Medicare covers most cancer treatments, but not all of them, and what you pay depends on which part of Medicare you have

Medicare Part A covers inpatient hospital care for cancer treatment, including surgery and chemotherapy given while you stay overnight. Medicare Part B covers outpatient services: doctor visits, lab tests, imaging scans, radiation therapy, and chemotherapy given in a clinic or doctor's office. Part D covers prescription cancer drugs you take at home. The catch is that you will pay a share of the cost — a deductible, copayments, or coinsurance — and some newer drugs or treatments may not be covered at all.

If you have Original Medicare (Part A and B), you are responsible for costs after you meet your deductible and pay your share of each service. If you have a Medicare Advantage plan (Part C), your coverage and costs work differently — your plan sets its own rules about which hospitals and doctors you can see and what you pay out of pocket. Either way, understanding what is and is not covered before you start treatment can save you from surprise bills.

Key Takeaways

  • Medicare Part A covers hospital stays for cancer surgery and inpatient chemotherapy; Part B covers outpatient treatment, imaging, and lab work; Part D covers oral cancer medications.
  • You will owe a deductible and then copayments or coinsurance for each service, and these costs vary depending on whether you have Original Medicare or a Medicare Advantage plan.
  • Some newer cancer drugs and clinical trial treatments may not be covered, and you should ask your doctor and Medicare before starting treatment whether a specific drug or procedure is covered.
  • Medicare covers cancer screening (mammogram, colonoscopy, PSA test) at no cost to you if you meet age and risk requirements.
  • If costs become unmanageable, hospital financial counselors and nonprofit organizations can help you find resources or payment plans.

What Medicare Part A Covers for Cancer

Part A covers the cost of a hospital stay when you need inpatient cancer treatment. This includes the hospital room, meals, nursing care, and most drugs given to you while you are admitted. If you have cancer surgery that requires an overnight stay, Part A pays for the hospital portion. If you receive chemotherapy as an inpatient — meaning you stay in the hospital overnight — Part A covers that too.

You pay a deductible once per benefit period (the hospital deductible is currently $1,676, though this amount changes each year). After you meet the deductible, you pay coinsurance — a fixed dollar amount per day — for days 1 through 60 of your stay, a higher amount for days 61 through 90, and an even higher amount if you stay longer than 90 days. Most cancer hospital stays are shorter than 60 days, so you will likely pay coinsurance for the number of days you are there.

What Medicare Part B Covers for Cancer

Part B covers outpatient cancer care: visits with your oncologist, imaging tests like CT scans and PET scans, lab work to monitor your treatment, radiation therapy, and chemotherapy given in a hospital outpatient department or a doctor's office. Part B also covers some supportive care, such as certain drugs to manage nausea or low blood cell counts during chemotherapy.

For Part B services, you pay 20 percent coinsurance after you meet your annual deductible (currently $240). This means if a chemotherapy infusion costs $5,000, you pay $1,000 and Medicare pays $4,000. If you have a supplemental insurance policy (Medigap), it may cover some or all of your coinsurance, depending on which plan you have.

Part B does not cover all cancer drugs. Drugs you inject yourself at home or take as pills are usually covered under Part D (prescription drug coverage), not Part B. However, drugs that a doctor or nurse administers — such as intravenous chemotherapy — are covered under Part B as part of the office visit or infusion service.

What Medicare Part D Covers for Cancer Medications

Part D covers prescription cancer drugs you take at home: oral chemotherapy pills, hormone therapies, targeted therapies, and immunotherapy drugs in pill or injectable form that you self-administer. Your Part D plan has a formulary — a list of covered drugs — and not every cancer drug is on every formulary. Some plans may require you to try a cheaper drug first before they will cover a more expensive one, a process called prior authorization.

Part D has a coverage gap (the "donut hole"): once you and your plan have spent a combined $5,850 on covered drugs in 2024, you enter the gap and pay a higher percentage of the drug cost until you reach the out-of-pocket limit of $7,050. After that, you pay a small copayment for the rest of the year. These dollar amounts change each year. If you take an expensive cancer drug, you may hit the gap quickly.

Before you start a new cancer medication, ask your doctor to check whether it is on your Part D formulary and whether prior authorization is needed. Your pharmacy can also tell you the cost and whether your plan covers it. If your plan does not cover a drug your doctor recommends, you can ask your doctor to request an exception, or you can switch to a different Part D plan during the annual enrollment period (October 15 to December 7).

