Medicare covers radiation therapy as a treatment for cancer, but what you pay depends on whether you receive it in a hospital, outpatient center, or doctor's office, and which type of Medicare you have.

Original Medicare (Part A and Part B) covers radiation therapy when a doctor orders it to treat cancer. Part B covers the radiation oncologist's services and the planning that goes into your treatment. Part A covers inpatient radiation therapy if you are admitted to a hospital. The outpatient facility or center where you receive the actual radiation also bills Medicare, and you will owe a copay or coinsurance for that facility use.

Medicare Advantage plans (Part C) must cover at least what Original Medicare covers, but the copays, coinsurance amounts, and rules about which facilities you can use vary by plan. Some plans charge a flat copay per radiation session; others charge a percentage of the cost. You should call your plan before starting treatment to find out your exact out-of-pocket cost.

Key Takeaways

  • Original Medicare covers the radiation oncologist's services under Part B and the facility charges under Part B for outpatient treatment, or Part A if you are hospitalized.
  • You will owe a Part B copay (usually 20% of the approved amount after you meet your deductible) for the doctor's services and a separate facility copay or coinsurance.
  • Medicare Advantage plans cover radiation therapy but charge different copays and may require you to use in-network facilities; call your plan before treatment starts.
  • Radiation therapy planning, imaging, and follow-up imaging are covered by Medicare when medically necessary for your cancer treatment.

How Original Medicare Pays for Radiation Therapy

Under Original Medicare, Part B pays for the radiation oncologist—the doctor who plans and oversees your treatment. After you meet your annual Part B deductible (which changes each year), you pay 20% of what Medicare approves for the doctor's services. The remaining 80% goes to the doctor.

Part B also covers the facility where you receive outpatient radiation—whether that is a hospital outpatient department, a freestanding radiation center, or a doctor's office with radiation equipment. You pay coinsurance (usually 20% after your deductible) for the facility charges as well. This means you may owe two separate 20% coinsurance amounts: one for the doctor and one for the facility.

If you are admitted to a hospital for inpatient radiation therapy, Part A covers your hospital stay, and you pay the Part A inpatient deductible plus daily copays for days 61 and beyond. Inpatient radiation is rare but may happen if you need intensive monitoring or if radiation is combined with other inpatient treatments.

What Radiation Therapy Includes Under Medicare

Medicare covers the full course of radiation therapy treatment itself—the daily or weekly sessions where you receive the radiation. It also covers the planning phase before treatment begins, which includes imaging (CT scans, MRI, or other scans), measurements, and computer modeling to map out exactly where the radiation will target the tumor.

Follow-up imaging after radiation therapy is covered when your doctor orders it to check how well the treatment worked or to monitor for recurrence. Imaging during treatment to verify that the radiation is hitting the right spot is also covered. However, if you need imaging for an unrelated reason, those scans follow the normal Medicare imaging rules and copays.

Supportive care during radiation—such as visits with your oncologist to manage side effects or adjust your treatment plan—is covered under Part B. Medications prescribed to manage radiation side effects (nausea, skin irritation, fatigue) are covered under Part D if you have prescription drug coverage, subject to your plan's formulary and copays.

Medicare Advantage Coverage for Radiation Therapy

If you have a Medicare Advantage plan, the plan must cover radiation therapy at least as well as Original Medicare does. However, the out-of-pocket costs can be very different. Some plans charge a flat copay per radiation session—for example, $50 per visit. Others charge a percentage of the cost, similar to Original Medicare's coinsurance model.

Many Medicare Advantage plans require you to use in-network providers and facilities. If you go out of network without prior approval, you may owe much more or the plan may not cover the service at all. Before you start radiation therapy, contact your plan to confirm that your radiation oncologist and the facility where you will receive treatment are in network.

Some Medicare Advantage plans require prior authorization before radiation therapy begins. This means your doctor's office must contact the plan and get approval before your first treatment session. Ask your plan and your doctor's office whether this step is needed, because treatment delays can happen if authorization is not obtained in advance.

