Different parts of Medicare can provide coverage for cancer treatments, including Opdivo. The coverage will depend on various factors, such as the phase of treatment and where a person receives treatment.

Cancer is a common condition that affects millions of people in the United States. Generally, the risk of cancer increases as people age, as most new cases of cancer occur in older adults. However, survival rates may be improving due to advances in screening and treatments.

Cancer treatment can be expensive, but Medicare can help cover certain expenses. Opdivo is an immunotherapy treatment for skin cancer, lung cancer, and certain resistant cancers. Typically, Medicare will cover the cost of cancer treatment with Opdivo.

This article discusses Opdivo and Medicare coverage. It also looks at associated costs and financial assistance options.

Glossary of Medicare terms

  • Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
  • Premium: This is the amount of money someone pays each month for Medicare coverage.
  • Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
  • Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
  • Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
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Opdivo is a medication that doctors prescribe for cancer treatment. It is a type of immunotherapy. This is a type of cancer treatment that changes how the immune system works, redirecting it to attack cancer cells.

People may receive Opdivo alone or combined with another medication called Yervoy and chemotherapy.

Slow intravenous infusions of Opdivo are a first-line treatment for people with melanoma that has spread to other parts of the body. Doctors may also prescribe Opdivo when the melanoma is not suitable for surgical removal.

Additionally, doctors may prescribe Opdivo for the following conditions:

Treatment regimens depend on a person’s specific circumstances. For example, for metastatic melanoma, the dosage is 240 milligrams (mg) of Opdivo every 2 weeks or 480 mg every 4 weeks. In an outpatient setting, a person will receive these doses as intravenous infusions over 30 minutes.

Medicare is a federal government health insurance program. It helps people ages 65 years and over pay their healthcare costs. Medicare also serves some younger people with certain disabilities or chronic health conditions.

Medicare has four parts:

  • Part A covers inpatient care in a hospital, clinic, or skilled nursing facility.
  • Part B covers outpatient medical care.
  • Part C, or Medicare Advantage, combines the benefits of Original Medicare (parts A and B), and it may also include Part D.
  • Part D is a stand-alone prescription drug plan for individuals enrolled in Original Medicare.

Medicare Advantage plan details

Qualified individuals can choose to receive health benefits from either Original Medicare (parts A and B) or a Medicare Advantage plan, which private insurance companies offer.

Medicare Advantage plans may include additional benefits, such as fitness, dental, hearing, and vision care.

Unlike Original Medicare, Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. This means the plan limits the amount that someone needs to spend on healthcare. In 2025, the in-network MOOP limit is $9,350. However, certain plans may set lower limits.

Common types of Medicare Advantage plans include the following:

  • Health Maintenance Organization (HMO) plans use provider networks, and people must select a primary care physician to coordinate care and issue specialists’ referrals.
  • HMO Point-of-Service plans allow members to use out-of-network providers at higher costs.
  • Preferred Provider Organization plans use provider networks, but members do not need to select a primary care physician or request specialist referrals.
  • Private Fee-for-Service plans set a specified amount that members pay for care.
  • Special Needs Plans help people with certain health conditions, disabilities, or income restraints.

This online plan finder tool can help people find and compare Medicare Advantage plans in their location.

Different parts of Medicare cover cancer treatments. However, a person will still be responsible for some of the cost, and an individual’s total out-of-pocket expenses will vary.

People may receive Opdivo treatment as an inpatient or an outpatient. Medicare’s coverage of Opdivo depends on the phase of treatment that someone is in and where they receive it.

Both Original Medicare (parts A and B) and Medicare Advantage plans cover cancer treatments. This can include:

Part A

Medicare Part A covers cancer treatment that a person gets as an inpatient in a hospital or other facility. If someone undergoes tests or receives medications during their stay, Part A covers the cost.

Part B

Medicare Part B is medical insurance that covers outpatient cancer care, which means that it covers intravenous Opdivo infusions that a person gets as an outpatient in a health center or doctor’s clinic.

Part C

Part C, or Medicare Advantage, plans equal original Medicare coverage for cancer treatment. However, the costs involved and coverage details vary among the different plans.

Part D

Medicare Part D covers prescription drugs for medications that people take at home. Therefore, Part D does not cover Opdivo because the drug is only available through an intravenous infusion at a clinic or a hospital.

Opdivo costs depend on the treatment plan, including dosage and the number of infusions a person receives.

Bristol-Myers Squibb lists the price of Opdivo as $7,787 per 240-mg infusion, typically given every two weeks. For those receiving Opdivo 480 mg every 4 weeks, the price would be $15,574. However, the company states that most people will pay less than the list price.

Medicare

Depending on a person’s specific Medicare benefits, they may pay 0% to 20% of the medication list price. If they have Medicare Part B, they may also have a supplemental insurance plan that may pay all or part of the costs.

A person can check with their Medicare plan for more details and to understand their specific costs.

Medicaid

Medicaid is a joint federal and state program that helps low income households and other qualified individuals access healthcare. Individual states administer the Medicaid programs, and eligibility criteria may differ.

If a person gets financial help through the Medicaid program, they may pay $0 to $20 for each dose of Opdivo.

People can determine their eligibility for Medicaid or find further information about Opdivo copays by visiting the Medicaid website.

Medicare Advantage

For a person enrolled in a Medicare Advantage plan, the cost of Opdivo depends on the plan’s coverage and out-of-pocket maximum. This means how much a person pays will depend on their plan’s benefit design and level of other healthcare expenses.

With Medicare Advantage plans, a person pays the standard Part B premium of $185 each month plus an additional premium for the Medicare Advantage plan. This depends on several factors, including plan location and a person’s age.

People may have out-of-pocket expenses to pay for Opdivo treatment. However, there are some programs that may help with the costs.

Medicaid

If a person has limited income and resources, the federally funded Medicaid program may be able to help with the costs. According to data from October 2024, more than 72 million people were currently enrolled in Medicaid.

Federally qualified health centers

If a person does not have private health insurance, they can check for available assistance by asking at a federally qualified health center (FQHC). An FQHC may provide some coverage, depending on the person’s income.

Medigap

A person enrolled in Original Medicare has an option to get a Medigap plan from a private insurance company.

Medigap is supplemental insurance that may cover some out-of-pocket expenses. However, a person will have to pay the monthly Medigap premium in addition to their Original Medicare premium.

Opdivo is an immunotherapy cancer treatment that people receive as an intravenous infusion.

Because doctors usually administer Opdivo as an outpatient treatment, Medicare Part B covers 80% of the costs. Medicare beneficiaries pay 20% or less of the price after they have met the deductible.

Medicare Part D does not cover Opdivo because a doctor must administer it in a clinic or hospital setting.