Living with cancer·Paying for care (US)·Getting the cost down

Which plans cover cancer care best

No insurer publishes a cancer-specific scorecard, so this page does the next honest thing: 11 US insurers and plan types ranked by one published metric at a time, with the year and the document behind every number and a blank wherever nothing has been published (8 rows have at least one figure). Then the rules that protect everyone in a category, published prices for cancer drugs, how NHS entitlement compares with private medical insurance in the UK, and how nine countries pay for cancer drugs.

Read this first

Not medical or financial advice. The metrics below are published for whole insurers across every condition, not for cancer care alone; a plan that denies few requests overall may still be strict with a particular drug. No composite score is used anywhere on this page. Check the linked policy page and your own plan documents, and ask the oncology practice's financial navigator before making a decision.

United States: insurers and plan types, ranked by the metric you choose

6 metrics · 11 rows

Prior authorisation figures come from CMS data on Medicare Advantage, analysed by KFF; Star Ratings from CMS; enrolment shares from KFF. Traditional Medicare has no prior authorisation for cancer drugs and no plan-level metrics, so its row carries facts rather than figures. Hover a number for its year, note and source; the last column links to each plan's published oncology or medical policies.

Ranked byLower is better; lowest first. 5 of 11 rows have a published figure.Download

Share of Medicare Advantage prior authorisation requests the insurer denied in full or in part in 2024, from CMS data analysed by KFF. Covers all services, not only cancer care. Source: KFF: Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024 (January 2026).

#	Plan or insurer	Prior authorisation denial rate	Other published figures	Oncology policy
1	Elevance Health (Anthem Blue Cross Blue Shield plans) National carrier	4.2%2024	Prior authorisation requests per member: 3.0 (2024) Share of Medicare Advantage enrolment: 7% (2025) Five-star Medicare Advantage contracts: 2 (2025)	Anthem clinical UM guidelines and medical policies
2	Humana National carrier	5.8%2024	Prior authorisation requests per member: 2.2 (2024) Share of Medicare Advantage enrolment: 18% (2025)	Humana medical coverage policies
3	Medicare Advantage (all insurers) Medicare Advantage	7.7%2024	Share of denials appealed: 11.5% (2024) Share of appeals overturned: 80.7% (2024)	Medicare.gov: Medicare Advantage plans
4	Centene (WellCare, Ambetter, state Medicaid plans) National carrier	12.3%2024	Prior authorisation requests per member: 2.9 (2024) Share of Medicare Advantage enrolment: 4% (2025)	WellCare clinical coverage guidelines
5	UnitedHealthcare (UnitedHealth Group) National carrier	12.8%2024	Prior authorisation requests per member: 1.0 (2024) Share of Medicare Advantage enrolment: 29% (2025)	UnitedHealthcare provider policies and protocols (medical, drug and Medicare Advantage policies)
	Original Medicare with Medigap Original Medicare	no published figure		CMS Medicare Coverage Database (NCDs and LCDs)
	Aetna (CVS Health) National carrier	no published figure	Share of denials appealed: 19.9% (2024) Share of Medicare Advantage enrolment: 12% (2025)	Aetna Clinical Policy Bulletins (medical and pharmacy)
	Cigna Healthcare National carrier	no published figure		Cigna coverage policies (medical and drug)
	Kaiser Permanente Integrated system	no published figure	Prior authorisation requests per member: 0.6 (2024) Share of denials appealed: 1.6% (2024) Share of appeals overturned: 51% (2024) Share of Medicare Advantage enrolment: 6% (2025)	Kaiser Permanente clinical review criteria (Washington provider manual)
	Blue Cross Blue Shield plans (independent Blues) Blue plans	no published figure	Share of Medicare Advantage enrolment: 14% (2025) Five-star Medicare Advantage contracts: 1 (2025)	Blue Cross Blue Shield Association: find your local plan's medical policies
	Medicaid (state programmes and managed-care plans) Medicaid	no published figure		Medicaid.gov: prescription drugs

Original Medicare with Medigap

People 65 and over, or with a qualifying disability, who keep Parts A and B and buy a Medigap supplement for the 20% coinsurance.

