Does Medicare Cover Cancer Treatment After Age 76?
Yes, Medicare plans offer some coverage for cancer treatments after age 76 as long as deductibles and copays are met.
Does Medicare cover cancer treatment after age 76? Though there may be a deductible or copay involved, Medicare does cover cancer treatment and preventative screenings, including for beneficiaries age 76 and up.
How Do the Parts of Medicare Cover Cancer Surgery?
The amount that Medicare will cover for cancer treatments can vary based on the type of cancer you have (such as breast cancer or prostate cancer) and the type of treatment plan prescribed by your doctor.
The type of policy you have can also play a role in your Medicare cancer coverage and how much you'll have to pay out-of-pocket.
There are four parts of Medicare, referred to as Part A, Part B, Part C and Part D.
Original Medicare (Parts A and B) Covers Chemotherapy and Cancer Treatments
Medicare Part A and Part B make up Original Medicare, which covers some hospital and medical care needs.
Medicare Part B covers doctor visits, surgeries and outpatient hospital services, including chemotherapy. Medicare Part A provides coverage for inpatient hospital care.
How Medicare pays for chemotherapy depends on where you receive your treatment:
- Hospital outpatient
You will typically pay a Medicare Part B copayment for chemotherapy received in a hospital outpatient setting. Your copay will typically be a set dollar amount, rather than a percentage of costs.
- Doctor's office or freestanding clinic
After meeting your Part B deductible ($240 for the year in 2024), you're typically responsible for paying 20% of the Medicare-approved amount for the treatment.
Original Medicare can also provide coverage for the following cancer treatment and screening services:
- Prostate cancer treatment
- Cervical and vaginal cancer screenings
- Multi-target stool DNA tests
- Screening colonoscopies
- Screening barium enemas
- Screenings fecal occult blood tests
- Screening flexible sigmoidoscopes
- Lung cancer screenings
- Clinical research studies
- Breast prostheses
Medicare Advantage Plans Cover Cancer Treatments and Can Offer Additional Benefits
Medicare Part C (Medicare Advantage) is an alternative to Original Medicare sold by private insurance companies. Medicare Advantage plans must provide at least the same coverage as Original Medicare, but sometimes include additional benefits like vision or dental.
Because Medicare Advantage plans must provide all of the same basic benefits as Part A and Part B, the cancer coverage of these plans will be identical to that of Original Medicare. Some Medicare Advantage plans may also offer benefits such as home modifications designed to help you age in place, which Original Medicare doesn't cover.
Many Medicare Advantage plans also offer prescription drug coverage, which can include cancer treatment medications.
Medicare Part D Plans Can Cover Cancer Drugs
Medicare Part D provides prescription drug coverage, including prescriptions that may help with cancer treatments. According to the American Cancer Society, any insurer who offers Medicare Part D must accept all applicants who apply and are eligible, even if they are diagnosed with cancer.
Some Medicare Part D prescription drug plans may help cover the costs of cancer drugs, including drugs related to chemotherapy treatment.
Medicare Supplement Insurance
Even as comprehensive as Medicare coverage is, it doesn't cover all of your out-of-pocket costs. Medicare Supplement Insurance plans help cover some of your out-of-pocket Medicare costs for chemotherapy and other cancer treatments, including deductibles, coinsurance and copayments.
The best time to purchase Medicare Supplement Insurance is when you are first eligible — during your open enrollment period. Your Medigap open enrollment period begins the month you are both 65 and enrolled in Medicare Part B.
If you are over the age of 76, you may have missed your Medigap open enrollment period. If you apply for Medigap coverage after your Medigap open enrollment period, an insurance company can use medical underwriting to determine your plan rates, and they may deny you coverage altogether.
There are certain special circumstances — called guaranteed issue rights — that may allow you to buy a policy without underwriting.
Learn more about common procedures that medicare covers.
Call today to speak with a licensed insurance agent who can help you compare Medicare and Medigap plans in your area that can help cover chemotherapy and other cancer treatments and costs.