Medicare Coverage for Cancer Treatment: Chemotherapy, Radiation, and More

A cancer diagnosis is one of the most stressful events a person can face -- and questions about coverage and costs add to that stress. Medicare covers a comprehensive range of cancer treatments, but the cost-sharing structure can be complex. Here is what you need to know.

Medicare covers several cancer screenings at no cost:

Colorectal cancer:

• Colonoscopy: Every 10 years (every 2 years for high-risk patients); no cost-sharing when performed as a screening
• Fecal occult blood test: Annually at no cost
• Stool DNA test (Cologuard): Every 3 years for average-risk patients

Breast cancer:

• Mammogram: Annually for women 40 and older at no cost

Cervical and vaginal cancer:

• Pap smear and pelvic exam: Every 24 months (annually for high-risk women) at no cost

Lung cancer:

• Low-dose CT scan: Annually for qualifying current/former smokers ages 50-77 at no cost

Prostate cancer:

• PSA test: Annually for men 50 and older at no cost

Cancer surgery is covered under Part A (inpatient) or Part B (outpatient) depending on where it is performed:

• Inpatient surgery: Part A covers the hospitalization; Part B covers the surgeon's fee
• Outpatient surgery: Part B covers the facility and surgeon fees (20% coinsurance after deductible)

Medigap Plan G covers Part A deductibles and Part B coinsurance, making surgery costs predictable.

IV chemotherapy administered in a clinical setting: Covered under Part B at 80% after the Part B deductible. This includes chemotherapy infusions at a hospital outpatient department, cancer center, or doctor's office.

Oral chemotherapy (pills and capsules): Covered under Part D. Cost-sharing depends on the drug's tier on your plan's formulary -- specialty tier drugs (Tier 5) typically have 25-33% coinsurance, which can be very high for expensive oral cancer drugs.

Important: Some oral chemotherapy drugs cost $5,000-$15,000 per month. If you are diagnosed with cancer, review your Part D plan's formulary and out-of-pocket maximum carefully. The Inflation Reduction Act's $2,100 annual out-of-pocket cap for Part D (effective 2025) provides significant protection.

External beam radiation therapy, brachytherapy, and stereotactic radiosurgery (CyberKnife, Gamma Knife) are covered under Part B at 80% after the deductible when performed in an outpatient setting.

IV immunotherapy and targeted therapy (pembrolizumab/Keytruda, nivolumab/Opdivo, trastuzumab/Herceptin, etc.) administered in a clinical setting: Covered under Part B at 80% after deductible.

Oral targeted therapy (imatinib/Gleevec, ibrutinib/Imbruvica, etc.): Covered under Part D -- often at specialty tier with significant cost-sharing.

Medicare covers routine costs of qualifying clinical trials -- the standard care you would receive whether or not you were in the trial. Medicare does not cover the investigational item or service itself (which is typically provided free by the trial sponsor).

Medicare covers supportive care alongside cancer treatment:

• Anti-nausea medications (Part D, or Part B if administered in office)
• Growth factors (G-CSF) to prevent infection during chemotherapy (Part B)
• Pain management
• Palliative care consultations (Part B)
• Mental health counseling (Part B)
• Nutritional counseling (Part B)

If you have Medicare Advantage and are diagnosed with cancer, verify that your oncologist and cancer center are in-network before beginning treatment. Major cancer centers (Mayo Clinic, Moffitt Cancer Center in Tampa) may not be in all MA networks.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.