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 are admitted. Medicare Part B covers outpatient services: doctor visits, lab tests, imaging scans, radiation therapy, and chemotherapy administered 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.
What Medicare does not cover is the main gap to watch for. Medicare does not pay for experimental cancer treatments outside of a clinical trial. It does not cover most complementary therapies like acupuncture or herbal supplements. It does not cover cosmetic reconstruction after mastectomy unless it is medically necessary to restore function. And it does not cover travel or lodging if you need treatment far from home. If your doctor recommends something and you are not sure whether Medicare will pay, ask your doctor's office to check before you proceed — they can contact Medicare or your plan directly.
Key Takeaways
- Medicare Part A pays for cancer treatment during a hospital stay, and Part B pays for outpatient treatment like chemotherapy, radiation, and doctor visits.
- You will owe a deductible, copayments, or coinsurance depending on which service you receive and which Medicare plan you have.
- Prescription cancer drugs taken at home are covered by Part D, but the drug must be on your plan's formulary and you may face prior authorization delays.
- Medicare does not cover experimental treatments outside a clinical trial, complementary therapies, or travel costs related to treatment.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs and coverage rules may differ from Original Medicare.
How Medicare Part A and Part B cover cancer care
If you are admitted to the hospital for cancer surgery or inpatient chemotherapy, Medicare Part A covers the hospital stay after you meet your deductible. In 2024, the Part A deductible is $1,632 per benefit period. After you pay that, Medicare covers all approved inpatient services — the room, nursing care, meals, lab work, and imaging. You do not owe anything else for inpatient care once the deductible is met, unless you stay longer than 60 days in a single benefit period, in which case coinsurance kicks in.
Outpatient cancer care — which is most cancer treatment — is covered by Medicare Part B. This includes office visits with your oncologist, CT scans and PET scans, blood tests, radiation therapy, and chemotherapy given in a hospital outpatient department or infusion center. For Part B services, you owe 20 percent coinsurance after you meet your annual deductible (which is $240 in 2024). Your doctor's office or the treatment center will bill Medicare, and Medicare will pay 80 percent. You owe the remaining 20 percent, unless you have a Medigap plan that covers it.
One important detail: if you receive chemotherapy as an outpatient, the facility may bill it as either a Part B service or a hospital outpatient service depending on where you go. Hospital outpatient chemotherapy sometimes costs more out of pocket because of how the facility bills. Ask your oncologist's office or the infusion center what your cost will be before your first appointment.
Prescription cancer drugs and Part D coverage
Cancer drugs you take at home — pills, injections, or infusions — are covered by Medicare Part D if they are on your plan's formulary. A formulary is the list of drugs your plan will pay for. Not every cancer drug is on every formulary, and some plans charge higher copayments for specialty drugs. Before you start a new cancer medication, ask your oncologist's office to check whether your Part D plan covers it and what your copayment will be.
Many cancer drugs require prior authorization, which means your doctor's office must contact your Part D plan and get approval before you fill the prescription. This can delay treatment by a few days to a week. If your plan denies the drug, your doctor can appeal or request an exception. Some plans have a step therapy requirement, meaning you must try a cheaper drug first before the plan will pay for the one your doctor wants. If this happens, ask your doctor whether the alternative drug is medically appropriate for you, or whether they can request an exception based on medical necessity.
Part D also has an annual out-of-pocket limit. Once you and your plan have spent a certain amount on your drugs in a calendar year, Medicare covers 95 percent of the cost for the rest of the year. The limit changes each year — in 2024 it is $7,050. If you are taking multiple expensive cancer drugs, you may hit this limit and then owe very little for the rest of the year.
What you pay: deductibles, copayments, and coinsurance
Your costs depend on which part of Medicare pays and which type of service you receive. Here is what to expect:
| Service | Medicare Part | What You Pay |
|---|---|---|
| Hospital stay for cancer surgery or inpatient chemo | Part A | $1,632 deductible per benefit period; then $0 for days 1–60 |
| Doctor visit, lab test, imaging scan | Part B | $240 annual deductible; then 20% coinsurance |
| Radiation therapy | Part B | $240 annual deductible; then 20% coinsurance per session |
| Outpatient chemotherapy | Part B | $240 annual deductible; then 20% coinsurance |
| Prescription cancer drugs (at home) | Part D | Copayment per drug; varies by plan and drug tier |
If you have Original Medicare and want to lower your out-of-pocket costs, you can buy a Medigap policy. Medigap Plan G or Plan N, for example, covers your Part B coinsurance, so you would owe nothing after the deductible. If you have a Medicare Advantage plan instead, your costs are different — you may have a lower monthly premium but higher copayments per visit, and you must use doctors in the plan's network.
