Does Medicare Pay For Chemotherapy?
Yes. Medicare pays for chemotherapy if you have been diagnosed and are getting treatment for any of the following medical conditions:
Acute Lymphocytic Leukemia
Acute Myelogenous Leukemia
Chronic Lymphocytic Leukemia
You must be getting chemotherapy as part of your treatment for the medical condition. For example, if you are getting chemotherapy for your non-Hodgkin's lymphoma, Medicare will pay for your chemotherapy treatment.
If you are getting chemotherapy for another medical condition (even though it is not one of the above conditions), Medicare may or may not pay for your chemotherapy. You should talk to your doctor to find out if Medicare covers chemotherapy for another medical condition.
Medicare pays for chemotherapy as part of your inpatient hospital care, or your outpatient (ambulatory) care.
What if I don't have Medicare?
If you are not yet eligible for Medicare (Medicare is a federal health insurance program for people 65 and older, and people under 65 with certain disabilities), or if you are not yet 65, you may be able to get help with your chemotherapy costs from other sources, such as private health insurance. You should consult your doctor or pharmacist for more information.
How much does chemotherapy cost?
It's hard to say exactly how much chemotherapy will cost you, because there are so many factors to consider. Drugs, for example, may be cheaper if they are given in a doctor's office or at a hospital outpatient clinic, compared to costs if the same drugs were given in a hospital inpatient setting. (Inpatient treatment in a hospital is more expensive than outpatient care.) Also, if you are getting a combination of drugs (a combination chemotherapy "regimen"), some drugs may be more expensive than others.
The cost of chemotherapy is usually based on a fixed price per dose of the drug. The total cost of chemotherapy is the fixed price per dose multiplied by the number of doses of the drug you take. For example, if you take a drug that costs $100 per dose for 20 doses, the cost of the drug is $2000. (20 doses x $100 per dose = $2000.)
Here are some interesting facts about the cost of chemotherapy drugs:
The price of a dose of chemotherapy drug may vary from around $10 to over $1000.
Bigger doses of a drug usually cost more money.
If you need a combination chemotherapy regimen, the price for the drug(s) in that combination usually will be more expensive than the price of each drug if it were used by itself.
What if I can't afford to pay for my chemotherapy drugs?
If you cannot afford to pay for your chemotherapy drugs, you may be able to get help from one of the programs listed under "What other resources can I use to get help with the cost of my chemotherapy drugs?
" in the next section.
What other resources can I use to get help with the cost of my chemotherapy drugs?
You can ask your doctor or pharmacist for a drug discount card, which is a card that will get you a discount on your chemotherapy drugs.
The following government programs help people with the cost of their drugs:
Medicare Prescription Drug Coverage: This program provides coverage for people who are age 65 or older, or under 65 and disabled.
Medicare Part D Extra Help Program: This program provides free or low-cost prescription drugs to people with limited income and resources.
Medicare Part B Drug Coverage: This program provides coverage for people who are age 65 or older.
State Pharmaceutical Assistance Programs (SPAPs): These programs provide help paying for prescription drugs in the form of a discount card or pharmaceutical discount.
Some state and local governments have programs that will pay the cost of prescription drugs. You can find out whether your state has such a program by visiting the website of the National Association of State Medicaid Directors.
People with low income may be able to get free or low-cost drugs if they belong to certain health care programs (such as the Community Health Center Program or the Rural Health Clinic Program).
People without health insurance or prescription drug coverage may want to consider joining a patient assistance program. These programs provide free drugs to people who cannot afford them.
If you are facing a serious illness, you may be able to get help with the cost of many of your medical bills, including the cost of your prescription drugs, from a community foundation. You can find out more information about community foundations by visiting the website of the National Network of Grantmakers.
How do I know if I am eligible for any of the programs listed above?
You should contact your doctor, pharmacist, insurance company, or another health care provider for more information.
What if I want help paying for my chemotherapy drugs but I don't have any insurance?
If you aren't insured, you should contact your local hospital. Many hospitals have programs to help uninsured or under-insured people with the cost of their chemotherapy drugs.
You may also want to contact a community foundation. Community foundations help people facing serious illness with their medical bills, including the cost of their prescription drugs. You can find out more information about community foundations by visiting the website of the National Network of Grantmakers.
How do I apply for help with the cost of my chemotherapy drugs?
Each program has its own application procedure. You should contact your doctor or pharmacist for more information.