2025Part B pays 80% of the Medicare-approved amount for clinician-administered chemotherapy; the patient owes 20% with no annual cap unless a Medigap policy pays it. Medicare.gov: Chemotherapy
2025Medigap policies are standardised by letter; Plans G and N cover the Part B coinsurance in full, so the drug cost to the patient is the premium. Medicare.gov: Medigap (Medicare Supplement Insurance)
2025Any provider that accepts Medicare can be used without a network or referral, including the NCI-Designated Cancer Centers that treat patients (66 of the 74 are comprehensive or clinical centres). NCI: NCI-Designated Cancer Centers
2025Coverage rules are national coverage determinations and local coverage determinations, published for anyone to read, rather than proprietary plan policies. CMS Medicare Coverage Database (NCDs and LCDs)

CMS Medicare Coverage Database (NCDs and LCDs)

Medicare Advantage (all insurers)

The private-plan alternative to Original Medicare; more than half of eligible beneficiaries in 2025. Same benefit categories, plus networks, prior authorisation and an out-of-pocket cap.

2025About 62% of members were in contracts rated 4 stars or higher for 2025, weighted by enrolment. CMS fact sheet: 2025 Medicare Advantage and Part D Star Ratings (October 2024)
2022In a 2019 sample, 13% of prior authorisation denials and 18% of payment denials met Medicare coverage rules and would have been paid by Original Medicare. HHS Office of Inspector General, OEI-09-18-00260 (April 2022)
2025Every plan must cap in-network out-of-pocket spending for Part A and B services; CMS set the mandatory in-network limit at $9,350 for 2025. CMS: 2025 Medicare Advantage and Part D Rate Announcement (April 2024)

Medicare.gov: Medicare Advantage plans

UnitedHealthcare (UnitedHealth Group)

Largest Medicare Advantage insurer and a major employer and individual carrier; oncology criteria published as medical and drug policies.

2024The Senate PSI report found UnitedHealthcare's prior authorisation denial rate for post-acute care rose from 10.9% in 2020 to 22.7% in 2022, while its overall denial rate stayed flat. US Senate Permanent Subcommittee on Investigations, majority staff report: Refusal of Recovery (October 2024)

UnitedHealthcare provider policies and protocols (medical, drug and Medicare Advantage policies)

Humana

Second-largest Medicare Advantage insurer; little commercial business. Oncology requests are reviewed against published medical coverage policies.

2024The Senate PSI report found Humana's 2022 denial rate for long-term acute care hospital stays was about sixteen times its overall prior authorisation denial rate. US Senate Permanent Subcommittee on Investigations, majority staff report: Refusal of Recovery (October 2024)

Humana medical coverage policies

Aetna (CVS Health)

Medicare Advantage, employer and individual plans; the CVS Caremark pharmacy benefit manager sits in the same group. Oncology criteria are Clinical Policy Bulletins.

2024The Senate PSI report found CVS's 2022 prior authorisation denial rate for post-acute care was about three times its overall denial rate. US Senate Permanent Subcommittee on Investigations, majority staff report: Refusal of Recovery (October 2024)

Aetna Clinical Policy Bulletins (medical and pharmacy)

Elevance Health (Anthem Blue Cross Blue Shield plans)

Anthem-branded Blue plans in 14 states plus Medicaid and Medicare Advantage subsidiaries; oncology reviews often run through its Carelon subsidiary.

Anthem clinical UM guidelines and medical policies

Cigna Healthcare

Employer and individual plans; oncology drug criteria published as coverage policies. Not part of the Medicare Advantage analyses on this page.

