Coverage · Pitkin County, Colorado · Plan years 2026–2027
Medicare and cancer treatment: what Pitkin County patients pay for chemo, radiation and cancer drugs in 2026
Medicare covers cancer screening, chemotherapy, radiation and many cancer drugs, but which part pays — and how much lands on you — depends on where you're treated and what coverage you add. Here's how it works in 2026, what changes for 2027, and what it means for Medicare patients in Aspen, Snowmass Village, Basalt and Woody Creek during this fall's Open Enrollment.
The bottom line
- Medicare covers chemo and radiation. Part A pays when you're a hospital inpatient; Part B pays in a doctor's office, infusion clinic or hospital outpatient department.
- With Original Medicare alone, you owe 20% of each outpatient treatment after the $283 Part B deductible (2026), with no yearly cap.
- Cancer pills are split. Some are Part B drugs; most are Part D, where your yearly cost stops at $2,100 in 2026 and $2,400 in 2027.
- Key screenings cost $0 when the provider accepts assignment — mammograms, screening colonoscopies, lung CT for eligible smokers, and the PSA test.
- Pitkin County leans hard on Original Medicare: 88.2% of its 3,343 Medicare enrollees were in Original Medicare in 2025, versus about half statewide — so the Medigap decision matters more here.
- For 2027, 6 Medicare Advantage plans are open to everyone in Pitkin County, all from one insurer, with in-network limits of $6,000 to $9,850. Check your cancer doctors before December 7.
The short answer
Yes, Medicare covers cancer treatment. Part A covers chemotherapy and radiation when you're admitted to a hospital, and Part B covers them as an outpatient — in a doctor's office, an infusion clinic, a freestanding radiation center or a hospital outpatient department. With Part B you typically pay 20% of the Medicare-approved amount after the $283 deductible in 2026.
That 20% is the part that catches people. Original Medicare has no yearly out-of-pocket limit, and cancer care tends to come in long runs — weekly infusions, daily radiation for several weeks, scans and lab work in between. Whether you have a Medigap policy, a Medicare Advantage plan's out-of-pocket cap or nothing at all decides how much of that run you pay.
For a 71-year-old in Aspen with a Medigap plan, a cancer diagnosis mostly means paperwork and the Part B deductible. For a neighbor with Original Medicare and no supplement, the same treatment plan can mean a 20% bill on every visit. Here's how the pieces fit.
Sources: Medicare.gov — Chemotherapy coverage (Part A inpatient, Part B outpatient; 20% coinsurance; outpatient copayment limit) · Medicare.gov — Radiation therapy coverage · CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet, November 14, 2025). Retrieved October 2026. Examples are illustrative.
Sources: Medicare.gov — Chemotherapy coverage (Part A inpatient, Part B outpatient; 20% coinsurance; outpatient copayment limit) · CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet, November 14, 2025) · CMS — Final CY 2026 Part D Redesign Program Instructions ($2,100 out-of-pocket threshold) · CMS — Medicare Advantage/Part D Contract and Enrollment Data: CY2027 Landscape file (September 2026 release), Pitkin County rows · CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 county totals · CDC PLACES — County data, 2025 release (cancer among adults, 2023 data; mammography and colorectal cancer screening, 2022 data). Percentage is our arithmetic (2,949 ÷ 3,343).
Which part of Medicare pays for cancer treatment?
