Chemotherapy, or chemo, is a form of drug therapy that destroys fast-spreading cancer cells. It’s used to treat cancer and reduce symptoms like pain.
If you have a cancer diagnosis, your doctor might recommend chemo on its own or with other treatments. In either case, you’ll likely have a lot of questions, including how much chemotherapy will cost.
Understandably, navigating these costs can be overwhelming. Any feelings you have are valid.
It may help to learn about chemotherapy expenses before you begin treatment. This way, you can get a better idea of what to expect.
In this article, we’ll explore the factors that can affect the cost of chemotherapy. We’ll also provide tips for managing the costs with or without health insurance.
The cost of chemotherapy varies greatly.
A major factor is health insurance. Generally, if you have health insurance, you can expect to pay 10 to 15 percent of chemo costs out of pocket, according to CostHelper.com.
If you don’t have health insurance, you might pay between $10,000 to $200,000 or more.
The total price of chemotherapy also depends on:
- Type of cancer. The type of cancer will determine what kind of chemo treatment you need.
- Stage of disease. Typically, treating early stage cancer costs less than advanced stage cancers.
- Number of treatments. The more doses you need, the more chemo will cost.
- Duration of treatment. The length of your treatment plan is also a factor.
- Type of chemotherapy. Chemo can be taken by mouth or intravenously. It can also be injected into the skin, artery, or tumor.
- Treatment setting. Depending on the type of chemo, you may receive it at home or in a clinic, office, or hospital.
- Geographic location. Chemotherapy costs are usually higher in areas with high living costs.
- Side effects. If you experience side effects due to chemotherapy, you may need additional treatment. This can increase the overall cost of chemo.
Most health insurance providers help cover cancer treatment. However, every insurance plan is different. The best way to know what your plan includes is to speak with your insurance provider.
Insurance
Health insurance may cover the following aspects of cancer treatment:
Office visits
One of the main components of cancer treatment is frequent checkups with specialists. This includes specialists like oncologists.
In most cases, insurance providers partially cover the expense of each visit. You’ll be required to pay the remaining fee.
Depending on your plan, the fee might be a dollar amount (co-pay) or percentage (co-insurance). Your copay or coinsurance might be listed on your health insurance card.
Laboratory tests
Your doctor might perform laboratory tests, like blood or urine tests, as part of cancer treatment.
Typically, the fees for these tests are billed directly from the laboratory. Your insurance provider may cover part or all these costs.
Imaging tests
The group of healthcare professionals managing your care might use imaging tests to monitor your progress. This includes tests like:
These tests might be partially covered by health insurance.
Procedures and treatment
There are several types of cancer treatment:
- Surgery. Your insurance may provide partial coverage. If your surgeon is not in-network, your insurance plan might not cover the procedure.
- Radiation. Similarly, your insurance provider might partially cover radiation treatments.
- Drug therapy. Your provider might also help pay for drug therapy, including chemotherapy. Usually, intravenous (IV) drugs are covered under your medical plan, while pills are covered by a separate pharmacy plan.
Also, if you have to stay in the hospital, you might have to pay a fee per hospital admission or day.
Medicare
Medicare covers chemotherapy, plus other cancer treatments, according to Medicare.gov. Individuals still need to pay the annual deductible for both Part A and Part B. Medicare Part A covers costs related to a hospital inpatient stay. Medicare Part B provides coverage for treatment in outpatient settings, like an office or clinic. Medicare pays 80% of approved charges and the health consumer is responsible for the remaining 20%. Eligible Medicare beneficiaries often acquire additional ‘Medigap’ coverage with a Medicare supplement policy to reduce out-of-pocket expenses.
Financial assistance
If you don’t have health insurance, the following foundations can provide financial help:
Consider these tips to help ease the stress of managing chemo costs:
- Choose in-network providers. When possible, visit in-network providers. Your health insurance may not cover visits out-of-network.
- Plan for out-of-network visits. If you prefer or need out-of-network care, call your insurance provider first to determine if these services can be covered.
- Get a full list of treatment needs. Ask your healthcare team for a list of proposed treatments. Call your insurance provider to see what’s covered.
- Call pharmacies in advance. If you’re taking drugs for side effects, shop around and call different pharmacies to find the best price.
- Explore alternatives. Ask your doctor if there are substitutions for your treatments that insurance is more likely to cover.
- Check if you need pre-approval. Some treatments need to be pre-approved or precertified by your health insurance. If you start them without pre-approval, you might need to pay the full cost.
- Check coverage for emergency care. Ask your provider what forms of emergency care they cover. This way, you’ll have an idea of what to expect if you need emergency services.
- Pay your health insurance premiums. Though it may be difficult to pay monthly fees, it’s important to avoid a lapse in health insurance. Paying your monthly premiums on time will ensure you always have insurance.
- Keep track of bills. Ask a trusted relative or friend to organize your bills, receipts, and insurance claims. This will help you manage money and resolve any future issues.
- Work with a counselor. A social worker or hospital financial counselor can help establish special payment plans with your treatment center.
- Seek financial assistance. Foundations like Cancer Financial Assistance Coalition, Patient Access Network Foundation,and Patient Advocate Foundation offer financial help for cancer treatment costs.
Coping with cancer can be difficult, but you don’t need to do it alone. There are many programs that provide support and care for people with cancer. These groups can connect you to other individuals with similar experiences.
You may be able to find cancer support groups at your local hospital or online. You can also search for programs in your area on the following websites:
The exact cost of chemotherapy is different for each person. It depends on many factors, including the stage of your disease, number of treatments, and the form of chemotherapy. In most cases, health insurance will partially cover these expenses.
If you have questions, don’t hesitate to contact your healthcare team and insurance provider. The more you communicate your concerns and needs, the easier it will be to navigate the costs.
If you need financial help, consider working with a hospital financial counselor or financial assistance programs.