Cancer Screening and Prevention Coverage

Medicare covers certain cancer screenings at no cost to you — meaning you pay nothing, not even a copayment. These include mammograms for breast cancer (every one to two years for women 40 and older), colonoscopy for colorectal cancer (every 10 years starting at age 50, or more often if you have risk factors), and PSA blood tests for prostate cancer (once a year for men 50 and older, or earlier if you are at higher risk).

If a screening test finds something abnormal and your doctor does a biopsy or removes a polyp during the procedure, you may owe a copayment for that additional service. Screening is covered; diagnosis and treatment are not.

What Medicare Does Not Cover for Cancer

Medicare does not cover experimental cancer treatments or drugs not yet approved by the Food and Drug Administration, except in limited cases through clinical trials. If your doctor recommends a clinical trial, ask whether Medicare will cover the routine care costs (the standard treatment and monitoring) versus the experimental drug itself. Some trials are covered; others are not.

Medicare also does not cover certain supportive services that can help during cancer treatment: acupuncture for nausea, most nutritional counseling, wigs or prosthetics, or some types of mental health counseling (though it does cover some mental health visits). Complementary therapies like herbal supplements are not covered. If these services are important to you, ask your doctor whether they are medically necessary; sometimes Medicare will cover them if they are ordered by a doctor as part of your treatment plan.

Drugs purchased outside the United States are not covered, and neither are drugs you buy over the counter without a prescription. If you travel outside the U.S., Medicare generally does not cover care you receive abroad, with rare exceptions.

Medicare Advantage Plans and Cancer Coverage

If you have a Medicare Advantage plan (Part C), your cancer coverage works differently than Original Medicare. Your plan must cover everything Original Medicare covers, but it sets its own rules: which doctors and hospitals you can see (usually in-network only), what you pay for each service, and whether prior authorization is required. Some plans have lower monthly premiums but higher out-of-pocket costs; others charge more per month but cap your total yearly costs.

Before you start cancer treatment, call your Medicare Advantage plan and ask: Is my oncologist in-network? Is the hospital where I plan to have surgery in-network? Does my plan cover the specific chemotherapy drug my doctor recommended, or do I need prior authorization? What is my maximum out-of-pocket cost this year? These answers matter because going out-of-network can cost you much more, and some plans may not cover certain drugs without approval first.

Managing Cancer Treatment Costs

If your out-of-pocket costs for cancer treatment are high, talk to the hospital's financial counselor or patient advocate before or during treatment. Many hospitals have programs that reduce or forgive bills for patients with low income, and some offer payment plans so you do not have to pay the full amount upfront. Ask whether the hospital participates in any pharmaceutical information programs — drug manufacturers sometimes provide free or reduced-cost drugs to people who cannot afford them.

Nonprofit organizations like the American Cancer Society, CancerCare, and the National Association of Hospital Hospitality Houses offer grants, copayment information, and other financial help to people in treatment. Your social worker or patient navigator at the cancer center can connect you with these resources. If you are struggling to afford your Part D drugs, the Medicare Extra Help program (also called Low-Income Subsidy) can reduce your premiums and out-of-pocket costs if your income is below a certain level.

Frequently Asked Questions

Does Medicare cover the cost of a second opinion from another oncologist?

Yes. Medicare Part B covers office visits with any doctor who accepts Medicare, including a second-opinion consultation. You pay your usual copayment or coinsurance. If you have a Medicare Advantage plan, the visit is covered only if the oncologist is in your plan's network.

Will Medicare cover my cancer treatment if I travel to another state?

Yes, as long as you see doctors and use hospitals that accept Medicare. Original Medicare is accepted nationwide. If you have a Medicare Advantage plan, you may have limited coverage outside your plan's service area, so call your plan before you travel to confirm coverage.

What happens if my doctor prescribes a cancer drug that Medicare does not cover?

Ask your doctor to request a coverage exception from Medicare or your plan. Provide information about why this specific drug is medically necessary for you. If the exception is denied, you can pay out of pocket, ask your doctor about a covered alternative, or appeal the decision. Some drug manufacturers offer patient information programs that provide free or low-cost drugs if insurance does not cover them.

Does Medicare cover home health care after cancer surgery?

Yes, if your doctor orders it and you meet Medicare's requirements: you must be homebound, need skilled nursing or therapy, and be under a doctor's care. Part A covers home health services with no copayment as long as you are homebound. Once you can leave home, coverage stops.

Can I switch from Original Medicare to a Medicare Advantage plan if I am already being treated for cancer?

Yes, but only during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event. Be cautious: a new Medicare Advantage plan may not cover your current oncologist or hospital in-network, and you may face prior authorization delays for ongoing treatment. Review the plan's formulary and network before you switch.