DOES MEDICARE COVER CANCER TREATMENTS

Michael T Braden June 6, 2026 MEDICARE NEWS

DOES MEDICARE PAY FOR CANCER TREATMENT?

Yes. Medicare covers most chemotherapy and cancer drugs, which can reassure you that your treatment options are supported. Your out-of-pocket costs depend on whether the drug is infused in a clinic (Part B) or taken orally at home (Part D). Here is what each plan type pays, what chemo costs with Medicare, and how new negotiated drug prices are lowering costs for cancer patients.

Yes, Medicare covers chemotherapy and cancer drugs, with clear distinctions: Part B covers drugs administered in a doctor's office or outpatient clinic (infused chemo, immunotherapy, targeted therapy). Part D covers oral cancer medications you take at home. You pay 20% coinsurance for Part B drugs with no annual cap under Original Medicare, while Part D drugs are subject to the $2,100 annual out-of-pocket cap in 2026. This clarity helps you understand your coverage better.

Photo Of Braden Medicare Insurance's Poster: Does Medicare Cover Cancer Costs?

INFUSION THERAPY (COVERED UNDER MEDICARE PART B) 

·       Covered under Part B at outpatient facilities       

·       20% coinsurance after $283 deductible;

·       Medigap covers just as Original Medicare does

·       MA plans apply copay up to your Medicare Advantage Plan's MOOP(Maximum Out- Of-Pocket) Expense

ORAL CANCER DRUGS & MEDICATIONS (MEDICARE PART D)    

·       Covered under Part D drug benefit          

·       Specialty tier placement; $2,100 annual OOP cap in 2026

·       MA-PD plans include drug coverage

IMMUNOTHERAPY (MEDICARE PART B)    

·       Covered when administered by a provider: Keytruda, Opdivo, etc.

·       Billed under Part B

·       20% coinsurance applies

·       New negotiated prices coming in 2028.

RADIATION THERAPY (MEDICARE PART B)    

·       Covered at outpatient facilities          

·       20% coinsurance after deductible (Usually 15-30 treatment sessions)

·       Medigap covers coinsurance

INPATIENT CHEMOTHERAPY (MEDICARE PART A)    

·       Covered during hospital stays ($1,736 per Hospital Stay Period)

·       $0 coinsurance days 1-60

·       Includes all drugs during stay

ANNUAL OUT-OF-POCKET PROTECTION    

·       Original Medicare: no cap

·       MA: $8,850 max in-network (2026)

·       Part D: $2,100 cap

·       Medigap covered just as Original Medicare

COSTS USING ORIGINAL MEDICARE

Medicare Part B covers chemotherapy drugs, immunotherapy, and targeted therapy that are administered by a healthcare provider in an outpatient setting. This includes infusions given in your oncologist's office, hospital outpatient departments, and freestanding infusion centers. Part B also covers the administration itself, including the nursing time, supplies, and facility fees associated with your treatment.

Medicare reimburses providers for Part B drugs at the Average Sales Price (ASP) plus 6%. You pay 20% of the Medicare-approved amount after meeting your annual Part B deductible of $283 in 2026. There is no annual cap on Part B out-of-pocket costs under Original Medicare, which means a year of expensive infused cancer treatment could cost you thousands in coinsurance alone.

WHAT IS COVERED?

·       Infused chemotherapy drugs administered in a clinic or hospital outpatient department

·       Immunotherapy drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo)

·       Targeted biologic therapy administered by injection or infusion

·       Anti-nausea drugs administered during chemotherapy sessions

·       Administration fees, nursing time, and supplies for infusion

·       Blood tests and lab work related to chemotherapy monitoring

WHAT IS NOT COVERED

·       Oral chemotherapy drugs taken at home (covered under Part D)

·       Experimental or investigational cancer treatments not approved by FDA

·       Drugs administered during an inpatient hospital stay (covered under Part A)

·       Over-the-counter supportive medications (anti-nausea pills taken at home, etc.)

DID YOU KNOW…

A single infusion of Keytruda costs approximately $11,000. At 20% coinsurance, that is $2,200 per treatment, every 3 to 6 weeks. Over a year of treatment, your Part B coinsurance alone could exceed $15,000. This highlights why supplemental coverage (Medigap or Medicare Advantage) is essential for cancer patients on Original Medicare, helping you feel prepared for potential costs.

