Medicare covers most cancer surgery, but the amount you pay depends on which part of Medicare you have and the type of procedure
If you have Original Medicare (Part A and Part B), surgery to remove a tumor or treat cancer is covered as a medically necessary procedure. Medicare Part A covers the hospital stay, and Part B covers the surgeon's fee and related services. If you have a Medicare Advantage plan (Part C), your coverage works differently — your plan must cover cancer surgery, but you may face different copays, deductibles, or prior approval requirements than Original Medicare.
The real question is not whether surgery is covered, but how much you will pay out of pocket. With Original Medicare, you typically pay 20 percent of the approved amount for the surgeon and facility charges after you meet your Part B deductible. With a Medicare Advantage plan, you pay according to your plan's rules, which vary widely. Neither Original Medicare nor most Advantage plans cover all the costs, which is why many people carry a supplemental policy or choose a plan with lower out-of-pocket limits.
Key Takeaways
- Original Medicare Part A covers the hospital stay for cancer surgery, and Part B covers the surgeon and related services after your deductible.
- With Original Medicare, you typically pay 20 percent of approved charges for the surgeon and facility after meeting your Part B deductible of $240 per year.
- Medicare Advantage plans must cover cancer surgery but may require prior approval, charge different copays, or limit which hospitals and surgeons you can use.
- Supplemental insurance (Medigap) can cover much of the 20 percent coinsurance that Original Medicare does not pay.
- Chemotherapy, radiation, and other cancer treatments after surgery are covered separately and have their own cost-sharing rules.
How Original Medicare Covers Hospital and Surgeon Costs
When you have cancer surgery in a hospital, Medicare Part A covers the inpatient stay. You pay a deductible of $1,556 for the first 60 days of a hospital stay in 2024 (this amount changes yearly). After that, Medicare pays the full cost of the hospital, facility, anesthesia, and nursing care for days 1 through 60. If your stay extends beyond 60 days, you begin paying a daily coinsurance amount.
Medicare Part B covers the surgeon's fee, the pathologist who examines tissue removed during surgery, and any consultations with other doctors. You pay 20 percent of the approved amount for these services after you meet your annual Part B deductible, which is $240 in 2024. The surgeon's approved amount varies by location and procedure, so your actual 20 percent payment depends on what Medicare approves for your specific surgery.
One important detail: if your surgery is outpatient (you go home the same day), Part A does not explore. Instead, Part B covers the surgeon and the facility charges, and you pay 20 percent of approved amounts after your deductible. Outpatient cancer procedures — such as some biopsies, minor tumor removals, or port placements — follow this rule.
Medicare Advantage Plans and Prior Approval
If you are enrolled in a Medicare Advantage plan, your plan is required by law to cover cancer surgery. However, the plan controls how much you pay and may require you to get approval before the surgery. Many Advantage plans require prior authorization, meaning your doctor must contact the plan and receive written approval before scheduling the procedure. If your doctor does not obtain prior authorization and you have the surgery anyway, you may be responsible for the full cost.
Your out-of-pocket costs with an Advantage plan depend on your specific plan. Some plans charge a copay for surgery (for example, $500 to $1,500), while others use coinsurance (a percentage of the cost). Many Advantage plans also limit which hospitals and surgeons are in-network, so you may need to use a specific cancer center or surgeon to keep your costs lower. If you use an out-of-network provider, you typically pay more or the plan may not cover the service at all.
Before any cancer surgery, call your Advantage plan and ask: Does the plan require prior authorization? Which hospitals and surgeons are in-network? What is my copay or coinsurance for this procedure? Getting these answers before surgery prevents surprise bills.
What You Pay Out of Pocket With Original Medicare
Your actual costs depend on whether your surgery is inpatient or outpatient and whether you have supplemental insurance. Here is what a typical scenario looks like:
| Scenario | Your Costs |
|---|---|
| Inpatient surgery, first 60 days, with Original Medicare only | $1,556 deductible + 20% of surgeon's approved fee after Part B deductible |
| Inpatient surgery, first 60 days, with Medigap supplemental policy | Medigap typically covers the $1,556 deductible and the 20% coinsurance, depending on your plan |
| Outpatient surgery with Original Medicare only | $240 Part B deductible + 20% of approved facility and surgeon charges |
| Outpatient surgery with Medigap supplemental policy | Medigap typically covers the deductible and coinsurance, depending on your plan |
The 20 percent coinsurance can add up quickly if the approved amount is high. For example, if a surgeon's approved fee is $5,000, you pay $1,000 out of pocket (20 percent) after your deductible. This is why many people with Original Medicare buy a Medigap policy — it covers much or all of that 20 percent, depending on which Medigap plan you choose.
