Medicare covers radiation therapy as a cancer treatment, but your out-of-pocket costs depend on which part of Medicare you have and which type of radiation you receive.

If you have Original Medicare (Part A and Part B), radiation therapy is covered 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 radiation given during an inpatient hospital stay. You pay 20% of the Medicare-approved amount for outpatient radiation after you meet your Part B deductible, which is $240 in 2024.

If you have a Medicare Advantage plan (Part C), radiation therapy is covered, but your costs work differently. You may have a copay for each radiation session, a coinsurance percentage, or both — the amount depends on your specific plan. Some Medicare Advantage plans cover radiation at in-network facilities only, so you need to check whether your radiation oncology center is in your plan's network before starting treatment.

Key Takeaways

  • Original Medicare Part B covers radiation therapy for cancer, and you pay 20% of the approved cost after meeting your deductible.
  • Medicare Advantage plans cover radiation but may charge a copay per session or coinsurance, and some require you to use in-network providers.
  • Simulation and planning sessions before radiation begins are covered, as are imaging scans used to guide treatment.
  • You should ask your radiation oncology center whether they accept your Medicare plan and what your out-of-pocket costs will be before your first appointment.

What radiation therapy costs under Original Medicare

Under Original Medicare, you pay a coinsurance of 20% for outpatient radiation therapy once you have met your Part B deductible ($240 in 2024). This means Medicare pays 80% of what it considers the approved amount, and you pay the remaining 20%. The actual dollar amount depends on how many radiation sessions you receive and the type of radiation used.

If you receive radiation during a hospital stay, Part A covers it as part of your inpatient hospital benefit. You pay a copay for each day of your hospital stay (the amount changes yearly), not a separate charge for the radiation itself. Simulation appointments, where the radiation team maps out exactly where the radiation will target, are also covered under Part B at the same 20% coinsurance rate.

If you have supplemental insurance (Medigap), some plans pay part or all of your 20% coinsurance, which can lower your out-of-pocket costs significantly. Check your Medigap policy documents or call your supplemental insurance company to see what radiation therapy costs they cover.

What radiation therapy costs under Medicare Advantage

Medicare Advantage plans must cover radiation therapy, but they set their own cost-sharing amounts. Some plans charge a copay per radiation session — this might be $15 to $50 per visit, though amounts vary widely. Other plans use coinsurance, meaning you pay a percentage of the cost. A few plans cover radiation with no copay or coinsurance, but this is less common.

Many Medicare Advantage plans require you to use in-network providers. If your radiation oncology center is out of network, you may pay more or the plan may not cover the service at all. Before your first appointment, call your Medicare Advantage plan and ask: Is this radiation center in network? What is my copay or coinsurance per session? How many sessions does my plan expect I will need? Some plans also require prior authorization, meaning the radiation oncologist must get approval from the plan before treatment starts.

Types of radiation Medicare covers

Medicare covers external beam radiation therapy, the most common type, where a machine outside your body aims radiation at the tumor. It also covers brachytherapy, where radioactive material is placed inside or near the tumor. Both are covered under the same cost-sharing rules — 20% coinsurance under Original Medicare, or your plan's copay or coinsurance under Medicare Advantage.

Intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3D-CRT) are advanced forms of external beam radiation that shape the radiation beam to match the tumor's shape. Medicare covers these as well. Proton therapy, a newer type of radiation, is also covered when medically necessary, though it is available at fewer centers and may have different cost-sharing depending on your plan.

Planning and imaging before radiation starts

Before your first radiation treatment, you will have a simulation appointment where the radiation team uses CT scans or other imaging to map out the exact location and size of your tumor. This appointment is covered under Medicare Part B at 20% coinsurance. The radiation oncologist will also review your medical history and imaging scans to plan your treatment — these consultations are covered as well.

If you need additional imaging during your radiation course — such as CT scans to check how the tumor is responding — those scans are covered under Medicare Part B. The cost depends on the type of imaging. PET scans and MRI scans used for radiation planning are covered when medically necessary. Ask your radiation center to submit these scans to Medicare before your appointment so you know your cost ahead of time.

What to ask your radiation oncology center

Before your first appointment, contact your radiation center's billing department and ask these questions: Do you accept my Medicare plan? What is my out-of-pocket cost per radiation session? Will my plan require prior authorization before treatment starts? How many sessions does the radiation oncologist expect I will need? Do you bill Medicare directly, or will I need to pay upfront and seek reimbursement?

If you have Original Medicare, ask whether the center participates in Medicare, which means they accept Medicare's approved amount as payment in full and you pay only your coinsurance. If they do not participate, you may owe more. If you have a Medicare Advantage plan, ask specifically whether the center is in your plan's network and what your copay or coinsurance will be. Write down the answers and keep them with your appointment information.

When to contact Medicare or your plan

If your radiation center tells you that Medicare or your plan will not cover your radiation therapy, ask them to submit a coverage request to Medicare or your plan in writing. You can also contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask whether a specific type of radiation for your condition is covered. Have your diagnosis, the type of radiation recommended, and your Medicare number ready when you call.

If you receive a bill for radiation therapy that you believe Medicare should have covered, do not ignore it. Contact your radiation center's billing department first and ask them to resubmit the claim. If the bill is not resolved within 30 days, you can file a complaint with Medicare. Original Medicare beneficiaries can call 1-800-MEDICARE. Medicare Advantage members should contact their plan's member services line, which is on the back of your insurance card.

Frequently Asked Questions

Does Medicare cover radiation for all types of cancer?

Medicare covers radiation therapy when a doctor orders it as medically necessary treatment for cancer. This includes breast cancer, lung cancer, prostate cancer, head and neck cancers, and many others. The specific type of radiation — external beam, brachytherapy, or proton therapy — must also be medically necessary for your condition. Your radiation oncologist will determine whether radiation is appropriate for you.

What if I need radiation after my deductible is already met?

Once you have paid your Part B deductible ($240 in 2024), you continue to pay 20% coinsurance for each radiation session for the rest of the calendar year. The deductible resets on January 1. If you are receiving radiation that spans into the next calendar year, you will need to meet your deductible again for sessions in the new year.

Does Medicare cover radiation side effects or follow-up care?

Yes. Visits to your radiation oncologist during and after treatment are covered under Part B at 20% coinsurance. If you develop side effects like skin irritation or difficulty swallowing, treatment for those side effects is covered as well. Blood tests and imaging scans ordered to monitor your recovery are also covered under the same cost-sharing rules.

Can I switch Medicare plans if my current plan does not cover my radiation center?

You can switch Medicare Advantage plans during the Annual Enrollment Period (October 15 to December 7 each year) or during a Special Enrollment Period if you have a may have access to life event. If you are already receiving radiation, contact your current plan's member services to ask whether they will cover your treatment at your current center even if it is out of network, as some plans make exceptions for ongoing cancer care.

What happens if my radiation oncologist is not a Medicare provider?

If your radiation oncologist does not accept Medicare, you may have to pay the full cost upfront and then seek reimbursement from Medicare yourself, or you may owe the difference between what the doctor charges and what Medicare approves. Before starting treatment with a non-participating provider, ask your radiation center how billing will work and whether you will owe more than your normal coinsurance.