Does Medicare cover cancer treatment?

How Medicare Parts A, B, D, and Medicare Advantage cover cancer treatment. Deductibles, coinsurance, prior authorization, and the cost protections that apply to cancer patients.

Medicare covers cancer treatment comprehensively. Inpatient hospitalization falls under Part A. Outpatient care, infused drugs, radiation, surgery, and physician visits fall under Part B. Oral cancer drugs filled at a pharmacy fall under Part D. Medicare Advantage plans bundle all of these into a single plan with an annual out-of-pocket cap. This guide explains how each part applies to cancer care and where the cost-sharing responsibility lands.

Part A: inpatient hospital care

Medicare Part A covers inpatient hospital stays, skilled nursing facility care following a qualifying hospital stay, hospice, and some home health care. For cancer patients, Part A pays for:

Inpatient surgery and related hospitalization
Inpatient chemotherapy or immunotherapy administration during a qualifying hospital stay
Skilled nursing facility care during recovery (with coverage limits)
Hospice care for terminal-stage patients

Cost-sharing: There is a deductible per benefit period ($1,632 for 2024). Days 1 to 60 in a hospital stay have no additional coinsurance after the deductible.

Part B: outpatient care and infused drugs

Part B is where most cancer treatment cost-sharing happens. Part B covers:

Infused or injected cancer drugs administered at a clinic or hospital outpatient department, including Keytruda, Opdivo, Herceptin, Avastin, and similar. Medicare pays at Average Sales Price plus 6 percent. The beneficiary is responsible for 20 percent coinsurance after the Part B deductible ($240 for 2024).
Radiation therapy at hospital outpatient departments and freestanding radiation oncology centers.
Oncologist and specialist visits.
Outpatient surgery including biopsies.
Diagnostic imaging including CT, MRI, PET, and mammograms.
Laboratory services including tumor markers and biomarker testing.
Durable medical equipment ordered as part of cancer care.

Cost-sharing: 20 percent coinsurance on most services after the deductible. There is no annual out-of-pocket cap under Original Medicare Part B, which is why many cancer patients purchase a Medigap plan to cover the 20 percent.

Part D: oral cancer drugs

Part D covers oral cancer drugs filled at a retail or specialty pharmacy, including Ibrance, Verzenio, Xtandi, Tagrisso, and Lynparza. Part D is administered through private prescription drug plans approved by Medicare.

Cost-sharing under Part D depends on the specific plan:

Deductible. Varies by plan; up to the Medicare maximum.
Initial coverage period. The beneficiary pays a copay or coinsurance determined by the drug’s formulary tier. Specialty cancer drugs almost always land in the highest tier.
Catastrophic coverage. Starting in 2024, the Inflation Reduction Act caps total annual Part D out-of-pocket at approximately $3,500; in 2025 it is capped at $2,000.
Extra Help. Low-income beneficiaries can apply for Extra Help via SSA.gov, which reduces Part D copays to a few dollars per prescription.

For detail on how drugs are categorized between Parts B and D, see the Medicare Part D vs Part B guide.

Medigap (Medicare Supplement)

Medigap policies cover some or all of Original Medicare’s cost-sharing. For cancer patients, Medigap Plan G (the most comprehensive plan available to newly eligible beneficiaries) covers:

The Part A deductible
The Part B 20 percent coinsurance
Excess charges from providers who charge above Medicare-approved amounts

Medigap does not cover Part D (drug) cost-sharing. A separate Part D plan is required.

For cancer patients on expensive Part B drug regimens, Medigap transforms the financial picture. With Medigap Plan G, out-of-pocket for Part B drugs is typically just the annual Part B deductible, after which drug costs are fully covered.

Medicare Advantage

Medicare Advantage (Part C) plans bundle Parts A, B, and usually D into a single plan offered by a private insurer under contract with Medicare. Key cancer-relevant features:

Annual out-of-pocket maximum. $8,850 for 2024 in-network, $13,300 for combined in- and out-of-network. This cap does not exist under Original Medicare without Medigap.
Network restrictions. Most Medicare Advantage plans require in-network providers. Out-of-network care is either not covered or subject to much higher cost-sharing.
Prior authorization. Medicare Advantage plans often require prior authorization for specialist visits, imaging, and specialty drugs. Original Medicare has fewer prior authorization requirements.
Additional benefits. Some Medicare Advantage plans include benefits Original Medicare does not cover, such as dental, vision, fitness programs, and over-the-counter allowances.

For a detailed comparison, see Medicare Advantage vs Original Medicare for cancer.

What is not covered

Medicare does not cover:

Cosmetic procedures not medically necessary
Long-term custodial care (non-skilled nursing home care beyond the skilled nursing facility benefit period)
Most care received outside the United States
Experimental treatments not approved by the FDA (Medicare does cover many clinical-trial-related costs; see the clinical trial insurance coverage guide)
Most dental, vision, and hearing services (unless included in a Medicare Advantage plan)

Financial assistance for Medicare beneficiaries

Extra Help. Caps Part D drug costs at a few dollars per prescription. Apply via SSA.gov.
Medicare Savings Programs. State-administered programs that help pay Part A and Part B premiums and cost-sharing for low-income beneficiaries.
State Pharmaceutical Assistance Programs. Some states offer additional drug cost assistance for Medicare beneficiaries.
Disease-foundation copay funds. Medicare beneficiaries cannot use commercial-insurance copay cards due to anti-kickback rules, but they can use disease-foundation copay assistance from HealthWell, PAN Foundation, CancerCare, and others. See the financial assistance guide.
Manufacturer patient-assistance programs. Medicare beneficiaries whose income meets the program’s threshold can apply for free drug through the manufacturer’s patient assistance program.