Your out-of-pocket costs depend on which Medicare parts you have and which treatment you need

Medicare covers most cancer treatments — surgery, chemotherapy, radiation, immunotherapy, and targeted drugs — but you will pay a share of the cost. How much depends on whether you have Original Medicare (Part A and B), a Medicare Advantage plan (Part C), or both, plus whether you have prescription drug coverage (Part D). A single round of chemotherapy might cost you $100 to $500 out of pocket. A month of a newer cancer drug could cost $200 to $2,000. Surgery could mean $1,000 to $3,000 in your deductible alone. The range is wide because cancer treatment is not one thing — it is many things, each with its own cost structure.

The first step is knowing what coverage you actually have right now. If you have Original Medicare, pull out your Medicare card and check whether you have Part D. If you have a Medicare Advantage plan, find your plan documents or call the plan directly — they will tell you what your copay is for chemotherapy, what your deductible is, and whether the drugs you need are on their formulary (the list of drugs they cover). That one phone call will answer more questions than any general article can.

Key Takeaways

  • Original Medicare Part B covers chemotherapy and radiation at 80 percent after you meet your deductible, leaving you to pay 20 percent of the cost.
  • Cancer drugs taken by mouth are covered by Part D (prescription drug coverage), which has its own deductible and copay structure that varies by plan.
  • Medicare Advantage plans have different cost structures — usually lower copays but higher deductibles, and they may require prior authorization before treatment starts.
  • Hospital stays for surgery or inpatient chemotherapy are covered by Part A, but you pay a deductible per stay plus daily copays after 60 days.
  • Newer cancer drugs and clinical trials may not be covered, or may require you to pay the full cost upfront and seek reimbursement later.

How Original Medicare covers cancer treatment and what you pay

If you have Original Medicare (Part A and Part B), chemotherapy given in a hospital or outpatient center is covered by Part B. Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the other 20 percent, plus the deductible itself. For 2024, the Part B deductible is $240 per year. Once you hit that, you pay 20 percent of the cost of each chemotherapy session, each radiation treatment, and each scan or lab test related to your cancer care.

Radiation therapy works the same way — Part B covers it at 80 percent after your deductible. Surgery for cancer is covered by Part A if it happens in a hospital, or by Part B if it happens in an outpatient surgical center. Hospital stays also trigger a Part A deductible, which for 2024 is $1,556 per stay. You also pay a daily copay if you stay longer than 60 days.

Cancer drugs you take by mouth — like Gleevec, Tarceva, or Ibrance — are covered by Part D, not Part B. Part D is optional prescription drug coverage you have to sign up for separately. If you do not have Part D, you will pay the full retail price for these drugs, which can be hundreds of dollars per month. Part D plans have their own deductible (usually $100 to $500), copays or coinsurance, and a coverage gap called the "donut hole" where you pay more out of pocket once you hit a certain spending threshold.

Medicare Advantage plans and cancer treatment costs

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies. These plans must cover everything Original Medicare covers, but they do it differently. Instead of paying 20 percent coinsurance, you usually pay a fixed copay — for example, $50 per chemotherapy session or $200 per hospital day. The tradeoff is that Advantage plans have higher deductibles (sometimes $500 to $1,500) and they often require prior authorization before treatment starts.

Prior authorization means the plan's doctors review your treatment plan and decide whether to cover it before you begin. This can add one to two weeks to the start of your treatment. Some plans also limit which oncologists you can see — you must use doctors in their network. If you go out of network, you pay more or the plan does not cover it at all.

Prescription drugs are usually included in Medicare Advantage plans, so you do not need a separate Part D plan. However, the copay for cancer drugs can be high — $100 to $500 per month depending on the drug and the plan. Always ask your plan what the copay is for the specific drug your oncologist recommends before you start treatment.

Costs that Medicare may not cover

Medicare does not cover all cancer treatments. Clinical trials are sometimes covered and sometimes not — it depends on the trial and whether Medicare has decided to cover it. Newer drugs that are not yet approved by the FDA are almost never covered. Some hospitals charge facility fees on top of the doctor's fee, and Medicare may not cover the full facility fee, leaving you with a bill.

Complementary treatments like acupuncture, massage, or nutritional counseling are not covered by Medicare. Wigs and prosthetics after surgery or chemotherapy are not covered. Travel costs to get to treatment are not covered. If you need a second opinion from a specialist at a different hospital, Medicare covers the visit but not the travel.

If your oncologist prescribes a drug that is not on your plan's formulary (the list of covered drugs), you have options. You can ask your doctor to request a formulary exception, which means asking the plan to cover the drug anyway. This sometimes works, especially if there is no similar drug on the formulary. You can also switch to a different Part D plan or Medicare Advantage plan during the annual enrollment period (October 15 to December 7 each year), though you cannot switch mid-treatment if you are already enrolled.

Costs for specific cancer treatments

Chemotherapy given intravenously in a hospital or clinic is covered by Part B at 80 percent. The drugs themselves are covered, the nurse time is covered, and the facility is covered. Your 20 percent share depends on what the approved amount is for your specific drugs and your location. A single infusion might cost Medicare $2,000 to $5,000, meaning you pay $400 to $1,000 out of pocket (after your deductible).

