The treatments cancer patients typically receive in hospitals such as chemotherapy and radiation therapy make things difficult not only medically but also financially. If you or someone close to you is currently undergoing the treatment, you might be wondering whether Medicaid or Medicare will pay for these therapies. The answer can very well depend on your specific plan, although both programs offer excellent coverage. Here is what you need to find out.
Does medicare cover chemotherapy and radiation therapy?
Yes, Medicare covers chemotherapy and radiation therapy, but the specific part of Medicare that provides coverage depends on where you receive the treatment.
- Medicare Part A: Covers chemotherapy and radiation therapy if you are admitted to the hospital as an inpatient.
- Medicare Part B: Covers these treatments if you receive them as an outpatient in a hospital, doctor’s office, or freestanding clinic.
If you have Original Medicare, you may need to pay:
- A 20% coinsurance for outpatient treatments after meeting the Part B deductible.
- A copayment for treatments in a hospital outpatient setting.
Keep in mind that some treatments may be recommended more frequently than Medicare covers, or your doctor might suggest therapies Medicare does not include. In these cases, you might have to pay for some or all of the costs.
Does medicaid cover chemotherapy and radiation therapy?
Medicaid also provides coverage for chemotherapy and radiation therapy, but the rules can vary by state since Medicaid programs are state-administered. In general, Medicaid covers:
- Chemotherapy drugs
- Radiation therapy treatments
- Doctor visits and consultations related to cancer care
To qualify for Medicaid, you must meet specific income and asset limits, which vary by state. If you are already enrolled in both Medicaid and Medicare, Medicaid can act as secondary insurance, helping to cover costs that Medicare does not pay.
What should you know about eligibility for coverage?
Understanding whether you qualify for coverage depends on your plan:
- For Medicare:
- You must be age 65 or older or meet eligibility due to a disability or specific medical condition like end-stage renal disease.
- Enrollment in Medicare Part A and/or Part B is required.
- For Medicaid:
- Your eligibility depends on your income, family size, and state requirements.
- Medicaid expansion under the Affordable Care Act has made it easier for many low-income adults to qualify.
What out-of-pocket costs can you expect?
Even with Medicare or Medicaid, you might still have some out-of-pocket costs for cancer treatment. Here is a breakdown of what you might pay:
- For Medicare beneficiaries:
- The Part B deductible (for 2024, this is $240 but may adjust in 2025).
- Coinsurance of 20% for outpatient care.
- For Medicaid recipients:
- In most cases, Medicaid has little to no cost-sharing, but this depends on your state.
If you have additional insurance or a Medigap policy, these plans may help reduce your out-of-pocket expenses.
How to find out what your plan covers?
If you are unsure about your coverage, here are some steps to help:
- Talk to your doctor: Ask if the recommended treatments are covered by Medicare or Medicaid.
- Check your plan details: Log into your Medicare or Medicaid account or review your plan documents.
- Contact your provider: Call Medicare at 1-800-MEDICARE or your state Medicaid office for detailed information.
Having clarity about what your plan covers can help you focus on your treatment without worrying about unexpected bills.
