Medicare Coverage for Immunotherapy Cancer Treatment

Medicare covers certain types of immunotherapy to treat cancer. Immunotherapy uses medications made from living organisms to help your immune system fight cancer.

Each part of Medicare — Part A hospital insurance, Part B medical insurance and Part D prescription drug plans — will cover different aspects of immunotherapy.

Medicare Advantage plans (Medicare Part C) are required by law to cover everything Medicare Part A and Part B cover but may include additional benefits depending on your particular plan.

In addition to providing coverage for immunotherapy, Medicare covers radiation therapy and chemotherapy used to treat cancer.

The U.S. Centers for Medicare & Medicaid Services announced in 2019 that it would cover CAR-T cell (chimeric antigen receptor T cell) immunotherapy in certain cases.

This type of immunotherapy is highly personalized, using your own T cells to find and kill cancer cells. It’s also very expensive. As of 2019, a one-time treatment of CAR-T cell therapy was estimated to cost as much as $475,000, or up to $1.5 million if you include tests and hospitalization.

Medicare will only cover CAR-T cell therapy if you receive it in a hospital or other health care facility that is enrolled in the U.S. Food and Drug Administration’s Risk Evaluation and Mitigation Strategies (REMS) drug safety program.

The treatment also must meet other specific FDA requirements in order to be covered by Medicare Part B medical insurance.

You will still have to pay certain out-of-pocket costs for immunotherapy cancer treatment even if you are covered by Medicare.

Your Medicare Part B deductible ($257 in 2025) applies. After meeting your deductible, you will also have to pay 20% of the Medicare-approved cost of your immunotherapy treatments.

Your Medicare Part A deductible ($1,676 in 2025 for each benefit period) will most likely be met if you complete all your necessary doctor visits and immunotherapy treatment sessions.

A Medigap policy may help cover some of your out-of-pocket costs if you have Original Medicare — Medicare Part A and Part B. Medigap plans are sold by private insurers. Check with your plan’s administrator to find out exactly what costs you may still be responsible for paying.

Medicare Advantage plans are also sold by private insurers. They are required by law to cover everything Original Medicare covers. Medicare Advantage plans also have a maximum out-of-pocket limit that may save you money.

Check with your Medicare Advantage plan administrator to find out the specific benefits your plan offers and to see if your plan provides additional benefits above what Original Medicare will cover.

Medicare will typically cover Keytruda (pembrolizumab) or Opdivo (nivolumab) for cancer immunotherapy treatment if the medications are deemed medically necessary. Medicare may require that your doctor confirm the necessity of the treatment.

If your doctor prescribes a higher dose than the FDA recommends, Medicare may decline coverage of these treatments.

Both medications are expensive, and you will still be responsible for your Medicare Part B deductible plus 20% of the Medicare-approved costs for the drugs.

If you have Original Medicare and no Medigap coverage, your out-of-pocket costs after you reach your deductible could range from $1,000 to $1,950 for each Keytruda infusion, according to Merck & Co., the manufacturer of Keytruda.

A Medigap policy or Medicare Advantage plan may substantially reduce your out-of-pocket costs according to Merck. The company claims 41% of patients with Medicare Advantage plans had no out-of-pocket expenses for an infusion.

Since coverage for Medigap and Medicare Advantage plans vary depending on your plan and where you live, you should check with your plan administrator to determine exactly what your financial responsibility will be for Keytruda infusions.

Depending on the type and amount of Medicare coverage you have, you can expect to spend anywhere from zero dollars to as much as $2,670 per Opdivo infusion, according to Bristol-Myers Squibb Co., the manufacturer of Opdivo.

Bristol-Myers claims that more than 60% of patients paid $25 or less for each infusion in 2019.

Medigap and Medicare Advantage plans can greatly reduce your out-of-pocket costs. Check with your plan administrator about what your responsibility will be for your plan.