Does Medicare Cover Prostate Cancer Treatment?
Medicare covers screenings and treatment for prostate cancer. Part A covers hospital care, while Part B covers outpatient care and outpatient cancer medications.
Original Medicare (parts A and B) covers treatment for cancer, including prostate cancer, prescribed by a doctor who accepts Medicare. Medicare Advantage plans must also provide similar coverage.
Medicare typically does not cover experimental treatments but may approve some additional treatments for prostate cancer in certain circumstances.
Keep reading to learn what Medicare covers for prostate cancer, how much you can expect to pay, and ways to help cover out-of-pocket costs.
What prostate cancer treatments does Medicare cover?
Medicare covers cancer treatment and many of the related expenses of cancer care for prostate cancer and other types of cancer. Different parts of Medicare may cover various aspects of your care.
Medicare Part A (hospital care) covers the care you receive while admitted to a hospital. This may include:
surgery
postsurgery care
hospital stay
testing or imaging you receive in the hospital
any treatment you receive while admitted
Medicare Part B (outpatient care) covers cancer care you receive when not admitted to the hospital, like in a doctor’s office or clinic. This can include:
infused cancer medications, like chemotherapy and immunotherapy, including autologous cellular immunotherapy
some oral cancer medications that you take at home, such as hormone therapy like abarelix (Plenaxis)
anti-nausea drugs prescribed as part of cancer treatment
outpatient appointments
outpatient lab work or imaging tests
Does Medicare cover prostate screenings?
Medicare Part B covers cancer screenings, including once-yearly screenings for prostate cancer for males over 50 years old.
These screenings typically include a digital rectal exam and a prostate-specific antigen (PSA) blood test.
If you have a diagnosis of prostate cancer and are undergoing treatment or in remission after treatment, Medicare typically covers more frequent medically necessary monitoring of your cancer.
What prostate cancer treatments does Medicare not cover?
Medicare may not cover prostate cancer treatments performed by a healthcare facility or professional that does not accept Medicare.
Medicare also does not usually cover experimental treatments. This includes treatments that the Food and Drug Administration (FDA) has not yet approved.
How much does prostate cancer treatment cost with Medicare?
According to 2024 data from the National Cancer Institute, people who receive a diagnosis of prostate cancer typically accrue costs of $28,108.50 per person for initial care.
However, your specific out-of-pocket costs for prostate cancer treatment can depend on how advanced your cancer is and your specific treatment plan and coverage.
To lower your out-of-pocket costs, ensure that the healthcare professional accepts assignment, meaning they accept the Medicare-approved amount for the services you need.
A 2019 study looked into the diagnosis and treatment costs with Medicare for prostate cancer that has not spread to other parts of the body. Researchers estimated that for males 70 years old and over within 3 years of diagnosis, the cost may vary between $4,887 and $27,899.
You may also need to pay the out-of-pocket costs of prescription medication. Research from 2023 estimates the per-person cost of prescription medications for prostate cancer as $312.30.
Part B or Part D typically covers the costs of these medications. Depending on the specific drugs a doctor prescribes, you may have a copayment.
A Medicare supplement, or Medigap, plan may cover some of these out-of-pocket costs.
Medicare costs in 2024
If you require inpatient hospital care as part of your treatment, such as surgery, you will be responsible for paying:
the Part A deductible of $1,632 per benefit period
a copayment for an inpatient hospital stay if you require a stay longer than 60 days
For outpatient care, you will be responsible for the following costs in addition to your Part B premium:
the Part B deductible of $240
20% of outpatient costs after you reach the annual deductible
Your medication costs can vary depending on your specific Part D plan and the drugs covered by it.
Frequently asked questions
Does Medicare fully cover cancer treatment?
While Medicare covers cancer treatment, you will still be responsible for your deductibles and outpatient costs. A Medigap plan may help cover these additional costs.
Does Medicare cover proton radiation therapy for prostate cancer?
Medicare covers proton radiation therapy for prostate cancer.
Is laser ablation for prostate cancer covered by Medicare?
Medicare does not cover laser ablation for prostate cancer. But Medicare may cover laser ablation for enlarged prostate in some circumstances.
Takeaway
Medicare covers approved treatments for prostate cancer but may not cover experimental ones.
You will still need to pay out-of-pocket costs associated with your treatment, including:
your monthly premiums
your deductibles
20% of the costs of outpatient care after meeting your deductible
copayments for prescription medications or hospital stays over 60 days
Medigap plans may cover some of your out-of-pocket costs. You can also find out if you qualify for a Medicare savings program.
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