Radiation therapy is also covered by Part B at 80 percent. A full course of radiation for breast cancer or prostate cancer is usually 5 to 8 weeks of daily treatments. Each treatment might cost $300 to $500 approved amount, so your 20 percent share is $60 to $100 per day. Over six weeks, that could total $1,800 to $3,000 out of pocket.

Immunotherapy drugs like Keytruda or Opdivo are covered by Part B if given intravenously, or by Part D if taken by mouth. These drugs are expensive — the approved amount can be $5,000 to $10,000 per infusion. Your 20 percent share is $1,000 to $2,000 per infusion. If you need monthly infusions, your annual out-of-pocket cost could reach $12,000 to $24,000 before you hit any out-of-pocket maximum.

Targeted drugs like Herceptin (for HER2-positive breast cancer) or Gleevec (for chronic myeloid leukemia) work the same way. Herceptin infusions are covered by Part B at 80 percent. Gleevec is a pill, so it is covered by Part D. Costs vary widely depending on the drug and your plan.

Out-of-pocket maximums and when they explore

Original Medicare does not have an out-of-pocket maximum. You can keep paying 20 percent of your costs forever, with no cap. This is a real risk if you have expensive cancer treatment. Some people spend $10,000, $20,000, or more in a single year. This is why many people with Original Medicare buy a Medigap policy (supplemental insurance) to cover the 20 percent coinsurance.

Medicare Advantage plans do have an out-of-pocket maximum, usually $6,700 to $7,550 per year for in-network care. Once you hit that number, the plan pays 100 percent of your in-network costs for the rest of the year. Out-of-network costs do not count toward this maximum and may not be covered at all.

Part D also has an out-of-pocket maximum, but it is calculated differently. Once you and your plan have spent a combined total of about $7,050 on covered drugs in 2024, you move into "catastrophic coverage" and you pay only 5 percent of the cost of drugs for the rest of the year.

How to find out what your specific treatment will cost

The only way to know what you will actually pay is to ask your oncologist what drugs or procedures they recommend, then call your Medicare plan and ask what your copay or coinsurance will be. Bring the drug name, the dose, and how often you will receive it. Ask whether prior authorization is required. Ask whether the drug is on the formulary. Ask what your deductible is and whether you have already met it this year.

If you have Original Medicare, call Medicare directly at 1-800-MEDICARE and ask what the approved amount is for the specific procedure or drug. Then multiply that by 0.20 to find your 20 percent share. Subtract any deductible you have not yet met.

If you have a Medicare Advantage plan, call the plan's customer service number on the back of your card. They can tell you the exact copay and whether prior authorization is needed. If you have Part D, ask whether the drug is on the formulary and what tier it is on — higher tiers have higher copays.

Many cancer centers have financial counselors who can help you understand your costs. Ask your oncologist's office whether they have one. Some drug manufacturers offer copay information programs that can reduce your out-of-pocket cost to $5 or $10 per month, even if your plan's copay is higher. Your oncologist's office usually knows about these programs and can help you sign up.

Medigap and other ways to reduce your costs

If you have Original Medicare and are worried about the 20 percent coinsurance, you can buy a Medigap policy (supplemental insurance) from a private company. Medigap Plan G or Plan N will cover most or all of your 20 percent coinsurance, plus your deductible. The monthly premium for Medigap varies by age, location, and which plan you choose — usually $100 to $300 per month — but it caps your out-of-pocket costs.

If you have a Medicare Advantage plan, you cannot buy Medigap. Instead, look at whether you should switch to a different Advantage plan during open enrollment. Some plans have lower copays for cancer drugs or lower deductibles. You can switch once per year, from October 15 to December 7.

Nonprofit organizations like CancerCare, Patient Advocate Foundation, and American Cancer Society offer financial help to people with cancer. Some offer grants to cover copays or deductibles. Some offer free rides to treatment. Some offer free counseling to help you understand your insurance. Search online for "[your cancer type] financial information" or call 211 to find local programs.

Frequently Asked Questions

Does Medicare cover cancer screening like mammograms or colonoscopies?

Yes. Medicare Part B covers mammograms every one to two years for women 40 and older, colonoscopies every 10 years (or more often if needed), and other cancer screenings at no cost to you — no copay, no coinsurance, no deductible. Screening is free. Treatment is not.

What happens if I cannot afford my cancer treatment?

Talk to your oncologist's office about copay information programs run by drug manufacturers. Ask about financial counseling. Call 211 or search CancerCare.org to find grants or other help. Some hospitals have charity care programs that reduce or forgive bills for people with low income. Do not skip treatment because of cost without exploring these options first.

Can I switch Medicare plans in the middle of cancer treatment?

You can switch Medicare Advantage plans or Part D plans during the annual open enrollment period (October 15 to December 7). You cannot switch mid-year unless you have a may have access to life event. If your current plan is not covering your treatment well, talk to your oncologist about whether you should wait until open enrollment to switch, or whether there are other options now.

Does Medicare cover the cost of traveling to a cancer center far from home?

No. Medicare does not cover travel, lodging, or meals. However, some nonprofit organizations and some cancer centers offer travel information. Ask your oncologist's office or call 211 to find programs in your area.

What if my oncologist recommends a drug that Medicare does not cover?

Ask your doctor to request a formulary exception (for Part D drugs) or prior authorization (for Advantage plans). If that does not work, ask whether there is a similar drug on your plan's formulary that would work instead. If not, you may be able to pay out of pocket and seek reimbursement later, but confirm this with your plan before you do.