ORAL CANCER MEDICATIONS ARE COVERED UNDER MEDICARE PART D

Oral cancer drugs that you take at home are covered under Medicare Part D. These include oral chemotherapy agents, hormone therapies, and targeted oral medications for various cancers. Many newer cancer treatments are oral, including drugs for breast cancer (Ibrance, Kisqali, Verzenio), prostate cancer (Xtandi, Erleada), blood cancers (Imbruvica, Calquence), and multiple myeloma (Pomalyst).

Under Part D, oral cancer drugs are typically placed on Tier 4 (preferred specialty) or Tier 5 (non-preferred specialty), which carry the highest cost-sharing. However, the Inflation Reduction Act's $2,100 annual out-of-pocket cap means that no matter how expensive your oral cancer drug is, you will never pay more than $2,100 total for all Part D drugs in a calendar year. The Medicare Prescription Payment Plan (M3P) lets you spread this cost into monthly installments of approximately $175.

WHAT MEDICARE PART D COVERS

·       Oral chemotherapy drugs (capecitabine, temozolomide, etc.)

·       Oral targeted therapy (Ibrance, Xtandi, Imbruvica, Calquence, etc.)

·       Hormone therapy drugs (letrozole, anastrozole, tamoxifen)

·       Oral anti-nausea medications prescribed for chemo side effects

·       Oral immunomodulators (Pomalyst, Revlimid)

WHAT MEDICARE PART D DOES NOT COVER

·       Drugs not on your plan's formulary (may require exception or plan change)

·       Over-the-counter supportive care medications

·       Drugs used for experimental or off-label purposes not approved by your plan

·       Costs vary by plan tier, but capped at $2,100 total out-of-pocket per year for all Part D drugs (2026). M3P can spread costs monthly.

Picture of Braden Medicare Insurance's Poster Of Cancer Treatment Options

HOW MEDICARE NEGOTIATED PRICING IS LOWERING THE COST OF CANCER TREATMENTS

Several oral cancer drugs now have Medicare-negotiated prices: Imbruvica dropped 38% in 2026, while Xtandi (48%), Pomalyst (60%), Ibrance (50%), and Calquence (40%) will have lower prices starting January 2027. Combined with the $2,100 cap, cancer patients on Part D are seeing significant relief.

CANCER COSTS UNDER MEDICARE ADVANTAGE PLANS (MEDICARE PART C)

Medicare Advantage plans cover all the same cancer treatments as Original Medicare (Part A and Part B), plus most plans include Part D drug coverage (MAPD). The key difference is the annual maximum out-of-pocket (MOOP) limit. In 2026, the in-network MOOP for Medicare Advantage plans cannot exceed $8,850, meaning your total costs for Part A and Part B services are capped regardless of how many infusions or treatments you receive.

However, Medicare Advantage plans use provider networks. If your oncologist or cancer center is not in your plan's network, you may face higher costs or need to switch providers. Some plans require prior authorization for cancer treatments, which can delay therapy. Before enrolling in or staying with a Medicare Advantage plan after a cancer diagnosis, verify that your oncologist, hospital, and preferred cancer center are all in-network.

WHAT IS COVERED

·       All Part B cancer treatments (infused chemo, immunotherapy, radiation)

·       Part D oral cancer drugs (included in MAPD plans)

·       Annual MOOP limit protects against unlimited Part B coinsurance

·       Some plans offer additional cancer support benefits (transportation, care coordination)

WHAT IS NOT COVERED

·       Out-of-network cancer treatment (unless PPO plan, at higher cost)

·       Treatments denied due to prior authorization requirements

·       Experimental treatments not covered by the plan

·       Copays and coinsurance up to the plan's annual MOOP ($8,850 max in-network for 2026). Part D drugs subject to the $2,100 OOP cap

BE AWARE OF NETWORK RESTRICTIONS & LIMITATIONS…

If you are diagnosed with cancer while enrolled in Medicare Advantage, verify immediately that your oncologist and preferred treatment facility are in-network. If you need to see an out-of-network specialist or travel to a cancer center, consider switching to Original Medicare with a Medigap plan during the appropriate enrollment period.

COSTS WITH MEDIGAP/MEDICARE SUPPLEMENT POLICY

Medicare Supplement (Medigap) plans are specifically designed to cover the gaps in Original Medicare, including the 20% Part B coinsurance that makes infused cancer treatment so expensive. With a Medigap Plan G, for example, your only out-of-pocket cost for Part B cancer treatment is the $283 annual deductible. After that, Plan G pays 100% of the Medicare-approved coinsurance for all Part B services, including chemotherapy infusions, immunotherapy, radiation, and related lab work.