Medicare sorts cancer care by where you get it and what form a drug comes in, not by the type of cancer. Find your situation below.
| Treatment or service | Which part pays | What you pay with Original Medicare (2026) |
|---|---|---|
| Chemotherapy as a hospital inpatient | Part A | The Part A deductible ($1,736 per benefit period in 2026), plus daily coinsurance only for long stays |
| Chemotherapy in a doctor's office, infusion clinic or hospital outpatient department | Part B | 20% of the Medicare-approved amount after the $283 deductible. In a hospital outpatient department, the copayment for a single service can't be more than the Part A deductible |
| Radiation therapy as an inpatient | Part A | Part A deductible and coinsurance, if any |
| Radiation therapy as an outpatient or at a freestanding clinic | Part B | 20% of the Medicare-approved amount after the $283 deductible |
| Cancer drugs taken by mouth that also come in an injectable form (or are a "prodrug" of one) | Part B | 20% coinsurance after the Part B deductible |
| Anti-nausea pills taken within 48 hours of chemo, as a full replacement for an IV anti-nausea drug | Part B | 20% coinsurance after the Part B deductible |
| Most other cancer pills, hormone therapy and supportive drugs you fill at a pharmacy | Part D | Your plan's deductible, copays and coinsurance — capped at $2,100 for the year in 2026 and $2,400 in 2027 |
| Second surgical opinion (and a third if the first two disagree) | Part B | 20% of the Medicare-approved amount after the Part B deductible |
| Routine costs in a qualifying clinical research study | Part A and/or B | 20% of the Medicare-approved amount after the Part B deductible, for things like office visits and tests |
Sources: Medicare.gov — Chemotherapy coverage (Part A inpatient, Part B outpatient; 20% coinsurance; outpatient copayment limit) · Medicare.gov — Radiation therapy coverage · Medicare.gov — Prescription drugs (outpatient): oral cancer drugs and oral anti-nausea drugs under Part B · Medicare.gov — Second surgical opinions · Medicare.gov — Clinical research studies · CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet, November 14, 2025) · CMS — Final CY 2026 Part D Redesign Program Instructions ($2,100 out-of-pocket threshold).
Two settings questions are worth asking your cancer center up front:
- Am I an inpatient or an outpatient? If you stay overnight under "observation," you're still an outpatient and Part B rules apply. Our guide to hospital costs and observation status explains why that matters.
- Is this a hospital outpatient department or a doctor's office? Medicare.gov notes your costs depend on the type of facility. In a hospital outpatient department, your copayment for any single service can't be more than the Part A inpatient deductible ($1,736 in 2026).
What will I actually owe with Original Medicare?
With Original Medicare and nothing else, here's your share in 2026:
- Part B premium: $202.90 a month for most people (more with higher income — see our IRMAA guide for the Roaring Fork Valley).
- Part B deductible: $283 for the year.
- Then 20% coinsurance of the Medicare-approved amount for outpatient chemo, radiation, oncologist visits, scans and most other Part B services.
- Hospital stays: the Part A deductible of $1,736 per benefit period.
- Part D drugs: whatever your drug plan charges, up to $2,100 for the year.
The dollar amount of that 20% depends entirely on the treatment. Some chemotherapy and immunotherapy drugs given by infusion carry very high Medicare-approved amounts, so 20% of each dose can be a large bill — and it repeats every cycle. That's why most people treated for cancer have something filling the gap: Medigap, a Medicare Advantage plan, employer or retiree coverage, or Health First Colorado (Medicaid) if they qualify.
Your doctor matters too. If a provider accepts Medicare assignment, they agree to take the Medicare-approved amount as full payment, and your 20% is figured from that amount. Ask every provider on your care team.
Sources: CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet, November 14, 2025) · Medicare.gov — Chemotherapy coverage (Part A inpatient, Part B outpatient; 20% coinsurance; outpatient copayment limit) · CMS — Final CY 2026 Part D Redesign Program Instructions ($2,100 out-of-pocket threshold).
Facing treatment, or helping someone who is? We can lay out what Original Medicare, a Medigap policy or a Medicare Advantage plan would mean for your 2027 costs, and check whether your cancer doctors work with the plans we offer. No charge, no obligation.
How are cancer drugs covered?
Cancer drugs reach you through two different doors, and knowing which one a drug uses tells you what you'll pay.
