Medicare Coverage of Chemotherapy

What It Is

Chemotherapy treatments for cancer

What's Covered

Medicare Part A covers chemotherapy provided to an inpatient at a hospital or skilled nursing facility. Medicare Part B covers chemotherapy for an outpatient in any setting.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B plans.) To find out whether your plan provides extra coverage or requires different co-payments for chemotherapy, contact the plan directly.

If you have a Medicare Part D prescription drug plan: If you're enrolled in a Medicare Part D plan, it may cover outpatient prescription medications you take to manage symptoms of your disease or of the chemotherapy treatments. To find out whether your plan covers the outpatient drugs you're taking, and what your co-payments are for these drugs, contact the Part D plan itself.

What Medicare Pays

For a hospital or skilled-nursing-facility inpatient, the cost of chemotherapy is considered part of the overall covered hospital charges, which are paid by Medicare Part A under its schedule of deductible and coinsurance amounts.

For an outpatient, the amount of coverage Medicare Part B provides for chemotherapy depends on the setting in which the treatment is provided. For chemotherapy in a doctor's office, freestanding clinic, or independent treatment center, Medicare Part B pays 80 percent of the Medicare-approved amount for the treatment. If chemotherapy is provided by a hospital outpatient department, the patient is responsible for a fixed co-payment amount.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

5 Comments So Far. Add Your Wisdom.

10 months ago

If chemotherapy is received as an outpatient in a hospital, how many treatments will Medicare cover and what percentage?

almost 2 years ago

We had a conversation with some friends last night (we are all retired) and the statement was made that one of their friends that we do no know is also on Medicare and was denied Chemo as a result of the new health care law. Is this true????

over 2 years ago

How much is the average chemo treatment and how much is the average allowable charge from medicare?

almost 4 years ago

I found this helpful in that it answered my question directly.

over 4 years ago

My wife and I have a Part C Medicare Advantage Plan. ¶My wife will be having chemotherapy. We are having a difficult time finding exactly how much the chemotherapy will cost. If we can pin that down, we can then see if we can qualify for copay assistance. ¶This Website, and a few others I believe, state (or imply) that the copay is different if the chemotherapy is received as an outpatient from a hospital than if it is received at a doctor's office. ¶I would appreciate learning more specifics about: Is the hospital-outpatient significantly lower than 20%, (I hope)? For intravenous chemotherapy, does the "doughnut hole" apply (I hope not)? Thank you very much JohnAJ


Want More Medicare Info?

< Browse Other Medicare Topics