This is why many Medicare advisors recommend Medigap for beneficiaries with cancer or at high risk for cancer. Cost predictability is unmatched: you pay your monthly Medigap premium plus the $283 deductible, and everything else is covered. No networks, no prior authorization requirements, and no risk of surprise bills from out-of-network providers. You can see any oncologist in the country who accepts Medicare. Compare plans in your area to see what Medigap options are available.

WHAT IS COVERED

·       20% Part B coinsurance for all infused cancer drugs

·       Part A hospital deductible ($1,736 in 2026) for inpatient cancer stays

·       Coinsurance for radiation therapy, lab work, and imaging

·       Skilled nursing facility coinsurance (days 21-100)

·       Nationwide provider access with no network restrictions

WHAT IS NOT COVERED

·       Part D prescription drugs (separate Part D plan required for oral chemo)

·       Services not covered by Medicare (experimental treatments, etc.)

·       Long-term custodial care

WHY MEDICARE SUPPLEMENT/MEDIGAP PLANS ARE SO IMPORTANT FOR THOSE WITH ORIGINAL MEDICARE…

A cancer patient receiving Keytruda infusions every 3 weeks at $11,000 per infusion would pay over $15,000 per year in Part B coinsurance under Original Medicare alone. With Medigap Plan G, that same patient pays only $283 for the entire year. The monthly premium (typically $150-$300) is far less than the potential coinsurance exposure.

UPDATES ON MEDICARE COST NEGOTIATIONS FOR CANCER MEDICATIONS

THE COST OF IMBRUVICA DROPPED ALMOST 40% IN 2026

Imbruvica (ibrutinib) for CLL and mantle cell lymphoma dropped 38% from $14,934 to $9,319 per month under Medicare's first round of drug price negotiations.

NEGOTIATING CANCER DRUG TREATMENTS IN 2027

Xtandi (48% cut), Pomalyst (60% cut), Ibrance (50% cut), and Calquence (40% cut) will have negotiated prices effective January 1, 2027.

CANCER DRUG SELECTIONS FOR 2028

Erleada (prostate), Kisqali (breast), Verzenio (breast), and Lenvima (thyroid/liver/kidney) are selected for negotiation with prices effective in 2028.

COMING IN 2029, PART B DRUG NEGOTIATIONS

CMS proposed a permanent framework in June 2026 that will bring Part B-infused drugs (including Keytruda) into negotiation, starting with prices effective in 2029.

ANSWERS TO THE MOST COMMONLY ASKED QUESTIONS RELATING TO MEDICARE AND CANCER TREATMENTS

1.     Medicare covers FDA-approved chemotherapy drugs that are medically necessary for your cancer diagnosis. This includes traditional chemotherapy, immunotherapy, targeted therapy, and hormone therapy. Experimental or investigational treatments in clinical trials may have limited coverage.

2.     Under Part B, you pay 20% coinsurance after the $283 deductible with no annual cap. A Medigap plan covers this coinsurance. Under Part D, oral chemo is capped at $2,100 in total out-of-pocket costs per year. Medicare Advantage caps all Part A/B costs at the plan's MOOP (up to $8,850 in 2026).

3.     Oral cancer drugs taken at home are covered under Part D. The exception is oral drugs with an equivalent IV formulation, which are covered under Part B. In that case, Part B may cover the oral version at the same cost-sharing as the IV form.

4.     Under Original Medicare, prior authorization is generally not required for chemotherapy. However, Medicare Advantage plans may require prior authorization for certain cancer treatments. If your MA plan denies authorization, you have the right to appeal.

5.     In 2026, Imbruvica (CLL/MCL) dropped 38%. In 2027, Xtandi (prostate, 48% cut), Pomalyst (myeloma, 60%), Ibrance (breast, 50%), and Calquence (CLL, 40%) will have negotiated prices. Erleada, Kisqali, Verzenio, and Lenvima are selected for 2028.

6.     Medigap offers more predictable costs and unrestricted provider access, which many cancer patients prefer when they need specialist care. Medicare Advantage has a MOOP cap but may restrict your choice of oncologists and require prior authorization. Carefully consider your treatment needs and provider preferences.

WRAPPING THINGS UP

We hope you enjoyed reading about how cancer treatments and cancer medications are covered under Medicare Advantage and Original Medicare. If you ever have any questions about coverage, we always encourage Medicare beneficiaries to reach out to their Medicare Broker.  If you do not have a broker, please reach out to us, and we will be glad to help you find a new Medicare Broker in your area.  You can call or text Michael at (480) 225-1393, email him at mike@bradenmedicare.com, or visit our website www.bradenmedicare.com and complete a Contact Us form.