Chemotherapy costs can vary significantly depending on factors such as your cancer diagnosis, supportive care, and the type of chemotherapy being used.
After a cancer diagnosis, your doctor may recommend chemotherapy, which is often referred to as “chemo.” “Chemotherapy” is a broad term for chemical agents used to treat cancer and other conditions. Chemotherapy medications affect cellular processes in your body, destroying cancer cells or preventing their growth and spread.
Chemo is standard practice for many types of cancer, but the costs vary as much as the conditions chemo is used to treat.
If your doctor has recommended chemotherapy, you may wonder what your out-of-pocket costs will be, what your health insurance will cover, and what indirect expenses (such as time off from work) you might need to account for.
Read one to learn the basics of chemotherapy costs, what you need to know about insurance coverage, and how to find resources if you need help affording care.
Chemotherapy costs in cancer care depend on many factors, including:
- your cancer diagnosis
- the type of chemotherapy
- the length of your treatment
- supportive care
A
Infusion and injectable drugs given in care settings can cost more because they require a train professional to administer the drugs and a visit to your oncology clinic. Research based on data from 2011 found that at that time, costs for these medications already ranged from
And the costs are rising, according to the American Cancer Society (ACS). By the year 2030, cancer care costs are expected to increase by 34% compared to the costs in 2015.
Even with insurance, the cost of chemotherapy can be substantial. Medicare provides coverage for chemotherapy but may still require you to cover up to 20% of costs after your deductible, depending on which insurance plan you qualify for.
Keep in mind that out-of-pocket costs differ from the overall cost and depend on the coverage your insurance offers. For example, if you are covered through Medicare, cancer treatments received in a clinical setting are usually covered as a part of hospital insurance (Medicare Part B), but oral medications are covered under prescription drug benefits (Medicare Part D).
Other expenses associated with chemotherapy
The cost of your chemotherapy medication is not the only cost linked to chemotherapy treatment. You’ll also be billed for any chemo-related services and supportive therapies, such as:
- doctor visits and hospital stays
- transportation to and from appointments
- laboratory tests
- diagnostic imaging
- homecare equipment and nursing
- supportive medications (pain relievers, anti-nausea medications, etc.)
- mental health and other specialist services
- rehabilitation and palliative care
If you have to travel, there may be vehicle or flight expenses and hotel costs. You may need to take unpaid time off from work. Arranging child care, house sitting, and pet sitting can also add to your overall expenses.
Chemotherapy for cancer can be demanding of both your time and your health. There may be times when you need to travel for care or can’t return to work because of the toll chemotherapy takes on your overall health.
In the United States, you have certain rights in the workplace if you have a cancer diagnosis. The Americans with Disabilities Act (ADA) protects you from discrimination and unlawful termination due to a medical condition.
If you work for a company with 15 or more employees, the ADA also requires your employer to provide accommodations for certain conditions, including cancer.
Possible accommodations covered under the ADA include:
- periodic breaks to rest
- private areas to take medication
- work-from-home approval
- reassignment of some responsibilities to other employees
To learn more about your rights in the workplace, you can visit ADA.gov or call 1-800-514-0301.
The Family and Medical Leave Act (FMLA)
When you need to take time off for chemotherapy care, the FMLA can protect your employment status, though it does not guarantee pay during your absence. Under the FMLA, you can take up to 12 weeks of unpaid leave for a medical condition in each 12-month period.
You’re eligible for FMLA coverage if you work for an employer that has at least 50 employees within 75 miles of one another and you’ve worked for that employer for at least 12 months and for a minimum of 1,250 hours within that time.
You can learn more about the FMLA by visiting the U.S. Department of Labor website.
Other options when you need time off from work
Depending on your place of employment, you may have other options available if you need time off for chemotherapy.
Paid time off (PTO) options include:
- vacation time
- sick leave
- personal days
If you’re unable to use your PTO when you need to or don’t have enough available, discuss your options with your employer. Some companies offer employee assistance programs, which provide access to some wellness-focused services.
You may also be able to negotiate work-from-home hours or a new schedule.
In the event that you have to take unpaid time off, be aware that many employers have limits on how much you can take and how often. Even with certain government protections in place, there are some situations where your job may be in jeopardy.
When you can’t stay employed
If it’s not possible to stay employed during chemotherapy, you may still have access to some income through Social Security Disability Insurance (SSDI). SSDI provides financial assistance if you’re unable to work as a result of certain cancer diagnoses.
You can apply for SSDI online or by calling 1-800-772-1213 to make an appointment at your local office.
Health insurance coverage matters when it comes to paying for chemotherapy. Different plans offer different coverage and out-of-pocket costs.
