Does Medicare Cover Immunotherapy for Cancer?

• by Christian Worstell
• August 30, 2023
• Reviewed by John Krahnert

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.

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 2023, the Medicare Part B deductible is $226 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.

How long will Medicare pay for immunotherapy?

Medicare will cover immunotherapy for up to 2 years. 

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 other benefits not covered by Original Medicare. 

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.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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