Cancer treatment has two costs you'll see on bills: the drug or procedure itself, and the facility/administration cost. Insurance treats them separately, so it helps to know what to expect.
With in-network commercial insurance, most patients pay only their deductible, copays, and coinsurance until they hit their annual out-of-pocket maximum. For ACA-compliant plans in 2024, that maximum is $9,450 for individuals and $18,900 for families. After you hit it, the plan pays 100% of in-network covered services for the rest of the calendar year.
What this looks like in practice: a patient with a $3,000 deductible and a $7,500 OOP max who starts chemotherapy in January will typically pay $3,000 quickly (often in the first 1–2 infusions), then 20% coinsurance on subsequent care, then nothing once they hit the $7,500 cap. Almost all cancer patients on commercial plans hit the cap.
Medicare beneficiaries: Part B covers 80% of outpatient cancer care after the small annual deductible. A Medigap policy picks up the remaining 20%, leaving most cancer patients with nearly $0 out of pocket. Part D oral drugs are capped at $2,000/year in out-of-pocket spending starting in 2025.
Without insurance: a single chemotherapy infusion can range from $1,000 to $12,000 depending on the drug. Radiation therapy courses commonly run $10,000–$50,000. Don't panic at sticker prices — almost no one pays them. Cash-pay rates are usually 40–70% less than the chargemaster, and pharmaceutical manufacturers run patient-assistance programs that often cover the entire cost of high-priced drugs for qualifying patients.
Hidden costs to plan for: parking and gas, time off work (California State Disability Insurance replaces ~60–70% of wages), and accommodations if you're traveling for care. Many cancer centers — including Keck Medicine USC — have social workers who can connect you to nonprofit grants for these expenses.
Before treatment starts, ask the cancer center for a Good Faith Estimate (federal law requires it for self-pay patients) or a benefits verification (for insured patients). Both put numbers on paper before you commit.