Most plans, whether through a private company or a government agency, consist of the following coverage basics:
- Premium: the amount of money you pay biweekly, monthly, or yearly to have health insurance coverage
- Deductible: the amount you must pay out of pocket before your insurance plan will start to cover costs
- Copayment: a set amount of money you pay out of pocket for a specific service, usually due at the time that service is performed
- Coinsurance: an out-of-pocket percentage you owe for healthcare service before your carrier covers the rest of the costs
- Out-of-pocket maximum: the most you’ll be required to pay out of pocket each year, with your insurance picking up 100% of costs after the maximum is met
The percentages and costs for these categories will depend on the insurance carrier. For example, you might not have a copayment for regular doctor care, but someone with a different plan might pay $20 for each visit.
The type of insurance you have also affects your chemotherapy cost coverage. Some insurance plans, such as health maintenance organizations (HMOs), will cover costs only if you receive chemotherapy services from a provider who is contracted with the HMO.
This is known as staying “within your network.”
Other plans cover costs for out-of-network doctors too. Preferred provider organizations (PPOs), for example, offer a discount if you stay in-network but will still cover costs for out-of-network care (at an additional fee).
You might also consider a savings-type plan such as a health savings account (HSA), which allows you to set money aside for medical expenses in a special bank account. While programs such as HSAs don’t have in-network requirements, they tend to have high deductibles and can only give you access to money you’ve placed in the account.
For many people, this amount is far less than the cost of several months of cancer treatment.
Reviewing all these insurance details can help you determine whether your health insurance offers the best coverage for chemotherapy. As a general rule, you can make the most of your health insurance coverage by:
- fully understanding your plan and out-of-pocket costs
- staying within your network
- requesting generic medications when possible
- taking time to compare prices for tests, procedures, and prescriptions
- requesting telehealth for routine checkups, which may be less costly
Medicare
Medicare, a federal health insurance program that serves people over 65 years old and those with certain medical conditions, also offers multiple types of health coverage.
Original Medicare — which consists of Parts A, B, and D — offers basic coverage for in-hospital care (Part A), outpatient services (Part B), and prescription coverage (Part D).
Medicare Advantage Plans are also available. These advanced insurance options include plans structured as HMOs, PPOs, and other frameworks but offer additional benefits such as wellness packages.
To qualify for Medicare, you must meet certain age and health criteria, which are outlined in the Medicare & You 2024 handbook.
Medicaid
Medicaid is a joint state and federal program that provides health insurance coverage to certain low income families. Medicaid coverage varies by state, and you must meet income eligibility requirements.
You can apply for Medicaid by visiting Medicaid.gov and selecting the state you live in or by visiting the federal Marketplace website and selecting your state of residence there.
The Health Insurance Marketplace
The Health Insurance Marketplace, often referred to as the “Marketplace,” was established under the Affordable Care Act as an affordable health insurance resource for U.S. citizens and nationals.
Marketplace plans are similar to plans from private carriers but are streamlined to help make insurance more transparent and accessible. All Marketplace plans cover 10 essential benefits:
- outpatient care
- emergency services
- hospitalization
- pregnancy, maternity, and newborn care
- mental health and substance use services
- prescription drugs
- rehabilitative and habilitative services (physical therapy, occupational therapy, etc.)
- laboratory services
- preventive and wellness services
- pediatric services
Chemotherapy care may involve many of those benefits, but chemotherapy coverage will vary depending on the Marketplace plan you select. You can review Marketplace options by visiting Healthcare.gov.
What is the average out-of-pocket cost for chemotherapy?
The amount you’re required to pay out of pocket for chemotherapy varies widely depending on your cancer diagnosis and treatment plan. Research from 2019 found that the average out-of-pocket cost for cancer drugs on Medicare Part D was $8,000 per year.
However, ACS case studies show that out-of-pocket costs can be upwards of $30,000 per year for some people.
What’s the best way to cut chemotherapy costs?
Cutting costs in cancer treatment isn’t always possible, but you may be able to save on expenses by:
- requesting generic or biosimilar medications
- doing telehealth when possible
- comparing doctor-administered chemo options with oral prescriptions
- participating in a clinical trial
Who can you contact if you need help paying for chemo?
Your doctor’s office may be able to direct you to local organizations for help with chemo costs, but the following resources can also provide guidance:
- Medicine Assistance Tool is a search engine that can help you find financial assistance resources for specific chemotherapy medications.
- CancerCare Financial and Co-Pay Assistance offers several financial assistance options for cancer-related costs.
- The Children’s Leukemia Research Association offers limited funds and a matching donation program to help with the costs of certain cancer treatments.
Managing the costs of chemotherapy can be challenging. Not only will overall expenses vary significantly depending on your diagnosis and treatment plan, but there may be indirect costs associated with time off, travel, or supportive care.
Understanding how your insurance works, what options are available to you, and what rights you have when it comes to chemotherapy can help you prepare. If you need help paying for cancer treatment, several government programs and advocacy agencies offer options.