Out-of-Pocket Costs You Should Expect

With Original Medicare, your costs depend on whether you have already met your Part B deductible for the year. Once you meet it, you pay 20% coinsurance for both the doctor's services and the facility charges. A typical course of radiation therapy lasts 5 to 8 weeks with multiple sessions per week, so your total coinsurance can add up quickly.

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your Part B coinsurance, depending on which Medigap plan you have. Plans G, F, and N cover the Part B coinsurance; other plans cover it partially or not at all. Check your Medigap policy or call your supplemental insurance company to see what radiation therapy costs you will owe.

If you cannot afford the out-of-pocket costs, ask your radiation oncology center's financial counselor about payment plans, hospital financial information programs, or nonprofit organizations that help cancer patients with treatment costs. Many cancer centers have funds set aside to help uninsured and underinsured patients.

Radiation Therapy for Different Types of Cancer

Medicare covers radiation therapy for any cancer type when a doctor orders it as medically necessary treatment. This includes breast cancer, lung cancer, prostate cancer, head and neck cancers, lymphomas, and others. The coverage rules are the same regardless of cancer type.

Specialized radiation techniques—such as intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), or stereotactic body radiation therapy (SBRT)—are covered by Medicare when your doctor determines they are medically necessary for your specific cancer and location. These techniques may be more precise or deliver radiation in fewer sessions, but Medicare does not charge more for them than for standard radiation therapy.

Palliative radiation therapy—radiation given to relieve pain or other symptoms rather than to cure the cancer—is also covered by Medicare. This might be used to shrink a tumor pressing on a nerve or to treat bone metastases causing pain.

How to Prepare Your Medicare Coverage Before Treatment

Once your doctor recommends radiation therapy, ask your oncology center's billing or financial counselor to contact Medicare (or your Medicare Advantage plan) to verify coverage before your first appointment. They can tell you exactly what your out-of-pocket costs will be and whether any prior authorization is needed.

Gather your Medicare card and any supplemental insurance information and have it ready when you call or visit the radiation center. If you have a Medicare Advantage plan, also have your plan's member handbook or customer service number available so you can confirm in-network status and copay amounts.

Ask whether the radiation center offers a payment plan if your coinsurance is high, and whether they can bill your supplemental insurance directly. Some centers will also help you understand whether you might be uninsured for any part of the treatment—for example, if a particular imaging scan falls outside Medicare coverage for some reason—so you can plan ahead.

Frequently Asked Questions

Does Medicare cover proton therapy?

Yes, Medicare covers proton therapy when a doctor determines it is medically necessary for your cancer. Proton therapy is a type of radiation therapy that may be used for certain cancers, particularly in children or when the tumor is near sensitive organs. You pay the same coinsurance as you would for standard radiation therapy.

What if my radiation oncologist is out of network on my Medicare Advantage plan?

Contact your plan when ready to ask whether they will make an exception or whether you can get an out-of-network referral. Some plans will cover out-of-network oncologists if no in-network specialist is available in your area. If the plan will not cover the out-of-network provider, you may owe the full cost of treatment.

Does Medicare cover radiation therapy for non-cancer conditions?

Medicare covers radiation therapy for some non-cancer conditions, such as certain benign tumors or thyroid disease, when a doctor orders it. However, coverage varies by condition. Ask your doctor and the radiation center to verify with Medicare before treatment starts.

Will I still owe coinsurance if I have met my Part B deductible?

Yes. Once you meet your Part B deductible, you pay 20% coinsurance for covered services for the rest of the year. This coinsurance applies to radiation therapy services. If you have a Medigap plan that covers coinsurance, your supplemental plan will pay the 20% instead of you.

Can I change my Medicare plan during radiation therapy?

You cannot change Medicare Advantage plans or switch to Original Medicare during the year unless you have a may have access to life event. Starting radiation therapy is not considered a may have access to event. If you are unhappy with your plan's coverage, you can switch during the annual open enrollment period (October 15 to December 7), but the change takes effect January 1.