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Does Medicare Advantage Cover Immunotherapy for Cancer?

By Zawn Villines
Medicare Advantage plans cover immunotherapy for cancer, but the specific drugs available vary from plan to plan.

Immunotherapy supports the body’s immune system when fighting cancer, according to the National Cancer Institute. It's a biological therapy that uses materials made from living organisms to address cancer. The right immunotherapy for you depends on the type of cancer that you have, since different treatments vary in their effectiveness. But does Medicare cover immunotherapy for cancer? This depends on the coverage that you have, the type of cancer that you have, and the specific immunotherapy that your doctor recommends. 

When It Comes to Cancer, What Does Medicare Advantage Cover? 

Medicare Advantage plans must cover the same clinical and hospital services that Original Medicare covers. According to the Centers for Medicare and Medicaid Services, this includes some oral and intravenous chemotherapy treatments, outpatient radiation treatment, and the costs of some inpatient clinical trials. Medicare Advantage plans also offer private health insurance that may cover additional services, such as coverage for immunotherapy drugs. 

It’s important to note that the coverage for specific immunotherapy drugs varies between Medicare Advantage plans. So if you’re enrolling in a new plan, you’ll need to check the plan’s guidelines for coverage. For example, a United Healthcare Medicare Advantage plan covers many different types of immunotherapy, but only if the drug is approved by the Food and Drug Administration (FDA).

Some doctors also use off-label immunotherapy based on early clinical trial results or evidence of a drug’s effectiveness in treating other types of cancer. Off-label use means that the FDA has not approved the drug for the specific use that the doctor recommends. Not all plans cover these uses. 

United Healthcare, for example, only covers off-label use for drugs that have peer-reviewed data supporting their use on an off-label basis. You and your doctor may need to get advanced approval for off-label use, and supply particular documentation or peer-reviewed literature that supports the specific off-label use your doctor is recommending. 

If you already know the drugs that you need, review the plan documents before enrolling in a new plan. You might even consider changing plans during open enrollment to maximize your coverage. 

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