Does Medicare Cover Immunotherapy for Cancer?

Original Medicare typically does cover immunotherapy for cancer if it is deemed medically necessary by a doctor. The part of Original Medicare (Part A or Part B) that covers your immunotherapy for cancer will depend on the type of facility in which you undergo treatment.

Medicare Advantage (Part C) plans may also cover immunotherapy for cancer if ordered by your doctor.

Medicare Advantage plans also include an annual out-of-pocket spending limit. This can potentially save you money in Medicare costs for your cancer treatment.

Original Medicare does not include an out-of-pocket spending limit.

A woman smiles as she speaks with her doctor

Will Medicare cover cancer treatments?

Depending on where your cancer treatment (including immunotherapy) is administered, Medicare Part A or Part B may cover some of your costs:

  • If you receive immunotherapy as an inpatient, the hospital costs related to your immunotherapy are typically covered by Medicare Part A (Hospital Insurance).

  • If you receive immunotherapy as an outpatient, your doctor’s services are covered by Medicare Part B (Medical Insurance).

Immunotherapy is an innovative cancer treatment that modifies the cells of your immune system to help fight and kill cancer cells.

  • One type of immunotherapy for cancer is the use of certain injectable medications, such as Keytruda, that stimulate the immune system to attack cancer cells. Some cancer drugs are covered by Medicare Part B.

  • Another type of immunotherapy is less common but may soon be covered by Medicare. Car T-cell therapy (Chimeric Antigen Receptor T-cell therapy) re-engineers a patient’s T-cells (a type of white blood cell present in the immune system) to attack cancer cells.

    In 2019, the Centers for Medicare & Medicaid Services (CMS) announced it will consider making a coverage determination for Car T-Cell therapy for Medicare beneficiaries who have cancer.

Speak with your doctor to learn more about immunotherapy and other cancer treatments and how Medicare may or may not cover them.

How much does immunotherapy for cancer cost with Medicare?

Even if Medicare covers your immunotherapy, there are some out-of-pocket costs you should expect to pay, which may include:

  • Medicare Part B deductible
    You must meet your Part B deductible before your Medicare coverage kicks in. In 2019, the Medicare Part B deductible is $185 per year.

  • Medicare Part B coinsurance
    Once you meet your Part B deductible, you are typically responsible for paying a coinsurance of 20 percent of the Medicare-approved amount for most doctor’s services.

There is no annual limit on how much you could pay for the Part B coinsurance in a given year. This means that your Part B coinsurance costs could add up quickly for immunotherapy and other cancer treatments.

Some Medicare Advantage plans may cover cancer drugs

Medicare Advantage plans are required to provide at least the same coverage as the benefits that are offered by Original Medicare.

If your immunotherapy is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

Many Medicare Advantage plans offer additional benefits that aren’t covered by Original Medicare, such as prescription drug coverage.

Depending on the plan you have, your Medicare Advantage plan may provide coverage for certain cancer medications that Medicare Part B doesn’t cover.

These cancer drugs may include, but aren’t limited to:

  • Prescription chemotherapy drugs that are only available as oral medications
  • Anti-nausea drugs
  • Certain prescription immunotherapy drugs that aren’t injectable

Medicare Advantage plan availability and benefits may vary, and a Medicare Advantage plan that covers immunotherapy for cancer might not be available where you live.

To learn more and to compare plans in your area if you’re eligible to enroll, call to speak with a licensed insurance agent today.

 

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