Medicare and Cancer Treatment

Cancer is one of the leading causes of morbidity and death across the world. In spite of the latest advancements in the medical field, a large percentage of patients does not receive appropriate treatment for cancer due to the delayed diagnosis and higher costs involved. Here is a brief discussion about whether Medicare covers cancer treatments.

Types of cancer treatments

The form of cancer treatment recommended often depends on the type of cancer, its stage, and the extent of spread. Some options for cancer treatment include:

Surgery for the removal of cancer cells from the affected organs and tissues
Radiation therapy to shrink tumors and destroy cancer cells
Chemotherapy that uses anti-cancer medications to kill abnormal cancer cells
Immunotherapy that enhances the natural immune system functions to increase its ability to fight and kill cancer cells

Let us have a look at whether Medicare covers these cancer treatments.

Does Medicare cover surgery for cancer?

Surgical treatment for cancer often involves cutting out the tumor mass with or without the surrounding healthy tissue, and lymph nodes. Surgery is more effective for treating a solid tumor that is well defined and contained in a small area.

Surgery is not recommended for cancers that have spread significantly to the nearby or distant healthy tissues or blood cancers. In some cases, surgery is combined with other forms of cancer treatments for better results.

The cost of cancer therapies involving surgery may include the cost of the operating room fees, surgeon, anesthesiologist, equipment, pathologist, and medicines. Medicare usually covers these costs when the surgery is performed as a part of the cancer treatment and is considered medically necessary.

In-patient surgery may be covered by Medicare Part A while the outpatient surgery is covered by Medicare Part B.

Medicare Advantage plans offered by private insurance agencies contracted with Medicare also cover surgery for cancer treatment.

Does Medicare cover radiotherapy for cancer treatment?

Radiation therapy in high doses helps to kill abnormal cancer cells and shrinks tumors. Medicare Part A usually covers the costs of radiation cancer treatment when the patient is admitted in a hospital and treated as an in-patient.

Medicare Part B covers radiation treatment when the therapy is performed on an out-patient basis in a clinic. Medicare Advantage plans may also cover radiation.

Does Medicare cover chemotherapy?

Chemotherapy refers to the use of anti-cancer medications to treat cancer. Medicare usually covers chemotherapy treatment when the patient is treated in a hospital, outpatient clinic, or the doctor’s office.

Chemotherapy costs depend on the chemotherapy medications administered. If chemotherapy is administered intravenously at the doctor’s office, it is covered by Medicare Part B. When it is administered intravenously in a hospital, it is covered by Medicare Part A.

Prescription drugs to be taken orally at home are covered by Medicare Part D Prescription Drug Plan. The patient can receive Medicare Part D coverage through a Medicare Advantage prescription drug plan or a stand-alone Prescription Drug Plan.

Does Medicare cover immunotherapy for cancer treatment?

Immunotherapy includes the use of medications that boost the immune response to kill cancer cells more effectively. Medicare may cover immunotherapy cancer treatments if it is determined to be medically necessary by the doctor.