Medicare covers radiation treatments, but you’ll be responsible for any out-of-pocket costs after your plan has paid its share. Medigap plans can reduce or eliminate out-of-pocket costs for your treatments.
Cancer treatments can get expensive quickly, especially when you need regular chemotherapy or radiation therapy. The good news is that your Medicare plan will likely cover most of your radiation therapy expenses.
Radiation therapy is when a trained radiation oncologist (cancer doctor) directly aims beams of energy at a tumor or area affected by cancer.
This article will explain when and how Medicare covers radiation therapy. Even though your Medicare plan does provide coverage, the usual out-of-pocket costs will still apply.
Let’s look at the different parts of Medicare and what they’ll cover when it comes to radiation treatments, including proton therapy.
Medicare Part A
Medicare Part A will cover costs related to an inpatient hospital stay and treatment. If you’re in the hospital and receive any radiation therapy, it’s usually covered.
Part A will also cover costs for any medications needed during your hospital stay, as well as meals you have while in the hospital.
Medicare Part B
Your Medicare Part B plan covers costs for cancer treatments and visits at outpatient medical centers like doctors’ offices and freestanding clinics. Services and treatments for cancer that may be covered under Part B include:
- cancer screening and prevention services
- radiation therapy
- medications to manage side effects (anti-nausea, pain relievers), when given by a healthcare professional in an outpatient setting
Medicare Part C
Your Medicare Part C (Medicare Advantage) plan covers all the things included in parts A and B. It may also cover extra items and services.
Your amount of coverage will depend on which plan you choose and whether you’re using an in-network provider, hospital, or pharmacy.
Medigap
Medigap (Medicare supplemental insurance) is a type of private insurance plan that helps cover your share of Medicare costs if you have parts A and B. Parts A and B together are known as Original Medicare.
With a Medigap plan, you will most likely have no out-of-pocket expenses for appointments, treatments, and prescription drugs related to cancer.
Note that Medigap plans can only be used with Original Medicare. If you have Medicare Advantage, you won’t be eligible to sign up for a Medigap plan.
Part A costs
The deductible amount for Medicare Part A is $1,632 per benefit period in 2024.
A benefit period starts the day after you’re admitted to a hospital. It ends after you haven’t had any inpatient care for 60 days following that hospital stay.
You may have more than one benefit period within a calendar year. You’ll owe the deductible amount for each benefit period. If you’re in the hospital for longer than 60 days, you’ll owe a coinsurance amount.
The coinsurance amounts for 2024 are:
- $352 per day for hospital stays lasting 61 through 90 days
- $816 per day for hospital stays that are 91 days and longer (for up to 60 extra lifetime reserve days)
Part B costs
The typical monthly premium for Part B is $174.70. But this may be higher depending on your income.
The deductible for 2024 for Medicare Part B is $240. After you’ve met your deductible, you’ll pay 20% of the costs for all other Medicare-approved treatments and services.
Is radiation covered by Medicare Advantage plans?
For Medicare Part C (Medicare Advantage), the cost will vary depending on which plan you have. Each plan may have different copays, coinsurance, and deductibles.
Many plans have 20% coinsurance costs until you reach the out-of-pocket maximum (the highest possible is $6,700). After you hit that amount, 100% coverage should kick in.
Remember, these costs all depend on what kind of plan you have. Check your specific plan to see what’s covered.
Medigap costs
A Medigap plan is generally a little more expensive than a Part C plan and doesn’t include prescription drugs. But it may be the most stress-free way to ensure that all cancer treatment costs are handled through your coverage.
What other cancer treatments are covered by Medicare?
Other than radiation, Medicare covers a variety of chemotherapy medications, some diagnostic tests and surgeries, breast prostheses, and more. Each part covers different items. Learn more: Does Medicare cover cancer treatment?
How much does radiation therapy cost for cancer patients?
It’s hard to estimate the exact out-of-pocket cost of radiation because different providers charge different amounts. That said, a 2022 study found that the subjects insured commercially or by Medicare Advantage all reached their annual out-of-pocket maximums of
Radiation therapy can be used as a stand-alone cancer treatment or in conjunction with other cancer treatments, like surgery or chemotherapy.
Medicare covers radiation therapy costs, though you may still be responsible for some out-of-pocket expenses. These will depend on the type of coverage you have.