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What does Medicare cover for cancer?
Cancer is the second leading cause of death in the United States. But millions of people today either are living with cancer or have had it. Generally, the sooner cancer is found and treated, the better your chances are for survival. Cancer starts when abnormal cells in the body grow out of control. There are many kinds of cancer, each acting differently, and varying in treatment options.
Find out what’s covered for cancer
Cancer treatment can cost a lot. But Medicare will help pay to diagnose medical and mental health conditions you face. Medicare covers these services:
Certain medical items
Ongoing medical treatment for your cancer diagnosis
Second opinions on surgery
Chemotherapy or drugs taken orally or intravenously
Medical treatment for other health conditions and side effects of your cancer treatment
Prescription drugs for chemotherapy and to treat side effects such as nausea
Healthcare services at home, such as a visiting nurse or rehabilitation therapist and home health aides
Assistance with daily tasks, called rehabilitative care
Mental health services
Experimental treatments in clinical trials
Short-term nursing home care
Hospice or end-of-life care
Medicare may not pay for everything you need. Medicare often does not cover these services:
Services that help you bathe, eat and do other activities of daily living that do not require skilled care
Stays in assisted living facilities
Long-term nursing home care
How to find a cancer treatment center
To get the best medical care possible for your cancer, choose your treatment center carefully. You may not be able to choose which hospital treats you in an emergency, but you can choose a center for your regular care.
The government has named some hospitals and healthcare organizations as excelling in treating certain conditions. These are called Centers of Excellence. The National Cancer Institute (NCI) has named the top centers treating cancer in the United States. These are called NCI-designated cancer centers.
Drugs covered by Medicare Part B
It can be hard to understand why Medicare covers some drugs under Part B and others under Part D. But it is important to know the difference. How you get your drugs and what you pay will differ if Medicare Part B or Part D covers your drugs.
Medicare Part B covers most of the drugs to treat your cancer that are given as a shot, through an IV tube or by mouth. These are called chemotherapy drugs. Your doctor or treatment center gets the drugs. Then your doctor or a nurse puts them in your veins or gives you a pill or liquid to swallow.
Many chemotherapy drugs can cause nausea and vomiting. You will get anti-nausea drugs when you get your chemotherapy.
Oral cancer drugs covered by Part B
Medicare Part B covers cancer drugs that you have put in your veins or can take by mouth. If your drug is only made to be taken by mouth, your Medicare Part D plan should cover it.
Medicare coverage of anti-nausea drugs
It covers them the same way Medicare covers cancer drugs. If you can take your anti-nausea drug by mouth or in your veins, then Medicare Part B will cover either one. But your doctor must give it to you within 48 hours of your cancer treatment. Otherwise, your Medicare Part D plan should cover it.
Covers of radiation therapy
Medicare Part B covers your radiation if you are an outpatient or in a freestanding facility. You will pay 20% coinsurance of the amount Medicare approves for the doctor visit. Medicare will pay the remaining 80%.
Medicare Part A covers your radiation therapy while you are a hospital inpatient.
Medicare coverage of second opinions
After you get your doctor’s diagnosis and cancer treatment plan, it is a good idea to get another cancer doctor’s advice before you start treatment. This is especially true if your doctor suggests surgery. This is called a second opinion.
Medicare covers most of the cost of a second opinion before surgery. A second opinion might tell you to follow your first doctor’s treatment plan. Or it can suggest that you change the plan. A second opinion can make you feel better than you have explored your treatment options. It also will give you a chance to get all your questions answered.