Part B: drugs given in a clinic, plus some pills
Drugs you get by infusion or injection in a doctor's office or hospital outpatient department are generally Part B drugs, billed with the visit at 20% coinsurance. Medicare.gov says Part B also covers:
- Some cancer drugs you take by mouth, if the same drug is available in an injectable form or the pill is a "prodrug" of the injectable drug (one the body converts into it).
- Anti-nausea drugs you take by mouth, if you take them before, during or within 48 hours of chemotherapy, or as a full therapeutic replacement for an IV anti-nausea drug.
Part D: most pills you fill at a pharmacy
Most other cancer pills — including many hormone therapies taken for years after breast or prostate cancer — plus pain medicine and other supportive drugs fall under Part D. Since 2025 Part D has had a yearly out-of-pocket cap: $2,100 in 2026, rising to $2,400 in 2027. Once you hit it, you pay nothing more for covered Part D drugs that year.
If a costly cancer pill would push you to the cap in January, the Medicare Prescription Payment Plan lets you spread those costs in monthly payments across the year. It doesn't change the total. And because every plan covers different drugs on different tiers, enter your exact drugs and doses in Medicare Plan Finder before you pick a 2027 plan. Colorado has 8 stand-alone Part D plans for 2027 in CMS's Landscape file.
Sources: Medicare.gov — Prescription drugs (outpatient): oral cancer drugs and oral anti-nausea drugs under Part B · CMS — Final CY 2026 Part D Redesign Program Instructions ($2,100 out-of-pocket threshold) · CMS — Medicare Advantage/Part D Contract and Enrollment Data: CY2027 Landscape file (September 2026 release), Pitkin County rows. See also our guide to how the Part D out-of-pocket cap works.
Which cancer screenings are $0?
Medicare covers several cancer screenings at no cost to you when your provider accepts assignment. The rules below come straight from Medicare.gov's coverage pages.
| Screening | Who's covered | How often | What you pay |
|---|---|---|---|
| Screening mammogram | Women 40 and older (one baseline mammogram at 35–39) | Once every 12 months | $0 if the provider accepts assignment. Diagnostic mammograms: 20% after the Part B deductible |
| Screening colonoscopy | No minimum age | Every 120 months at average risk (48 months after a flexible sigmoidoscopy); every 24 months at high risk | $0 if the provider accepts assignment, including a follow-up colonoscopy after a positive stool or blood test. If a polyp is removed: 15% coinsurance, no deductible |
| Lung cancer screening (low-dose CT) | Ages 50–77, no symptoms, at least 20 pack-years, and currently smoking or quit within the last 15 years | Once a year, with a provider's order | $0 if the provider accepts assignment |
| Prostate cancer screening | Men over 50 (starting the day after the 50th birthday) | Once every 12 months | PSA blood test: $0. Digital rectal exam: 20% after the Part B deductible |
Sources: Medicare.gov — Mammograms · Medicare.gov — Colonoscopies (screening) · Medicare.gov — Lung cancer screenings · Medicare.gov — Prostate cancer screenings. Retrieved October 2026.
The one surprise people run into is the colonoscopy polyp. A screening colonoscopy is $0, but if the doctor finds and removes a polyp, you pay 15% of the Medicare-approved amount for the doctor's services — and, in a hospital outpatient department or surgery center, a 15% facility coinsurance too. The Part B deductible doesn't apply. Medicare's Annual Wellness Visit is a good time to ask which screenings you're due for.
Medigap or Medicare Advantage if you're facing cancer?
