| Thu, Aug 20, 2020 @ 09:00 AM

Medicare Coverage for Cancer Screenings, Chemo and Radiation

Posted by Medicare Made Clear

There are a lot of different kinds of cancers to be aware of as you age, and preventative screenings are important. And if you are diagnosed, chemotherapy and radiation may be part of your treatment plan. Fortunately, Medicare does provide coverage for various cancer-related screenings and health care services.

What Cancer Screenings Does Medicare Cover?

Medicare covers a variety of preventative screenings related to different kinds of cancer including breast cancer, cervical cancer, prostate cancer, lung cancer and colorectal cancer.

How each screening is covered and how often you can get them vary. Coverage may also be dependent on you meeting specific conditions. The following are a list of some of the preventative screenings for cancer that Medicare will cover.

For breast cancer, Medicare covers two different mammograms.

  • A screening mammogram once every 12 months at no cost if your doctor accepts Medicare assignment for women with Medicare age 40 or older.
  • A diagnostic mammogram if medically necessary. Frequency will vary based on your individual situation. Medicare will cover 80 percent of the cost of this type of mammogram, while you will be responsible for the other 20 percent and the Part B deductible.

For cervical cancer, Medicare covers the following every 24 months for most women and every 12 months if you’re considered high-risk for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal Pap smear in the previous 36 months.

  • A Pap smear
  • A Pelvic Exam (also includes a clinical breast exam)

For prostate cancer, Medicare covers the following screenings once every 12 months for men over 50.  

A PSA test doesn’t cost you anything if you get it done by a doctor that accepts Medicare, but you may pay a fee if the doctor does not. For a DRE, you will pay 20 percent of the Medicare-approved amount for the exam and your physician’s services. You’ll also be responsible for the Part B deductible. Finally, a copayment will be due if the exam is done in a hospital outpatient setting.

For lung cancer, Medicare Part B will cover the following screening if you meet certain conditions.

  • A Low-Dose Computed Tomography (LDCT) if all of the following conditions are met:
    • You’re over age 55
    • You get a written order from your doctor
    • You’re either a current smoker or have quit within the last 15 years
    • You have a history of smoking an average of one pack or 20 cigarettes per day for 30 years
    • You don’t exhibit any signs or symptoms of lung cancer

For colorectal cancer, Medicare covers a traditional screening colonoscopy and other preventative tests including:

  • A colonoscopy every 10 years for most people and once every 24 months if you’re considered high-risk for colon cancer.
  • A fecal occult blood test (FOBT) every year at no additional cost if you’re age 50 or older, and your doctor accepts Medicare.
  • A screening barium enema every 24 months, if you’re age 50 or older and at a high risk for colorectal cancer, or every 48 months if this test is used instead of a flexible sigmoidoscopy or traditional colonoscopy.
  • A multi-target stool DNA lab test once every three years if you’re age 50 to 85, show no symptoms of colorectal disease, and are considered being of average risk for developing colorectal cancer.

Does Medicare Cover Chemotherapy?

Yes, Medicare will cover chemotherapy if you have cancer. Medicare Part A provides coverage if you’re a hospital inpatient, and Part B will provide coverage if you receive chemotherapy in a hospital outpatient setting, doctor’s office or freestanding clinic.

If you receive chemotherapy as an outpatient, the location where you get treatment impacts how much you pay. In a hospital outpatient setting, you will have a copayment. For chemo given in your doctor’s office or a freestanding clinic, you’ll pay 20 percent of the Medicare-approved amount and will also be responsible for the Part B deductible.

Medicare Part D plans may also cover some chemotherapy treatments and related prescription drugs. Part D plans may cover the following cancer drugs: anti-nausea drugs, oral prescription drugs for chemotherapy, pain medication or other drugs used as part of your cancer treatment.

Does Medicare Cover Radiation Therapy?

Medicare Part A or Part B may cover radiation therapy. Part A will provide coverage for radiation therapy if you’re an inpatient, and you’ll pay the Part A deductible and coinsurance. Part B will provide coverage if you receive radiation therapy as an outpatient or as a patient of a freestanding clinic. You will pay 20 percent of the Medicare-approved amount and be responsible for the Part B deductible if therapy is done at a freestanding clinic

Does Medicare Advantage Cover Cancer Screenings and Treatments?

If you have a Medicare Advantage plan, the plan must still provide at the least the same coverage as Original Medicare (Parts A & B) but it could have different rules and costs. If you have cancer and a Medicare Advantage plan, be sure to check with your plan provider to understand what the rules and costs may be for screenings, chemotherapy, radiation and other related services or items needed for your treatment.

Different parts of Medicare can help cover the various screenings, treatments and prescription drugs you may need as part of your cancer treatment plan. Make sure to always read your coverage details carefully so you understand what is covered, how and where you’ll need to receive treatments, and what your costs will be.

For further information related to how Medicare works for cancer-related health services, tests and treatments, please see the various reference sources listed below.

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