Medicare covers chemotherapy drugs and related services, but the amount you pay depends on which part of Medicare you have and which drug your doctor prescribes.

If you have Original Medicare (Part A and Part B), chemotherapy administered in a hospital outpatient department or doctor's office is covered under Part B. You pay 20 percent of the approved amount after you meet your Part B deductible. If you receive chemotherapy as an inpatient in a hospital, Part A covers it as part of your hospital stay, and you pay the hospital deductible plus copayments based on the length of stay.

If you have a Medicare Advantage plan (Part C), chemotherapy coverage varies by plan. Most plans cover chemotherapy, but your copayments, coinsurance, and deductibles may be different from Original Medicare. You will need to check your specific plan's coverage details or call the plan directly.

Chemotherapy drugs taken by mouth at home are covered under Part D (prescription drug coverage) if your plan includes them on its formulary — the list of drugs the plan covers. Some oral chemotherapy drugs are expensive, and you may pay more out of pocket depending on which tier of the formulary your drug is on.

Key Takeaways

  • Original Medicare Part B covers chemotherapy given in a hospital outpatient setting or doctor's office, and you pay 20 percent of the approved cost after your deductible.
  • Chemotherapy drugs taken at home by mouth are covered under Part D prescription drug coverage, but the amount you pay depends on which tier your specific drug is on.
  • Medicare Advantage plans cover chemotherapy, but copayments and deductibles vary by plan, so you should contact your plan to learn your exact costs.
  • Supportive care drugs given alongside chemotherapy — such as anti-nausea medications — are also covered, though coverage rules may differ depending on how they are given.

How Original Medicare Covers Chemotherapy in Different Settings

When chemotherapy is given in a hospital outpatient department or in a doctor's office, Original Medicare Part B pays 80 percent of the approved amount. You are responsible for the remaining 20 percent, but only after you have paid your Part B deductible for the year. The deductible amount changes each year.

If you receive chemotherapy as an inpatient in a hospital — meaning you are admitted and stay overnight — Part A covers the cost. You will pay the Part A hospital deductible (a single payment per benefit period) plus copayments for each day you stay. The copayment amount depends on how long you are hospitalized.

Some chemotherapy is given in an infusion center that is part of a hospital's outpatient department, while other infusion centers are independent facilities. Medicare covers chemotherapy at both types of locations under Part B, as long as the facility is Medicare-certified. The copayment rules are the same: you pay 20 percent after your deductible.

Oral Chemotherapy Drugs and Part D Coverage

Chemotherapy pills and capsules taken at home are covered under Medicare Part D, your prescription drug plan. However, not every chemotherapy drug is on every plan's formulary. Before you start a new oral chemotherapy drug, ask your doctor to check whether your Part D plan covers it.

Oral chemotherapy drugs are placed on different tiers of the formulary, and your copayment depends on which tier your drug is on. Tier 1 drugs (generic) usually have the lowest copayment. Tier 2 drugs (preferred brand-name) have a higher copayment. Tier 3 drugs (non-preferred brand-name) and Tier 4 drugs (specialty) have the highest copayments. Some specialty chemotherapy drugs may cost hundreds of dollars per month out of pocket.

If your Part D plan does not cover your chemotherapy drug, or if the copayment is too high, you can ask your doctor to request an exception. The plan may agree to cover the drug or lower your copayment if your doctor explains why that specific drug is medically necessary for you.

What Happens After You Meet Your Deductible and During the Coverage Gap

With Original Medicare Part B, once you pay your annual deductible, Medicare pays 80 percent of approved chemotherapy costs for the rest of the year. Your 20 percent copayment continues for each treatment.

With Part D prescription drug coverage, you move through different cost phases as you spend money on drugs. After you pay your deductible, you enter the initial coverage phase, where you pay your copayment or coinsurance. As your out-of-pocket spending increases, you may enter the coverage gap (also called the "donut hole"), where you pay a higher percentage of the drug cost. Once your out-of-pocket spending reaches a certain amount, you enter catastrophic coverage, where Medicare pays most of the cost and you pay a small copayment.