Treatments Medicare does not cover
Medicare does not cover experimental cancer treatments unless you are enrolled in a clinical trial that Medicare has approved. If your oncologist recommends a clinical trial, ask whether it is a Medicare-approved trial — if it is, Medicare will cover the routine care costs (doctor visits, lab work, imaging) while you are in the trial, though the experimental drug itself may not be covered. You can search for Medicare-approved trials on the National Cancer Institute website.
Medicare also does not cover complementary or alternative therapies like acupuncture for nausea, herbal supplements, or naturopathic treatments, even if your doctor recommends them. Some cancer centers offer these services, and you would pay out of pocket. Reconstructive surgery after mastectomy is covered if it is medically necessary to restore function, but purely cosmetic reconstruction is not covered.
Travel and lodging for cancer treatment are not covered by Medicare, even if you must travel to a distant medical center for specialized care. Some cancer organizations and foundations offer travel grants or lodging information — ask your oncologist's office or social worker whether you may have access to for any of these programs.
How to check coverage before treatment starts
Before you begin any cancer treatment, contact Medicare or your plan to confirm coverage. If you have Original Medicare, call 1-800-MEDICARE and ask whether a specific treatment, drug, or procedure is covered. Have your Medicare number ready and the name of the treatment your doctor recommended. Medicare can tell you whether it is a covered service and what you will owe.
If you have a Medicare Advantage plan, call the plan directly — the number is on your insurance card. Ask whether your oncologist is in network, whether the treatment facility is in network, and what your copayment will be. Ask about prior authorization requirements for any drugs or procedures your doctor has mentioned.
Your doctor's office can also check coverage for you. Many oncology practices have staff who specialize in insurance verification. Call and ask them to verify coverage for your treatment plan before your first appointment. This takes a day or two but can prevent surprises later.
Medicare Advantage and Medigap: how they change what you pay
If you chose a Medicare Advantage plan instead of Original Medicare, your coverage for cancer treatment is the same in scope — you still get Part A and Part B services — but your costs are different. Medicare Advantage plans often have lower monthly premiums but higher copayments per visit. You may owe $30 to $50 per oncology visit, $100 to $250 per imaging scan, and $50 to $100 per chemotherapy session, depending on your plan. You must also use doctors and hospitals in the plan's network, so confirm that your oncologist and treatment facility are in network before you start.
If you have Original Medicare and want to reduce your out-of-pocket costs, you can buy a Medigap policy. Medigap Plan G covers your Part B coinsurance (the 20 percent), so after you meet your deductible, you owe nothing for doctor visits, lab work, imaging, or radiation. Plan N is similar but slightly cheaper and covers most coinsurance. Medigap does not cover Part D drugs, so you still need a separate Part D plan for prescription medications.
Frequently Asked Questions
Does Medicare cover chemotherapy at home?
Chemotherapy you inject or infuse at home is covered by Medicare Part D if the drug is on your plan's formulary. You will owe a copayment, which varies by drug and plan. Intravenous chemotherapy given in a clinic or hospital is covered by Part B, and you owe 20 percent coinsurance after your deductible.
What if my oncologist prescribes a drug that Medicare does not cover?
Ask your doctor to request a coverage exception or appeal the denial. Many plans will cover a non-formulary drug if your doctor documents that you have tried the formulary alternatives and they did not work, or that the non-formulary drug is medically necessary. This process takes one to two weeks, so ask your doctor to start it as soon as possible.
Do I have to pay for genetic testing for cancer risk?
Medicare covers genetic testing (like BRCA testing) if your doctor orders it for a medical reason and the test is performed by an approved lab. You owe 20 percent coinsurance after your Part B deductible. Some Medicare Advantage plans may cover it differently, so check with your plan.
Will Medicare pay for a second opinion from another oncologist?
Yes. A second opinion visit is a regular doctor visit covered by Part B. You owe 20 percent coinsurance after your deductible. Some cancer centers offer second opinion consultations by phone or video, which are also covered.
What happens if I need cancer treatment after I turn 65 but before I enroll in Medicare?
You are responsible for the full cost until Medicare begins. Enroll in Medicare during your initial enrollment period (the three months before and after your 65th birthday) to avoid a permanent penalty on your premiums. If you miss this window, you can enroll during the general enrollment period (January 1 to March 31 each year), but your coverage will not start until July 1.