Chemotherapy, Radiation, and Other Cancer Treatments
Surgery is often just the first step. Medicare Part B covers chemotherapy, whether it is given in a hospital outpatient department, a cancer center, or a doctor's office. You pay 20 percent of the approved amount after your Part B deductible. If chemotherapy is given during an inpatient hospital stay, Part A covers it as part of your hospital bill.
Radiation therapy is also covered by Part B when given in an outpatient setting. You pay 20 percent of approved charges. If you receive radiation as an inpatient, Part A covers it.
Targeted drugs and immunotherapy are covered if they are FDA-approved for your type of cancer and your doctor prescribes them as medically necessary. If the drug is given by infusion in a hospital or clinic, Part B covers the administration. If it is a pill you take at home, it may be covered under Part D (prescription drug coverage) instead, which has its own deductible and copays.
Supportive care — such as anti-nausea medications, pain management, and visits with oncologists — is covered under Part B. Mental health counseling related to your cancer diagnosis is also covered.
Costs You May Not Expect
Medicare covers the core cancer treatment, but several costs can surprise you. Genetic testing to determine if you carry mutations like BRCA1 or BRCA2 is covered if your doctor orders it as part of cancer diagnosis or treatment planning. However, if you pursue genetic testing for family planning or personal risk assessment before a cancer diagnosis, coverage may be limited.
Clinical trials for cancer treatment are covered by Medicare if the trial is approved and you meet the criteria. The trial sponsor typically covers the experimental drug, but Medicare still covers routine care and monitoring.
Reconstructive surgery after mastectomy is covered by law, including surgery on the other breast to match. However, coverage for cosmetic procedures beyond reconstruction is not included.
Home health care after surgery is covered if you are homebound and a doctor orders it. Skilled nursing care, physical therapy, and wound care at home are all covered. However, non-medical help — such as housekeeping or meal preparation — is not covered by Medicare.
How to Prepare Before Your Cancer Surgery
Before scheduling surgery, contact Medicare or your Advantage plan and ask for a written summary of what will be covered. If you have Original Medicare, ask your surgeon's office to submit a claim to Medicare before surgery so you can see what the approved amount will be and estimate your 20 percent cost. Many surgeons' offices can do this in advance.
If you do not have supplemental insurance and the out-of-pocket cost is high, ask your hospital's financial counselor about payment plans or hospital charity care programs. Many cancer centers have financial information programs for patients without insurance or with high deductibles.
Keep all bills and explanations of benefits (EOBs) from Medicare or your plan. If you receive a bill that seems wrong — for example, a bill for the full amount instead of just your 20 percent — contact the provider and ask them to resubmit to Medicare. Billing errors are common and often corrected.
Frequently Asked Questions
Do I need prior approval from Medicare before cancer surgery?
Original Medicare does not require prior approval for medically necessary cancer surgery. However, Medicare Advantage plans often do, so contact your plan before scheduling. If your Advantage plan requires prior authorization and your doctor does not obtain it, you may owe the full cost.
What if my cancer surgery costs more than Medicare's approved amount?
If your surgeon is a Medicare-participating provider, they agree to accept Medicare's approved amount and cannot bill you for the difference. If your surgeon is non-participating, they can charge up to 15 percent more than the approved amount, and you are responsible for that extra charge. Always ask whether your surgeon participates with Medicare before surgery.
Does Medicare cover a second opinion before cancer surgery?
Yes. Medicare Part B covers a consultation with another oncologist or surgeon to get a second opinion. You pay 20 percent of the approved amount after your Part B deductible. Many cancer centers encourage second opinions, and some insurance plans cover travel costs to major cancer centers for this purpose.
Will I owe anything if I have both Original Medicare and a Medigap policy?
It depends on which Medigap plan you have. Plans G, F, and N cover most or all of your Part B coinsurance and deductible. Plan A covers coinsurance but not the deductible. Check your Medigap policy documents or call your supplemental insurance company to confirm what your plan covers for surgery.
What happens if I have Original Medicare and cannot afford the 20 percent cost?
Contact your hospital's financial counselor or social worker before surgery. Many hospitals have charity care programs or can set up a payment plan. Some nonprofit organizations also offer financial support for cancer patients. Your oncology team can refer you to resources in your area.