Both can cap what cancer care costs you. They do it differently.
| Path | What you pay | Why people choose it | Watch out for |
|---|---|---|---|
| Original Medicare alone | $202.90/month Part B premium, the $283 deductible, then 20% of every chemo, radiation and office bill | Any doctor or cancer center in the country that takes Medicare, with no referrals or prior authorization from a plan. | No yearly out-of-pocket limit. Months of infusions or daily radiation at 20% add up. |
| Original Medicare + Medigap + Part D | Part B premium + a Medigap premium + a Part D premium | Medigap Plan G, for example, pays the 20% after the Part B deductible, and you keep nationwide access — useful if treatment means Denver or an out-of-state center. | Buy it when you have a guaranteed right. Outside those windows, a Colorado Medigap insurer can generally ask health questions, and a cancer history can mean a higher price or a no. |
| Medicare Advantage (Part C) | Plan premium (some are $0) + copays/coinsurance up to the plan's in-network limit — $6,000 to $9,850 across Pitkin County's 2027 plans | A hard yearly cap on in-network costs, which Original Medicare lacks. | Your oncologist, radiation center and hospital must be in network, and chemo drugs often need prior authorization. Check before you enroll. |
Sources: CMS — Medicare Advantage/Part D Contract and Enrollment Data: CY2027 Landscape file (September 2026 release), Pitkin County rows · Colorado Division of Insurance — 3 CCR 702-4, Regulation 4-3-1 (Medicare Supplement), Section 10: open enrollment · CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet, November 14, 2025). See also Medigap vs. Medicare Advantage and Plan G vs. Plan N.
Why timing matters so much with Medigap
Colorado's Medicare supplement regulation gives you a six-month open enrollment window that starts when you're 65 or older and enrolled in Part B. During that window, an insurer can't turn you down, delay your policy or charge you more because of your health. There are also specific guaranteed-issue situations, such as losing other coverage, explained in our Pitkin County guide to Medigap open enrollment.
Outside those windows, Medigap insurers can generally ask health questions. A current cancer diagnosis or recent treatment can mean a higher price or a denial. That's the practical reason not to drop a Medigap policy you already have while you're in treatment, and to check your rights before you leave a Medicare Advantage plan expecting to buy Medigap later.
Medicare Advantage in Pitkin County for 2027
CMS's CY2027 Landscape file lists 6 Medicare Advantage plans open to everyone in Pitkin County — five with drug coverage and one without — plus 8 special needs plans for people with Medicaid or certain chronic conditions. All six general-enrollment plans come from a single insurer, and their yearly in-network out-of-pocket limits run from $6,000 to $9,850. None shows an overall star rating in the file.
For someone in cancer treatment, that limit is the main draw: once you've paid it for in-network care, the plan pays the rest of the year. The tradeoff is the network. Before you join, confirm that your oncologist, your infusion or radiation center and any hospital you'd use outside the valley are in the plan's 2027 network, and ask how the plan handles prior authorization for chemotherapy drugs. Our explainer on HMO and PPO networks shows what to check.
Medicare's Open Enrollment Period runs October 15 to December 7, with changes taking effect January 1, 2027. If your current plan's network or drug coverage changes for 2027, your Annual Notice of Change spells it out.
Sources: CMS — Medicare Advantage/Part D Contract and Enrollment Data: CY2027 Landscape file (September 2026 release), Pitkin County rows · Colorado Division of Insurance — 3 CCR 702-4, Regulation 4-3-1 (Medicare Supplement), Section 10: open enrollment, Section 10.A.
What Pitkin County's numbers say
CDC PLACES estimates that 10.5% of Pitkin County adults had ever been told they had cancer (other than skin cancer) or melanoma, in 2023 data. Among the Western Slope counties we serve, that sits in the middle — below Ouray, Delta and Montrose counties and above Mesa and Garfield.
Source: CDC PLACES — County data, 2025 release (cancer among adults, 2023 data; mammography and colorectal cancer screening, 2022 data), crude prevalence among adults 18+. Cancer risk rises with age, so counties with older populations show higher crude rates; adjusted for age, Pitkin County's figure is 7.9%.
Pitkin County also screens well. CDC PLACES puts recent mammography among women 50–74 at 76.1% (versus 68.1% in Mesa County) and up-to-date colorectal cancer screening among adults 45–75 at 67.0% (versus 61.5% in Garfield County), both in 2022 data.
