Medicare covers chemotherapy, but the amount you pay depends on which part of Medicare you have and where you receive treatment

Medicare Part B covers chemotherapy drugs and related services when you receive them as an outpatient — meaning you go to a hospital, cancer center, or doctor's office for treatment and return home the same day. Medicare Part D covers some oral chemotherapy drugs (pills or capsules you take at home). If you are in a Medicare Advantage plan (Part C), your coverage works differently and depends on your specific plan's rules.

The key distinction is location. Chemotherapy given in a hospital outpatient department or infusion center is handled under Part B. Chemotherapy given during an inpatient hospital stay is covered under Part A. Oral chemo drugs are covered under Part D if they are on your plan's formulary — the list of drugs your plan will pay for.

You will still owe out-of-pocket costs. After you meet your Part B deductible, you typically pay 20 percent of the Medicare-approved amount for chemotherapy services and drugs. The exact amount varies based on the drug, the dose, and where you receive treatment.

Key Takeaways

  • Medicare Part B covers chemotherapy drugs and administration when given as an outpatient at a hospital, cancer center, or doctor's office.
  • You pay 20 percent coinsurance after your Part B deductible is met, with no annual out-of-pocket limit under Original Medicare.
  • Oral chemotherapy drugs are covered under Part D if they appear on your plan's formulary, and you pay your plan's copay or coinsurance.
  • Medicare Advantage plans cover chemotherapy but have different cost structures and may require prior authorization from your plan before treatment begins.
  • Inpatient chemotherapy during a hospital stay is covered under Part A, and you pay your hospital deductible and daily copays.

How Medicare Part B covers outpatient chemotherapy

When you receive chemotherapy as an outpatient, Medicare Part B pays for the drugs themselves, the nurse or technician time to administer them, and related services like lab work and imaging that are part of your cancer treatment plan. The facility where you receive treatment — whether a hospital outpatient department, an independent infusion center, or an oncologist's office — bills Medicare directly for these services.

Your cost is 20 percent of the Medicare-approved amount for each service, after you have paid your Part B deductible for the year. If your chemotherapy regimen costs $5,000 per infusion and Medicare approves $4,000 of that, you would owe $800 (20 percent of $4,000) per infusion, assuming your deductible is already met. The facility may bill you for the difference between what they charge and what Medicare approves, but they cannot bill you more than the 20 percent coinsurance.

Original Medicare has no annual out-of-pocket maximum for Part B services, which means your costs can continue to accumulate throughout the year. Many people with cancer add a Medigap policy (supplemental insurance) to cover some or all of that 20 percent coinsurance.

Oral chemotherapy drugs covered under Part D

Some chemotherapy comes as a pill or capsule you take at home rather than as an infusion. These oral chemotherapy drugs are covered under Medicare Part D (prescription drug coverage) if they are listed on your plan's formulary. Not all Part D plans cover all oral chemo drugs, and coverage rules vary by plan.

Before you start an oral chemotherapy drug, check with your Part D plan to confirm it is covered. You can call the plan directly, check your plan's website, or ask your oncologist's office to verify coverage. Some plans require prior authorization — meaning your doctor must submit a request to the plan before you fill the prescription — and some drugs may be subject to quantity limits or step therapy (trying a different drug first).

Your cost for an oral chemo drug depends on which tier of the formulary it sits on. Tier 3 and Tier 4 drugs typically carry higher copays or coinsurance than Tier 1 or Tier 2. Once you reach the coverage gap (also called the "donut hole"), you pay a higher percentage of the drug cost until you reach the catastrophic coverage phase.

Chemotherapy during an inpatient hospital stay

If you receive chemotherapy while admitted to a hospital as an inpatient, it is covered under Medicare Part A. You pay your Part A deductible (a single amount per benefit period) plus daily copays for each day of your hospital stay. The chemotherapy drugs and administration are included in the hospital's bill to Medicare and do not carry a separate charge to you beyond the daily copay.

Part A covers up to 60 days of inpatient care per benefit period. If your cancer treatment requires a longer hospital stay, you may owe additional copays for days 61 through 90, and even more for days beyond 90 if you use your lifetime reserve days.

