4 days ago
Does Medicare Cover BCG Treatment for Bladder Cancer?
BCG is an immunotherapy treatment. Medicare may cover BCG when medically necessary to treat certain types of bladder cancer or after a transurethral resection of bladder tumor (TURBT).
Bacillus Calmette-Guerin (BCG) is the standard immunotherapy drug for bladder cancer. Immunotherapy uses your own immune system to attack cancer cells. With BCG, the doctor inserts a catheter into your bladder to deposit a drug made from a weakened strain of Mycobacterium bovis, a vaccine for tuberculosis.
Original Medicare (parts A and B) covers approved treatments and services for bladder cancer that your healthcare team deems medically necessary, which can include BCG.
Read on to learn about when Medicare might cover BCG, your eligibility for coverage, and your anticipated costs.
Are you eligible for BCG treatment for bladder cancer with Medicare?
Doctors tend to recommend BCG treatment for carcinoma in situ and non-muscle invasive bladder cancer, which includes noninvasive (stage 0) and minimally invasive (stage 1) bladder cancers.
They also typically would suggest it after you've received a procedure known as transurethral resection of bladder tumor (TURBT) to reduce your chance of the cancer returning.
Generally, Original Medicare should approve BCG if you need it under these circumstances. Part A will cover it while you're hospitalized, whereas Part B will cover it if you get the treatment as an outpatient. If you're enrolled in Medicare Advantage (Part C), you should receive the same coverage.
Is Anktiva covered by Medicare?
The U.S. Food and Drug Administration (FDA) has approved the drug Anktiva for use alongside BCG treatment. Like BCG, Anktiva is administered into the bladder. Medicare Part A and B may cover Anktiva if medically necessary, with covered BCG treatment.
Note that Parts A and B should cover the drug itself and not just the catheter administration procedure. This is because you cannot administer the medication to yourself, in which case it would fall under the coverage of Medicare Part D.
That said, currently there is a shortage of the BCG drug. For this reason, according to the Centers for Medicare & Medicaid Services (CMS), Medicare may approve your treatment at a dose less than the usual dose of 81 milligrams (mg) or 1 vial per session.
How much does BCG treatment for bladder cancer cost?
A 2021 study analyzed the administration of BCG therapy within the Veterans Affairs Health System between 2000 and 2015. After one year, the median cost was around $29,459, increasing to $55,267 by two years, and reaching $117,361 at five years.
That said, your share of this cost after your Medicare coverage kicks in depends on the part of Medicare responsible for your coverage. Under Part B, after you've met the 2025 deductible of $257, Part B will pay for 80% of any covered treatment or service. You also have to pay a monthly premium, which starts at $185, depending on your income.
Under Part A, in most cases, you don't have a premium, though you must meet a $1,676 deductible. Once you do, Part A will cover your treatment fully for the first 60 days of hospitalization. After that, you begin to incur a daily cost that increases over time until you become responsible for the full, remaining cost.
If you're covered by Part C, your plan is managed by a private insurer, which means your premium, deductible, and coinsurance depend on your plan. According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025.
In addition, to remain enrolled in a Part C plan, you still have to pay the Part B premium. That said, some Part C may cover your Part B premium.
Where can you get help with the cost of BCG treatment for bladder cancer?
Several factors affect the cost of treating bladder cancer, including:
how aggressive the cancer is
the stage at which it was diagnosed
the treatment prescribed by your doctor
Managing your medical expenses starts with ensuring that your doctor accepts your Original Medicare or Part C plan.
If you're enrolled in Original Medicare, you can also consider enrolling in a Medicare supplement plan (Medigap) to help with out-of-pocket costs, such as copayments and deductibles.
You can choose from 10 different plans, depending on factors like your location and coverage needs. However, you cannot use Medigap with Medicare Advantage (Part C) plans.
You may also wish to check if you qualify for a Medicare Savings Program (MSP) and Extra Help, and if you might dually qualify for Medicare and Medicaid. Outside of Medicare, you may wish to check non-profit financial assistance programs.
What other treatments does Medicare cover for bladder cancer?
Medicare Part A covers inpatient hospital stays, including cancer treatments and diagnostics you receive as an inpatient. Part A also offers:
some coverage for care at home, such as skilled nursing and physical therapy
limited coverage for care in a skilled nursing facility after 3 days in the hospital
care in a hospice
In the case of medically necessary outpatient treatments and services to treat bladder cancer, Medicare Part B covers:
visits with your doctor (including oncologists and other specialists)
diagnostic testing (lab tests, ultrasound, etc.)
many chemotherapy drugs administered through an IV at your doctor's office or a clinic
some chemotherapy drugs administered orally
outpatient clinic radiation treatments
durable medical equipment, such as feeder pumps and wheelchairs
Any treatment drugs you can take yourself would fall under Part D coverage. That said, Medicare may not cover every medication. Always confirm coverage and expected costs before receiving treatment. If Medicare doesn't cover the treatment you need, discuss payment plans or other options with your doctor.
Takeaway
Medicare covers treatment and services for bladder cancer; however, you may still have significant out-of-pocket costs depending on factors like recommended treatment or the stage of your cancer.
You can work with your doctor to develop a treatment plan that maximizes your Medicare coverage.
If you have additional coverage, such as a Medicare Part D (prescription drug) plan or a Medigap (Medicare supplement) plan, many of your out-of-pocket costs will be covered.
