{"id":53614,"date":"2022-09-09T13:30:19","date_gmt":"2022-09-09T17:30:19","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=53614"},"modified":"2025-12-04T11:20:44","modified_gmt":"2025-12-04T16:20:44","slug":"does-medicare-cover-chemotherapy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-chemotherapy\/","title":{"rendered":"Does Medicare cover chemo?"},"content":{"rendered":"<p><a href=\"#does-medicare-cover-chemotherapy\">Does Medicare cover chemotherapy?<\/a> | <span style=\"font-weight: 400;\"><a href=\"#what-if-my-chemo-treatments-are-denied-by-medicare\">What if my chemo treatments are denied by Medicare?<\/a> | <a href=\"#how-much-does-chemotherapy-cost-with-medicare\">How much does chemotherapy cost with Medicare?<\/a> | <a href=\"#ways-to-save-on-chemotherapy\">Ways to save on chemotherapy<\/a><\/span><\/p>\n<p><span style=\"font-weight: 400;\">More than 14% of Medicare beneficiaries have received a cancer diagnosis, according to the <\/span><a href=\"https:\/\/www.lls.org\/sites\/default\/files\/2022-06\/Medicare%20PartBandDreport.pdf\"><span style=\"font-weight: 400;\">Leukemia &amp; Lymphoma Society<\/span><\/a><span style=\"font-weight: 400;\">. Medicare beneficiaries older than age 65 accounted for 54% of all new cancer patients, according to the <\/span><a href=\"https:\/\/www.fightcancer.org\/sites\/default\/files\/2013-Medicare-Chartbook-Online-Version.pdf\"><span style=\"font-weight: 400;\">American Cancer Society<\/span><\/a><span style=\"font-weight: 400;\"> in 2011. Therefore, it\u2019s important for Medicare beneficiaries to understand what Medicare covers regarding chemotherapy treatments. Fortunately, Medicare covers most chemotherapy treatments and services.<\/span><\/p>\n<h2 id=\"does-medicare-cover-chemotherapy\"><span style=\"font-weight: 400;\">Does Medicare cover chemotherapy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Chemotherapy is a type of cancer treatment that\u2019s used to <\/span><a href=\"https:\/\/www.cancer.net\/navigating-cancer-care\/how-cancer-treated\/chemotherapy\/what-chemotherapy\"><span style=\"font-weight: 400;\">damage and destroy cancer cells<\/span><\/a><span style=\"font-weight: 400;\">, preventing them from multiplying. Medicare does cover chemotherapy. So, which parts of Medicare cover chemo treatments?<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Medicare Part A<\/b><span style=\"font-weight: 400;\"> (hospital insurance) covers chemotherapy treatments given in an inpatient setting.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Medicare Part B<\/b><span style=\"font-weight: 400;\"> (outpatient insurance) covers chemotherapy and radiation treatments given in an outpatient setting. Although chemotherapy is often administered in a hospital or clinic setting, it generally falls under Medicare Part B. Additionally, Medicare Part B covers <\/span><a href=\"https:\/\/www.medicare.gov\/coverage\/preventive-screening-services\"><span style=\"font-weight: 400;\">preventive cancer screenings<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Medicare Advantage prescription drug plans (Part C) or stand-alone Medicare Part D plans<\/b><span style=\"font-weight: 400;\"> will help cover the costs of chemotherapy prescriptions that you pick up at the pharmacy.<\/span><\/li>\n<\/ul>\n<table class=\" singlecare-table\">\n<thead>\n<tr>\n<th>\n<h2><span class=\"title\">What\u2019s covered<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"header-row\">\n<td><\/td>\n<td><b>Does Medicare Part B cover chemotherapy drugs?<\/b><\/td>\n<td><b>Does Medicare Part D cover chemotherapy drugs?<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Infusion drugs<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Drugs used at home are covered as Durable Medical Equipment.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Drugs given through an external infusion pump that are not covered by Part A or B may be covered.\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Injectable drugs<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Injectable drugs are covered and are administered by your healthcare provider.<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Injectable drugs that can be purchased in pharmacies may be covered.\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Oral anti-cancer drugs<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Oral anti-cancer drugs are covered by Medicare and you or your healthcare provider can administer the drug.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">If the drug is used to treat a condition other than cancer, it may be covered by Part D.\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Oral anti-nausea drugs<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Oral anti-nausea drugs are covered if administered within 48 hours of cancer treatment.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Oral anti-nausea drugs used for conditions other than cancer or administered more than 48 hours after cancer treatment may be covered.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><span style=\"font-weight: 400;\">What\u2019s not covered<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Most chemotherapy treatments and services are covered by Medicare. The only time Medicare may deny a claim is if the treatment or service is excluded from consolidated billing. In this scenario, the provider would just need to bill Medicare separately to be reimbursed. <\/span><\/p>\n<h4><span style=\"font-weight: 400;\">Consolidated billing exclusions<\/span><\/h4>\n<p><a href=\"https:\/\/www.cms.gov\/Medicare\/Billing\/SNFConsolidatedBilling\/Downloads\/2019-General-Explanation.pdf\"><span style=\"font-weight: 400;\">Consolidated billing<\/span><\/a><span style=\"font-weight: 400;\"> was established by the Centers for Medicare &amp; Medicare Services (CMS) in 1998. It was created to help eliminate duplicate billings for health services rendered to skilled nursing facility residents by multiple providers.