Does Medicare Pay for Chemo Treatments?

Medicare provides healthcare coverage for millions of individuals aged 65 or older and those with certain disabilities. Understanding how this federal health insurance program addresses chemotherapy treatment costs is important, given the substantial financial burden cancer care can represent. This overview clarifies how Medicare assists with chemotherapy expenses, helping individuals make informed healthcare decisions.

Chemotherapy Coverage Under Original Medicare

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), provides extensive coverage for chemotherapy treatments. The specific part of Medicare that covers chemotherapy depends on where the treatment is administered and the type of medication involved.

Medicare Part A covers chemotherapy administered during an inpatient hospital stay. This includes the hospital stay, medications, and treatments received while admitted. Part A also covers a limited stay in a skilled nursing facility following a hospital admission, and hospice care.

Medicare Part B covers chemotherapy treatments received in an outpatient setting, including intravenous (IV) chemotherapy given in a doctor’s office, clinic, or hospital outpatient department. Part B also covers related services such as doctor visits, laboratory tests, diagnostic imaging, durable medical equipment, and some oral chemotherapy drugs that cannot be self-administered. Additionally, Part B may cover anti-nausea medications administered within 48 hours of chemotherapy treatment.

Oral chemotherapy drugs self-administered at home typically fall under Medicare Part D, which is prescription drug coverage. Part D plans cover a wide range of prescription drugs, including many oral chemotherapy medications and other drugs used to manage chemotherapy side effects. Beneficiaries should check their specific Part D plan’s formulary, the list of covered drugs, to confirm coverage for their prescribed oral chemotherapy.

Understanding Your Costs with Original Medicare

While Medicare covers a significant portion of treatment costs, beneficiaries are responsible for deductibles, coinsurance, and copayments. These out-of-pocket expenses can accumulate, especially given the intensive nature of chemotherapy.

For inpatient chemotherapy, Medicare Part A requires a deductible for each benefit period. In 2025, the Part A inpatient hospital deductible is $1,676 per benefit period. If a hospital stay extends beyond 60 days, daily coinsurance applies: $419 per day for days 61-90, and $838 per day for days 91 and beyond, up to 60 lifetime reserve days.

Outpatient chemotherapy, covered under Medicare Part B, has specific costs. In 2025, the annual Part B deductible is $257. Once met, beneficiaries typically pay 20% of the Medicare-approved amount for most doctor services and outpatient chemotherapy treatments. Original Medicare Part B has no annual out-of-pocket maximum, meaning the 20% coinsurance can continue indefinitely for extensive treatments.

Medicare Part D, which covers self-administered oral chemotherapy drugs, has its own cost structure. The standard Part D deductible for 2025 is $590, though some plans may have a lower or zero deductible. After the deductible, beneficiaries typically pay 25% of their prescription drug costs during the initial coverage period. For 2025, due to the Inflation Reduction Act, the coverage gap is eliminated, and a $2,000 annual cap on out-of-pocket spending for covered drugs is established. Once this $2,000 threshold is reached, beneficiaries pay nothing for covered medications for the remainder of the calendar year.

Medicare Advantage and Supplemental Options

Beyond Original Medicare, beneficiaries have additional options influencing chemotherapy treatment costs and coverage. Medicare Advantage Plans and Medicare Supplement Insurance policies are private plans offering different financial structures and benefits.

Medicare Advantage Plans (Medicare Part C) are private plans providing all benefits of Medicare Part A and Part B. They must cover at least what Original Medicare covers, including chemotherapy. These plans often use copayments instead of coinsurance percentages and may include prescription drug coverage (Part D). Many also offer additional benefits like dental, vision, or wellness programs.

Medicare Advantage Plans include an annual out-of-pocket maximum. Once this limit is reached, the plan pays 100% of covered service costs for the remainder of the year. In 2025, the maximum out-of-pocket limit for in-network services is $9,350. This ceiling on annual out-of-pocket expenses can be beneficial given the high costs of chemotherapy.

Medicare Supplement Insurance (Medigap policies) are private plans that work alongside Original Medicare to help pay for out-of-pocket costs. These policies cover expenses like deductibles, copayments, and coinsurance not covered by Original Medicare. For individuals undergoing chemotherapy, a Medigap policy can significantly reduce financial responsibility for Part A and Part B costs, including the 20% coinsurance for outpatient chemotherapy, which has no out-of-pocket limit under Original Medicare. Various Medigap plans offer different levels of coverage, requiring a separate monthly premium in addition to the Part B premium.