Does Medicare Cover Chemotherapy?

Learn if Medicare covers chemo

by Amy De Vore+ on Aug 05, 2015 | 7 Comments

Before you undergo chemotherapy you will want to know does Medicare cover that? With 650,000 people undergoing chemotherapy each year, not knowing how you would be covered can be scary (and expensive), especially when you have other things to worry about.

Does Medicare cover Chemotherapy?

While Original Medicare does partially cover chemotherapy for in-patient (covered by Part A), most people receive chemo through out patient care. If you do not have Part B (or other creditable coverage,) you would have to pay everything out of pocket for your chemo.

As you can see these costs can add up even with Medicare:  if you are in the hospital you are are still responsible for your Part A deductible $1,340 and coinsurance, and/or in an out-patient facility Part B deductible ($183), copays, and coinsurance.

One of the benefits of Original Medicare is you can seek your care from any doctor in the country that accepts Medicare assignment. So, if you live in Texas, but the best oncologist for your cancer is in Michigan, you can see that doctor.

Does Medigap Cover Chemotherapy?

All Medigap plans pay part or all of your coinsurance and copays for out-patient chemotherapy, but only Medigap C and F will cover your Part B deductible. Now, if you receive your chemotherapy in the hospital most Medigap plans will pay all or part of your Part A deductible.

One of the benefits of Medigap is it works with Original Medicare’s nationwide network.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Chemotherapy?

As you may know, Medicare Advantage must cover everything that Medicare covers. Only thing is, Medicare Advantage plans may cover various services differently than the way Original Medicare covers it.

One of the drawbacks of Medicare Advantage is they are generally HMO networks. This means that you will have a limited network of doctors of hospitals to treat cancer.

Learn More about Medicare AdvantageGet a MA Quote

For further questions call a Senior65 agent at 800-930-7956.

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Reader Comments and Questions

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By claire on November 17, 2018

Currently I have Medicare A and B plus a medigap policy (Plan F) and a Part D plan. I have stage 4 lung cancer. My employer gives us a choice of a Medicare advantage plan for $59, per month or a very small reimbursement should I continue my current coverage. I do not understand if a Medicare Advantage Plan would cover all my chemo expenses or just 80%. Currently I pay only $20. drug copay every 3 weeks.(My part D coordinates with the State benefit). Should I continue on with my current regime or go for the Medicare Advantage Plan which will save me about $150 per month? I have to do chemo till I die.

Claire,
Sorry you are dealing with this major health issue. It sounds like your current Medigap plus Part D set up is doing a good job at paying for your treatment. There is no guarantee that switching to a Medicare Advantage would do as well. Without knowing the details about which plan you are considering, our general recommendation would be to stay with what is working. If you want to discuss your case in detail, give us a call.
-Staff at Senior65.com


By Mike on May 06, 2017

Didn't apply for Medicare part B or medigap when turned 65, just diagnosed with cancer, can I still get a medigap plan after being approved for part B?

Mike,
Thank you for your question. There are certain circumstances that could qualify you for guaranteed issuance into a Medigap plan, even if you have cancer (ie. enrolled in job-based insurance, live in a guaranteed issuance state). If you believe you have a qualifying event call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Amy from https://www.senior65.com/


By Rhonda Routh on February 22, 2017

I am on a chemo pill daily. This is life sustaining medicine. There is not a chemo For CML THAT IS INJECTABLE OR CAN BE GIVEN INTERVENOUSLY. IT PROBABLY IS CHEAPER TO TAKE PILLS SO I DO NOT UNDERSTAND. ARE WE ALL GOING TO DIE WHEN ELIGIBLE FOR MEDICARE?


By jim kelly on February 06, 2017

I have a medicare advantage plan. If i should seek outpatient treatment (chemotherapy) for cancer would my treatment be classified under Part D or Part B and what percentage of the charges would i be responsible for?

Jim,
Chemotherapy, like most administered drugs, are generally covered by Part B. However, if you were to be prescribed any drugs, that would covered by Part D. You will want to contact your Medicare Advantage plan to see how your specific plan covers chemo and other treatment.
-Amy from https://www.senior65.com/


By Jo Ann Gragg on January 21, 2016

I am retiring in the next month and will be enrolling in Medicare Part B. I am trying to decide between Medigap and the Advantage Plan PPO. Does Medigap have an out of pocket cap...I know the Advantage plans do but I want to know what it is that will not pay that accumulates in that cost. Thanks for your time.

Jo Ann,
Medigap plans do not have an out of pocket maximum; however, if you have Medigap Plan F you should have $0 out of pocket costs (after your premium) as long as Original Medicare covers it. Now for Medicare Advantage plans, each plan varies greatly. The only commonality is they must cover what Original Medicare covers, but they do not have to cover it in the same way. So, there isn't an umbrella answer to that.

Bottom line is if you were to have a serious illness or injury, Medicare Advantage generally costs you more than Medigap. Also, MA plans are usually HMOs and, in some areas, they have PPOs, so you have a small network of doctors and hospitals. Whereas, Medigap works with almost every doctor and hospital in the country.

Hope this helps in making your decision. Please call 800-930-7956, for any further help.
-Amy from https://www.senior65.com/


By Bethany Erickson on August 13, 2015

Why is an HMO something to consider when getting chemotherapy? Does it mean I won't get a good doctor?

Bethany,
An HMO plan is something to consider, not because you won't get a good doctor, but because you will have a limited, local network of doctors and hospitals, as well as seek care from your primary care physician before seeing a specialist. When you are enrolled in Original Medicare or Medigap, you have access to the largest network of doctors and hospitals, and you can go straight to a specialist, if you want. Hope this helps.
-Amy from https://www.senior65.com/


By John Ryder on August 06, 2015

Clearly, Medigap is the way to go if you have cancer. But what if you didn't enroll in Medigap when you first turn 65? Does it because of the AFfordable Care Act's rule that all plans have to accept you regardless of preexisting conditions still count?

John,
If you didn't enroll in Medigap when you first turned 65 and first eligible for Part B, in most states, you would have to undergo medical underwriting. The ACA preexisting rule applies to individual plans for non-Medicare plans. Hope this helps.
-Chris from https://www.senior65.com/



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