Does Medicare Part B Cover Cancer Treatment?
Navigate Medicare's approach to cancer care. Discover what Part B covers, understand your potential costs, and see how all Medicare parts integrate for comprehensive support.
Medicare Part B, a component of the federal health insurance program, provides coverage for a range of medical services. It primarily serves individuals aged 65 or older, and younger people with certain disabilities. Part B plays a foundational role in covering many aspects of cancer care, primarily focusing on outpatient medical services and supplies.
Specific Services Covered by Part B
Medicare Part B covers various outpatient services essential for cancer treatment. This includes physician services, such as office visits and consultations with oncologists or other specialists. Part B also covers second opinions for non-emergency surgical procedures, which can be important for patients making informed decisions about their treatment path.
Outpatient chemotherapy is a significant area of coverage under Part B. This includes chemotherapy administered intravenously, by injection, or through an implanted port in a doctor’s office, hospital outpatient setting, or a freestanding clinic. Some oral chemotherapy medications are also covered by Part B if they are typically administered in a clinical setting. Similarly, radiation therapy delivered in an outpatient clinic or hospital outpatient department is covered.
Diagnostic tests are also covered by Medicare Part B for detecting, diagnosing, and monitoring cancer. This encompasses various imaging scans like X-rays and CT scans, as well as laboratory tests and biopsies. Part B also covers certain cancer screenings, often provided with no out-of-pocket cost if specific eligibility criteria are met. These preventive screenings can include:
Mammograms for breast cancer
Pap tests for cervical cancer
Colonoscopies for colorectal cancer
Prostate-specific antigen (PSA) tests for prostate cancer
Durable medical equipment (DME) is covered when prescribed by a doctor for use in the home due to cancer-related needs. Examples include oxygen equipment, wheelchairs, or feeding pumps for enteral nutrition. Outpatient surgeries, such as the implantation of a port for chemotherapy, also fall under Part B coverage. Additionally, outpatient mental health services and specific dental services directly related to covered cancer treatments, like care needed before chemotherapy, are covered.
Understanding Your Out-of-Pocket Costs
While Medicare Part B covers many services, beneficiaries are responsible for certain out-of-pocket costs. Each year, individuals must meet an annual deductible before Part B coverage begins. For 2025, this Part B annual deductible is $257. Once this deductible has been satisfied, Medicare Part B typically pays 80% of the Medicare-approved amount for most covered services.
The remaining 20% of the Medicare-approved amount is the beneficiary’s coinsurance responsibility. This coinsurance applies to a wide range of services, including:
Doctor visits
Outpatient chemotherapy
Radiation therapy
Diagnostic tests
Original Medicare, which includes Part A and Part B, does not have an annual out-of-pocket maximum. This means there is no ceiling on the amount an individual might pay in coinsurance for covered services in a given year.
The Role of Other Medicare Options
Other Medicare components and related plans address aspects of cancer treatment not primarily covered by Part B, or they can help supplement Part B coverage. Medicare Part A covers:
Inpatient hospital stays, which are necessary for procedures such as cancer surgery or complex treatments requiring hospitalization
Skilled nursing facility care following a qualifying hospital stay
Hospice care for end-of-life support
Blood transfusions
For 2025, the Part A deductible is $1,676 per benefit period.
Medicare Part D specifically covers prescription drugs, including oral chemotherapy medications taken at home, anti-nausea drugs, and other prescriptions used as part of cancer treatment. Part D plans have a maximum deductible, which is limited to $590 for 2025. These plans also have an out-of-pocket maximum; for 2025, beneficiaries will not pay more than $2,000 out-of-pocket for covered drugs, after which catastrophic coverage begins.
Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans bundle the benefits of Part A and Part B, and often include Part D prescription drug coverage. While Medicare Advantage plans must provide at least the same coverage as Original Medicare, their cost structures, provider networks, and additional benefits can differ. Unlike Original Medicare, Medicare Advantage plans have an annual out-of-pocket maximum, which for 2025 can be up to $9,350 for in-network services.
Medicare Supplement Insurance, or Medigap plans, are another option that can help manage out-of-pocket costs associated with Original Medicare Parts A and B. These plans are sold by private companies and help cover expenses such as deductibles, coinsurance, and copayments. Medigap plans can significantly reduce financial exposure for cancer patients by covering some or all of the 20% coinsurance that Part B beneficiaries would otherwise pay. Some Medigap plans, such as Plan K and Plan L, also have their own out-of-pocket limits; for 2025, these limits are $7,220 for Plan K and $3,610 for Plan L.