Coverage under Medicare Advantage plans

If you have a Medicare Advantage plan (Part C), your chemotherapy coverage is provided by the private insurance company running your plan, not by Original Medicare. Most Medicare Advantage plans do cover chemotherapy, but the details vary widely: some plans may require you to use in-network providers, some may require prior authorization before treatment starts, and some may have different copay or coinsurance amounts than Original Medicare.

Before starting chemotherapy, contact your Medicare Advantage plan to understand your coverage. Ask whether your oncologist and treatment facility are in-network, whether prior authorization is required, what your out-of-pocket costs will be, and whether the plan has an annual out-of-pocket maximum (most do). Many Medicare Advantage plans have annual limits on out-of-pocket costs, which can be an advantage over Original Medicare if your treatment is extensive.

If your current Medicare Advantage plan does not cover your recommended treatment or requires you to use providers you do not want, you may be able to switch to Original Medicare or a different Medicare Advantage plan during the annual enrollment period (October 15 to December 7) or if you may have access to for a special enrollment period.

What is not covered and what you should know about costs

Medicare does not cover experimental chemotherapy drugs or clinical trials unless the trial is approved by Medicare. If your oncologist recommends a drug that is not yet approved by the FDA or is approved only for a different type of cancer, you may need to pay out of pocket or look for a clinical trial that covers the cost.

Medicare also does not cover supportive care drugs used to manage chemotherapy side effects — such as anti-nausea medications or drugs to boost white blood cell counts — under the same rules as the chemotherapy itself. These are typically covered under Part D if you have it, or under Part B if given as an injection in a medical setting.

Transportation to and from chemotherapy is not covered by Medicare, though some cancer centers and nonprofits offer free or low-cost rides. Wigs, prosthetics, and other items related to appearance after chemotherapy are generally not covered. Nutritional counseling and mental health services related to cancer treatment may be covered under Part B if provided by a may have access to provider, but coverage varies.

How to find out what your specific costs will be

The only way to know your exact out-of-pocket cost is to contact Medicare or your plan before treatment begins. If you have Original Medicare, call Medicare at 1-800-MEDICARE and ask for an estimate of what you will owe for your specific chemotherapy regimen. Provide the name of the drug, the dose, the frequency of treatment, and where you will receive it.

If you have a Medicare Advantage plan, call your plan's customer service number (on your insurance card) and ask the same questions. If you have Part D, ask whether your oral chemo drugs are covered and what tier they are on. Ask about prior authorization requirements and whether you will hit the coverage gap during your treatment period.

Your oncologist's office can also help. Many cancer centers have financial counselors who work with insurance companies regularly and can often get you a cost estimate faster than you can get one yourself. They may also know about patient information programs run by drug manufacturers that can reduce your costs.

Frequently Asked Questions

Does Medicare cover chemotherapy if I have not met my deductible yet?

Yes, but you will owe the full cost of chemotherapy until you meet your Part B deductible. Once the deductible is met, you pay 20 percent coinsurance. If your chemotherapy is urgent and you have not met your deductible, contact your provider about payment plans or patient information programs.

What happens if my oncologist prescribes a chemotherapy drug that Medicare does not cover?

Your oncologist can request prior authorization from Medicare or your plan, explaining why that specific drug is medically necessary. If the request is denied, you can file an appeal. You may also ask your doctor whether an alternative drug on Medicare's covered list would work for your cancer type.

Will I owe more if I go to an out-of-network cancer center?

Under Original Medicare, there is no in-network or out-of-network distinction — you pay 20 percent coinsurance anywhere. Under a Medicare Advantage plan, out-of-network providers typically cost more or may not be covered at all. Check your plan's provider directory before scheduling treatment.

Can I switch from Medicare Advantage to Original Medicare if my plan does not cover my chemotherapy?

You can switch during the annual enrollment period (October 15 to December 7). If your plan denies coverage for a drug your doctor prescribed, you may also may have access to for a special enrollment period that allows you to switch outside the normal window. Contact Medicare to ask whether you may have access to.

What if my chemotherapy costs more than what Medicare approves?

The provider cannot bill you for the difference between their charge and Medicare's approved amount. You owe only your deductible, coinsurance, and copays. If a provider tries to bill you for the difference, contact Medicare at 1-800-MEDICARE to report it.