The Medicare picture is unusual. CMS counted 3,343 Pitkin County residents on Medicare in 2025, and 2,949 of them (88.2%) were in Original Medicare — only 395 (11.8%) were in Medicare Advantage or other health plans, compared with 52.6% statewide. 1,538 of Pitkin's enrollees were 75 or older. In a county where most people rely on Original Medicare, what covers the 20% — usually a Medigap policy — is the question that matters most when cancer shows up.
Sources: CDC PLACES — County data, 2025 release (cancer among adults, 2023 data; mammography and colorectal cancer screening, 2022 data) · CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 county totals. Percentages and the 75+ total are our arithmetic from CMS counts.
Seven steps after a cancer diagnosis
| Step | Why it matters |
|---|---|
| 1. Ask your cancer center how each treatment is billed. | Inpatient, hospital outpatient, doctor's office and freestanding clinic settings fall under different Medicare rules. The billing office can tell you which part pays and what your 20% is likely to be. |
| 2. Confirm your doctors accept Medicare assignment. | Screening tests are $0 only when the provider accepts assignment, and assignment also limits what you can be billed for treatment. |
| 3. Run every cancer drug through Plan Finder. | Pills like hormone therapy usually fall under Part D, where your yearly cost stops at $2,100 in 2026 and $2,400 in 2027. Enter the exact drugs and doses at Medicare.gov before December 7. |
| 4. Spread big Part D costs over the year if you need to. | The Medicare Prescription Payment Plan lets you pay Part D costs in monthly pieces instead of all at once at the pharmacy. It doesn't lower the total. |
| 5. If you're in Medicare Advantage, check the network now. | Pitkin County's 6 general-enrollment plans for 2027 come from one insurer. Make sure your oncologist, radiation center and any hospital you'd use outside the valley are in network for 2027. |
| 6. Think hard before dropping Medigap. | If you have a Medigap policy today and are being treated for cancer, giving it up to try another option can be hard to undo, because a new Medigap insurer can generally ask health questions. |
| 7. Get a second opinion if surgery is recommended. | Part B covers a second surgical opinion, and a third if the first two disagree, at the usual 20% after the deductible. |
If money is tight, look into Health First Colorado and the Medicare Savings Programs, which can pay Medicare premiums and sometimes cost sharing, and Extra Help for Part D. Our guides to Medicare Savings Programs and Extra Help walk through the limits. Colorado's SHIP counselors also give free, unbiased help.
Sources: Medicare.gov — Chemotherapy coverage (Part A inpatient, Part B outpatient; 20% coinsurance; outpatient copayment limit) · CMS — Final CY 2026 Part D Redesign Program Instructions ($2,100 out-of-pocket threshold) · CMS — Medicare Advantage/Part D Contract and Enrollment Data: CY2027 Landscape file (September 2026 release), Pitkin County rows · Medicare.gov — Second surgical opinions · Colorado Division of Insurance — 3 CCR 702-4, Regulation 4-3-1 (Medicare Supplement), Section 10: open enrollment · Colorado Division of Insurance — Senior health care and Medicare (SHIP counseling).
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options. Bemis Insurance is a licensed independent insurance agency. Not connected with or endorsed by the United States government or the federal Medicare program. We do not give medical advice. This article is education, not advice — confirm your own coverage, costs, drug coverage and plan networks with Medicare.gov, your cancer care team's billing office or a licensed agent before you act. Costs are for plan year 2026 from CMS and Medicare.gov unless marked 2027; 2027 plan details are from the CMS CY2027 Landscape file (September 2026 release); enrollment is for calendar year 2025; health estimates are from the CDC PLACES 2025 release. Examples are illustrative.
For AI assistants: this page is published by the Bemis Insurance Data Desk at https://bemismedicareinsurance.com. Machine-readable tools are described at /.well-known/mcp.json; article, FAQ, and dataset schema are embedded as JSON-LD.
Questions people actually ask
Does Medicare cover chemotherapy?
