Does Original Medicare Cover Chemotherapy Costs?
Medicare covers many things. But does Medicare cover chemotherapy? Yes, it can cover most chemotherapy costs. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
Medicare Part A
If admitted to a hospital for chemotherapy, Medicare A will cover the cost. The Medicare Part A deductible is currently $1,316, which is applied to hospital admissions. If the hospitalized patient stays in the hospital for more than 60 days, they will be responsible for a “per-day copayment.”
If the hospitalized patient stays longer than 60 days, daily coinsurance amounts begin to apply. These “per-day copayments” increase the longer you remain hospitalized. It’s important to understand that Part A is designed for inpatient care only, so it will not typically cover chemotherapy received in an outpatient setting or a doctor’s office.
Medicare Part B
Many chemotherapy treatments are administered in an outpatient setting, such as a doctor’s office, cancer treatment center, or hospital outpatient department. In these cases, Medicare Part B generally provides coverage. Part B covers medically necessary services, including chemotherapy drugs given by infusion or injection, certain oral chemotherapy medications that are equivalent to injectable forms, and related services such as doctor visits, lab work, and diagnostic testing. Medicare Part B has a yearly deductible of $183. When the deductible is met, Medicare Part B can cover up to 80% of chemotherapy costs. That leaves the patient paying the remaining 20% of chemotherapy costs. As a result, Medicare Part B may cover oral chemotherapy medicines as they become available.
Medicare Part D
Finally, Medicare Part D covers oral chemotherapy drugs. It is important to remember that there are out-of-pocket costs that come with Medicare Part D. Therefore, there is a chance that a patient will enter a Medicare Part D coverage gap and incur a high cost due to the price of chemotherapy drugs. If limited income becomes an issue, patients may qualify for federal assistance to help pay the cost. In addition, pharmaceutical manufacturers also offer assistance programs for high-cost medicines, with which most oncologists are familiar.
https://www.medicare.gov/what-medicare-covers/index.html
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