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There\u2019s a list of drugs and services that are excluded from consolidated billing. However, the provider may bill Medicare directly for reimbursement. The below are only excluded if provided outside of a skilled nursing facility:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Radiation therapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Certain chemotherapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chemotherapy administration<\/span><\/li>\n<\/ul>\n<h4><span style=\"font-weight: 400;\">Which drugs are on the Medicare chemotherapy exclusion list?<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">Chemotherapy is one of the four major categories of services excluded from skilled nursing facility consolidated billing. Drugs on the Medicare chemotherapy exclusion list are unclear. Providers would need to check the <\/span><a href=\"https:\/\/www.cms.gov\/medicare\/billing\/snfconsolidatedbilling?redirect=\/snfconsolidatedbilling\/01_overview.asp\"><span style=\"font-weight: 400;\">annual consolidated billing updates<\/span><\/a><span style=\"font-weight: 400;\"> provided by CMS to verify what drugs and services can be billed separately to Medicare Part B.\u00a0<\/span><\/p>\n<h2 id=\"what-if-my-chemo-treatments-are-denied-by-medicare\"><span style=\"font-weight: 400;\">What if my chemo treatments are denied by Medicare?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If your claim for chemotherapy is denied, there could be a simple explanation, such as a billing code error. The first step would be to contact your provider directly. They may be able to determine what happened and bill Medicare correctly to resolve the issue. <\/span><span style=\"font-weight: 400;\">If your provider is unable to determine the reason for the denial, then your next step would be to <\/span><a href=\"https:\/\/www.medicare.gov\/claims-appeals\/how-do-i-file-an-appeal\"><span style=\"font-weight: 400;\">appeal the denial<\/span><\/a><span style=\"font-weight: 400;\">. The appeals process has five levels. Make sure to keep a copy of everything for your personal records. <\/span><\/p>\n<h4><span style=\"font-weight: 400;\">Does Medicare require prior authorization for chemotherapy?<\/span><\/h4>\n<p><span style=\"font-weight: 400;\">With Original Medicare, there is no <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\"> needed for chemotherapy.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">With a Medicare Advantage plan, you may need prior authorization. You need to contact your plan directly to find out what guidelines they have set in place.\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-chemotherapy-cost-with-medicare\"><span style=\"font-weight: 400;\">How much does chemotherapy cost with Medicare?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Chemotherapy can cost anywhere between <\/span><a href=\"https:\/\/health.costhelper.com\/chemo.html\"><span style=\"font-weight: 400;\">$10,000 and $200,000<\/span><\/a><span style=\"font-weight: 400;\"> without health insurance, depending on the type of cancer you have, the stage of the disease, the number of treatments, the duration of treatments, etc. A round of chemotherapy can cost anywhere between <\/span><a href=\"https:\/\/www.asbestos.com\/featured-stories\/high-cost-of-cancer-treatment\/\"><span style=\"font-weight: 400;\">$1,000 and $12,000 per month<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare does not cover 100% of the cost of chemotherapy treatments.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Since most outpatient chemotherapy treatments are covered under Part B, you\u2019ll be responsible for paying 20% coinsurance for all services and treatments. You\u2019ll also be responsible for the annual Part B deductible, which in 2026 is $283.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you have a Medigap plan, the 20% coinsurance will be billed directly to your Medigap (Medicare supplement insurance) carrier and covered. Depending on what letter plan you have, you may even get the annual Part B deductible covered.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Due to the high out-of-pocket costs of chemotherapy, you may consider enrolling in a Medigap plan to protect your finances since traditional Medicare does not have a maximum out-of-pocket limit.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For those who cannot afford a Medigap plan or get one due to pre-existing conditions, a Medicare Advantage plan (Part C) might be a useful option.<\/span><\/p>\n<p><a href=\"https:\/\/www.kff.org\/wp-content\/uploads\/sites\/2\/2011\/10\/11302.pdf\"><span style=\"font-weight: 400;\">Chronic Condition Special Needs Plans<\/span><\/a><span style=\"font-weight: 400;\"> are also offered through some Medicare Advantage carriers. These are limited to beneficiaries with specific chronic conditions, <\/span><span style=\"font-weight: 400;\">including some cancers<\/span><span style=\"font-weight: 400;\">. Plans are tailored for these specific conditions to best meet the needs of the beneficiary.