Medicare covers cancer treatment well, but the rules differ depending on which parts you have. Here's what each part covers and what to watch for.
Part A (hospital): inpatient cancer surgery, inpatient chemotherapy, hospice care, and skilled nursing facility care after a qualifying inpatient stay. After a small deductible per benefit period, Part A covers most of the cost for the first 60 days inpatient.
Part B (outpatient): oncologist office visits, infused chemotherapy, radiation, PET/CT/MRI scans, physician-administered drugs, durable medical equipment, and many preventive screenings (mammograms, colonoscopies, low-dose CT for lung cancer screening in eligible patients). After a small annual deductible, Medicare pays 80%; you pay 20%.
Part D (prescription drugs): covers most oral chemotherapy and supportive medications (anti-nausea, pain). The 2025 cap on out-of-pocket Part D spending is $2,000 per year — a huge change from prior years.
Medicare Advantage (Part C): private plans that must cover at least what Original Medicare covers and often include drug coverage and extras. Most require staying in-network and getting prior authorization. Your maximum out-of-pocket is capped (in 2024, no more than $8,850 for in-network care).
Medigap (Supplement): private policies that pay the 20% coinsurance and other gaps left by Original Medicare. Plan G is the most comprehensive plan available to new enrollees. For active cancer patients, a Medigap policy can mean the difference between thousands in out-of-pocket costs and nearly zero.
What Medicare doesn't cover: most dental and vision care, long-term custodial care, hearing aids (with some exceptions), and care outside the U.S. (Medicare Advantage plans sometimes include extras here).
If a claim or prior auth is denied: read the denial notice carefully — it explains why and how to appeal. You generally have 60–120 days to file. Original Medicare has 5 levels of appeal; Medicare Advantage has 5 also but the first level goes back to the plan. Many denials are overturned on appeal, especially with a letter from your oncologist explaining medical necessity.
Call 1-800-MEDICARE for coverage questions, or your State Health Insurance Assistance Program (HICAP in California) for free one-on-one counseling.