial counselor to explain why coverage was denied and what your options are, including whether alternative treatments are covered.
Do I need a referral from my primary care doctor to see MD Anderson?
Original Medicare does not require a referral. If you have a Medicare Advantage plan, check your plan's rules — some require a referral and some do not. MD Anderson can tell you what your plan requires when you call for insurance verification.
Can I use my Medigap insurance at MD Anderson?
Yes. MD Anderson accepts Medigap policies. Bring your Medigap card to your first appointment and give it to the registration staff. MD Anderson will bill Medicare first, then bill your Medigap plan for the costs Medicare does not cover.
What happens if I cannot afford my out-of-pocket costs?
MD Anderson has financial counselors and a financial information program for patients with hardship. You can also ask about payment plans that spread your costs over time. Contact MD Anderson's financial services department to discuss your situation.