\u00a0<\/span><\/p>\n<h2 id=\"ways-to-save-on-chemotherapy\"><span style=\"font-weight: 400;\">Other ways to save on chemotherapy<\/span><\/h2>\n<h3><span style=\"font-weight: 400;\">1. Medicare Extra Help<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/\"><span style=\"font-weight: 400;\">Extra Help program<\/span><\/a><span style=\"font-weight: 400;\"> provides financial assistance so people who meet low-income requirements or are dual-eligible for both Medicaid and Medicare can get discounts on their prescriptions and drug premiums.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">2. SingleCare coupons<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">There are thousands of <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">free coupons<\/span><\/a><span style=\"font-weight: 400;\"> available through SingleCare. These coupons can save you money, even if you currently have Medicare or another type of health insurance. You must choose to use SingleCare or Medicare\u2014you can\u2019t use both on the same prescription. There are some instances where you can save more money by using SingleCare instead of your Medicare prescription drug coverage plan. Some common chemotherapy drugs that SingleCare provides discount coupons for include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/bleomycin-sulfate\"><span style=\"font-weight: 400;\">Bleomycin sulfate<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/cladribine\"><span style=\"font-weight: 400;\">Cladribine<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/cytarabine\"><span style=\"font-weight: 400;\">Cytarabine<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/doxorubicin-hcl\"><span style=\"font-weight: 400;\">Doxorubicin HCl<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/fluorouracil\"><span style=\"font-weight: 400;\">Efudex (fluorouracil)<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/vinblastine-sulfate\"><span style=\"font-weight: 400;\">Vinblastine sulfate<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/vincristine-sulfate\"><span style=\"font-weight: 400;\">Vincristine sulfate<\/span><\/a><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">3. Medicaid<\/span><\/h3>\n<p><span style=\"font-weight: 400;\"> Medicaid is a health insurance program for low-income people of any age. Medicaid may cover or subsidize goods and services at a higher rate than Medicare. <a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility\/index.html\">Medicaid eligibility<\/a> and coverage is determined by the state<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/difference-between-medicare-and-medicaid\/\"><b>Medicare vs. Medicaid\u00a0<\/b><\/a><\/p>\n<h3><span style=\"font-weight: 400;\">4. Patient assistance programs<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Nonprofit organizations and drug manufacturers offer patient assistance programs to eligible cancer patients. Contact programs such as the <\/span><a href=\"https:\/\/www.cancercare.org\/copayfoundation\"><span style=\"font-weight: 400;\">Cancer<\/span><i><span style=\"font-weight: 400;\">Care<\/span><\/i><span style=\"font-weight: 400;\"> Co-Payment Assistance Foundation<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.lls.org\/copay\"><span style=\"font-weight: 400;\">The Leukemia &amp; Lymphoma Society\u2019s Co-Pay Assistance Program<\/span><\/a><span style=\"font-weight: 400;\">, and the <\/span><a href=\"https:\/\/www.healthwellfoundation.org\/\"><span style=\"font-weight: 400;\">HealthWell Foundation<\/span><\/a><span style=\"font-weight: 400;\"> for more information.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">5. Cancer organizations<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">There are many cancer organizations that provide financial assistance. Here are some examples:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.cancercare.org\/tagged\/financial_assistance\"><span style=\"font-weight: 400;\">Cancer<\/span><i><span style=\"font-weight: 400;\">Care<\/span><\/i><\/a> <span style=\"font-weight: 400;\">(800-813-4673)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.cancer.org\/support-programs-and-services.html\"><span style=\"font-weight: 400;\">American Cancer Society<\/span><\/a><span style=\"font-weight: 400;\"> (800-227-2345)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.lls.org\/support-resources\/financial-support\"><span style=\"font-weight: 400;\">The Leukemia &amp; Lymphoma Society<\/span><\/a><span style=\"font-weight: 400;\"> (800-955-4572)<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">6. 211<\/span><\/h3>\n<p><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-211\/\"><span style=\"font-weight: 400;\">211<\/span><\/a><span style=\"font-weight: 400;\"> is a non-emergency service that you can call to find services (including financial needs and health resources) in your community, state, or country. This free service is available 24\/7.<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Does Medicare cover chemotherapy? | What if my chemo treatments are denied by Medicare? | How much does chemotherapy cost with Medicare? | Ways to save on chemotherapy More than 14% of Medicare beneficiaries have received a cancer diagnosis, according to the Leukemia &amp; Lymphoma Society. Medicare beneficiaries older than age 65 accounted for 54% [&hellip;]<\/p>\n","protected":false},"author":133,"featured_media":626317,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[794,15],"coauthors":[20918],"class_list":["post-53614","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-cancer","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Does Medicare cover chemotherapy?<\/title>\n<meta name=\"description\" content=\"Medicare covers most chemotherapy treatments and services, but it does not cover 100% of the cost. 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