The deductible, copayment amounts, and coverage gap thresholds change each year. You can find the current amounts on Medicare.gov or by calling 1-800-MEDICARE.

Supportive Care Drugs and Other Services Related to Chemotherapy

Chemotherapy often causes side effects like nausea, vomiting, low blood cell counts, and fatigue. Drugs used to manage these side effects — called supportive care drugs — are also covered by Medicare. Anti-nausea medications, blood cell-boosting drugs, and pain medications given during or after chemotherapy are covered under the same rules as the chemotherapy itself.

If these supportive care drugs are given intravenously in a hospital or doctor's office, Part B covers them. If they are pills taken at home, Part D covers them. Lab work and imaging scans done to monitor your response to chemotherapy are covered under Part B.

Radiation therapy, surgery, and immunotherapy — other cancer treatments often used alongside or instead of chemotherapy — are also covered by Medicare under similar rules.

Medicare Advantage Plans and Chemotherapy Coverage

Most Medicare Advantage plans cover chemotherapy, but the details vary. Some plans may require you to use specific infusion centers or oncologists in their network. Others may require prior authorization — meaning your doctor must get approval from the plan before starting chemotherapy.

Your out-of-pocket costs in a Medicare Advantage plan depend on your plan's structure. You may have a copayment for each chemotherapy infusion, or you may have coinsurance (a percentage of the cost). Some plans have an annual out-of-pocket maximum, meaning once you reach that amount, the plan pays 100 percent of covered costs for the rest of the year.

If you are considering switching to or from a Medicare Advantage plan, remember that you can only change plans during the annual enrollment period (October 15 to December 7) or if you may have access to for a special enrollment period. If you are newly diagnosed with cancer, you may be able to switch plans outside the normal enrollment window.

How to Find Out What You Will Pay

The best way to learn your exact costs is to contact your oncologist's office and ask them to check your coverage. Give them your Medicare card or plan information, and ask them to verify that your chemotherapy drug and the infusion center are covered.

If you have Original Medicare, you can also call 1-800-MEDICARE to ask about coverage for a specific drug or service. If you have a Medicare Advantage plan, call the plan's customer service number on the back of your insurance card.

Some cancer centers have financial counselors who can help you understand your Medicare coverage and find resources if your out-of-pocket costs are high. Ask your oncology team whether this service is available to you.

Frequently Asked Questions

Does Medicare cover chemotherapy for all types of cancer?

Yes, Medicare covers chemotherapy drugs that are approved by the Food and Drug Administration for cancer treatment. However, if your doctor wants to use a drug for a type of cancer it is not officially approved for (called off-label use), Medicare may still cover it if there is evidence it is effective. Your doctor can request coverage if needed.

What if my chemotherapy drug costs more than my copayment?

If you have Part D and your drug is in a high tier, you pay the copayment amount set by your plan, not the full drug price. Medicare negotiates prices with drug manufacturers. If you believe your copayment is too high, ask your doctor to request a formulary exception or to suggest a lower-cost alternative drug.

Do I have to pay for chemotherapy if I have both Medicare and Medicaid?

If you have both Medicare and Medicaid (called dual coverage), Medicaid may help pay your Medicare copayments and deductibles. The amount Medicaid covers depends on your state's rules. Contact your state Medicaid office to learn what they cover.

Will Medicare cover chemotherapy clinical trials?

Medicare covers routine care costs for patients in approved cancer clinical trials, including chemotherapy drugs and related services. Ask your oncologist whether the trial you are considering is Medicare-approved.

Can I use my Medigap plan to help pay for chemotherapy?

Yes, Medigap plans cover some or all of your Medicare copayments and deductibles, depending on which Medigap plan you have. If you have a Medigap plan, it will automatically help pay your chemotherapy copayments after Medicare pays its share.