How Much Does Medicare Pay for Chemotherapy?

Medicare provides health insurance for individuals aged 65 or older and certain younger individuals with disabilities. Chemotherapy treatments can be costly, making it important to understand Medicare coverage. Various Medicare parts cover these expenses, each with distinct rules and patient responsibilities.

Medicare Part A Coverage for Chemotherapy

Medicare Part A, known as hospital insurance, primarily addresses costs incurred during inpatient hospital stays. This part covers chemotherapy when administered during an inpatient admission to a hospital or skilled nursing facility. It also extends to related services received while admitted, such as medications and certain treatments.

Individuals covered by Part A are responsible for a deductible for each benefit period, which is $1,676 in 2025. A benefit period begins upon inpatient admission and ends after 60 consecutive days without inpatient care. For extended stays, daily coinsurance amounts apply: $419 per day for days 61-90, and $838 per day for days 91 and beyond, utilizing up to 60 lifetime reserve days.

Medicare Part B Coverage for Chemotherapy

Medicare Part B, which is medical insurance, covers medically necessary outpatient services, including most chemotherapy treatments. This includes chemotherapy drugs administered in a doctor’s office, clinic, or hospital outpatient department. Part B also covers infusion services, doctor visits related to treatment, and necessary diagnostic tests.

After meeting the annual Part B deductible, which is $257 in 2025, individuals are responsible for 20% coinsurance of the Medicare-approved amount for most covered services. This 20% coinsurance applies to the cost of chemotherapy drugs and their administration, with no annual limit on out-of-pocket spending under Original Medicare. The monthly premium for Part B in 2025 typically starts at $185, though it can be higher based on income.

Medicare Part D Coverage for Chemotherapy Drugs

Medicare Part D plans provide coverage for prescription drugs, addressing medications that are typically self-administered. This includes oral chemotherapy drugs taken at home and other medications related to cancer treatment, such as anti-nausea drugs. The specific costs and covered drugs vary among different Part D plans, as each plan has its own list of covered medications, known as a formulary.

Part D coverage involves a deductible, which cannot exceed $590 in 2025. After the deductible is met, the plan helps pay for covered drugs, with individuals typically paying a copayment or coinsurance. Once total out-of-pocket spending reaches a certain threshold, individuals enter the catastrophic coverage phase, paying nothing for covered Part D drugs for the remainder of the calendar year. The coverage gap was eliminated as of January 1, 2025.

Impact of Other Medicare Plans on Chemotherapy Costs

Beyond Original Medicare (Parts A and B) and Part D, other Medicare plans can influence the financial burden of chemotherapy. Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans must provide at least the same benefits as Original Medicare Parts A and B, but they often include Part D prescription drug coverage and may offer additional benefits.

Medicare Advantage plans have their own cost-sharing structures, including copayments, coinsurance, and annual out-of-pocket maximums. The out-of-pocket maximum for in-network services can be as high as $9,350 in 2025, providing a cap on yearly expenses that Original Medicare does not offer. They cannot charge higher copayments than Original Medicare for certain services, including chemotherapy.

Alternatively, Medicare Supplement (Medigap) plans work in conjunction with Original Medicare. These plans are sold by private companies and help cover some or all of the out-of-pocket costs that Original Medicare does not pay, such as deductibles, copayments, and coinsurance for Parts A and B. Many Medigap plans can cover the 20% coinsurance for Part B services, significantly reducing an individual’s out-of-pocket expenses for outpatient chemotherapy. However, Medigap plans cannot be used with Medicare Advantage plans and do not help with Part D prescription drug costs.