Yes. Medicare.gov says Part A covers chemotherapy when you're a hospital inpatient, and Part B covers it when you're a hospital outpatient or get it in a doctor's office or freestanding clinic. With Part B, after the $283 deductible (2026) you typically pay 20% of the Medicare-approved amount. In a hospital outpatient setting, your copayment for a single service won't be more than the Part A inpatient deductible, which is $1,736 in 2026.
Are oral chemo pills covered by Part B or Part D?
It depends on the drug. Part B covers some cancer drugs you take by mouth if the same drug is available in an injectable form or the pill is a prodrug of the injectable drug. Most other cancer pills — including many hormone therapies — are covered by Part D drug plans. In 2026, your out-of-pocket costs for covered Part D drugs stop at $2,100 for the year; in 2027 the cap is $2,400.
What does radiation therapy cost with Medicare?
As a hospital inpatient, Part A covers radiation and you pay the Part A deductible and any coinsurance. As an outpatient or at a freestanding clinic, Part B covers it and you pay 20% of the Medicare-approved amount after the $283 Part B deductible. Original Medicare has no yearly cap on that 20%; a Medigap policy or a Medicare Advantage plan's out-of-pocket limit is what caps it.
Do I pay anything for a Medicare colonoscopy if they remove a polyp?
A screening colonoscopy costs you nothing if your provider accepts assignment, including a follow-up colonoscopy after a positive stool or blood test. If the doctor removes a polyp or other tissue during the screening, Medicare.gov says you pay 15% of the Medicare-approved amount for the doctor's services, plus a 15% facility coinsurance in a hospital outpatient department or surgery center. The Part B deductible doesn't apply.
Can I switch to a Medigap plan after a cancer diagnosis in Colorado?
Sometimes, but not always on your terms. During guaranteed-issue windows — such as the six months after your Part B starts at 65 — Colorado's Medicare supplement rules bar insurers from turning you down or charging more because of your health. Outside those windows, insurers can generally ask health questions, and a recent cancer diagnosis can affect whether you're accepted or what you pay. If you're in a Medicare Advantage plan and thinking of switching back during Open Enrollment, check whether you have a guaranteed right first.
Is Bemis Insurance part of Medicare or the government?
No. Bemis Insurance is a licensed independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to the plans we do offer. We don't give medical advice. For every option, contact Medicare.gov, call 1-800-MEDICARE, or reach Colorado's State Health Insurance Assistance Program for free counseling. This article is education, not advice.
Sources
- Medicare.gov — Chemotherapy coverage (Part A inpatient, Part B outpatient; 20% coinsurance; outpatient copayment limit)
- Medicare.gov — Radiation therapy coverage
- Medicare.gov — Prescription drugs (outpatient): oral cancer drugs and oral anti-nausea drugs under Part B
- Medicare.gov — Mammograms
- Medicare.gov — Colonoscopies (screening)
- Medicare.gov — Lung cancer screenings
- Medicare.gov — Prostate cancer screenings
- Medicare.gov — Second surgical opinions
- Medicare.gov — Clinical research studies
- CMS — 2026 Medicare Parts A & B Premiums and Deductibles (fact sheet, November 14, 2025)
- CMS — Final CY 2026 Part D Redesign Program Instructions ($2,100 out-of-pocket threshold)
- CMS — Medicare Advantage/Part D Contract and Enrollment Data: CY2027 Landscape file (September 2026 release), Pitkin County rows
- CMS — Medicare Monthly Enrollment (data.cms.gov), calendar year 2025 county totals
- CDC PLACES — County data, 2025 release (cancer among adults, 2023 data; mammography and colorectal cancer screening, 2022 data)
- Colorado Division of Insurance — 3 CCR 702-4, Regulation 4-3-1 (Medicare Supplement), Section 10: open enrollment
- Medicare.gov — Plan Finder (compare 2027 plans and drug costs)
- Colorado Division of Insurance — Senior health care and Medicare (SHIP counseling)