Cigna coverage policies (medical and drug)

Kaiser Permanente

Insurer and delivery system in one: members are treated by Permanente Medical Group oncologists in Kaiser hospitals, so far fewer requests go through prior authorisation.

2025Kaiser Foundation Health Plan contracts are rated by NCQA each year; the report card lists each regional plan separately. NCQA Health Plan Ratings (report cards, updated each autumn)

Kaiser Permanente clinical review criteria (Washington provider manual)

Centene (WellCare, Ambetter, state Medicaid plans)

Largest Medicaid managed-care insurer and the largest Marketplace (Ambetter) insurer, plus WellCare Medicare Advantage.

WellCare clinical coverage guidelines

Blue Cross Blue Shield plans (independent Blues)

Thirty-three independent licensees (Health Care Service Corporation, Highmark, Florida Blue and others) with their own medical policies; Anthem's Blues are counted under Elevance.

Blue Cross Blue Shield Association: find your local plan's medical policies

Medicaid (state programmes and managed-care plans)

Low-income adults and children, with eligibility set by each state. Cancer drugs on the state formulary or preferred drug list; most states contract managed-care organisations.

2014Federal rules limit Medicaid premiums and cost sharing for a household to 5% of family income, with nominal copayments for most services. MACPAC: Cost sharing in Medicaid

Medicaid.gov: prescription drugs

Rules that apply to everyone in a category

Whatever plan you hold, these limits and rights apply. Each carries the year it refers to; caps change every January.

2026Marketplace and most employer plans: the annual out-of-pocket maximum for in-network care is $10,600 for one person and $21,200 for a family in 2026 (it was $9,200 and $18,400 in 2025; it rises to $12,000 and $24,000 in 2027). HealthCare.gov glossary: out-of-pocket maximum
2026Medicare Part D: out-of-pocket spending on covered drugs is capped at $2,100 in 2026 ($2,000 in 2025), under the Inflation Reduction Act of 2022; oral cancer drugs taken at home are Part D drugs. Medicare.gov: Costs for Medicare drug coverage
2025Original Medicare Part B: 20% coinsurance on clinician-administered cancer drugs with no cap; a Medigap policy or Medicaid pays it for those who have one. Medicare.gov: Chemotherapy
2025Medicare Advantage: every plan must cap in-network out-of-pocket spending on Part A and B services; the CMS mandatory limit was $9,350 for 2025. CMS: 2025 Medicare Advantage and Part D Rate Announcement (April 2024)
2026Medicare price negotiation: the first negotiated prices took effect in 2026 and include Imbruvica (ibrutinib) at $9,319 for a 30-day supply against a 2023 list price of $14,934; prices for Xtandi, Pomalyst, Ibrance and Calquence take effect in 2027. CMS fact sheet: negotiated prices for initial price applicability year 2026 (August 2024)
2023Oral chemotherapy parity: 43 states and the District of Columbia require state-regulated plans to cover oral anticancer drugs on terms no less favourable than infused drugs; self-funded employer plans are exempt, which is why the federal Cancer Drug Parity Act keeps being reintroduced. American Cancer Society Cancer Action Network: oral chemotherapy fairness
2014Medicaid: household premiums and cost sharing may not exceed 5% of family income; copayments are nominal. MACPAC: Cost sharing in Medicaid
2024Medicare Advantage denials: 13% of prior authorisation denials sampled by the HHS Inspector General met Medicare coverage rules; 80.7% of denials that were appealed in 2024 were overturned. KFF: Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024 (January 2026)

Further reading: HHS Office of Inspector General, OEI-09-18-00260 (April 2022) · US Senate Permanent Subcommittee on Investigations, majority staff report: Refusal of Recovery (October 2024) · CMS: selected drugs and negotiated prices (2026 and 2027) · NCQA Health Plan Ratings (report cards, updated each autumn) · Congress.gov: Cancer Drug Parity Act, H.R. 1730 (118th Congress) · NCI: NCI-Designated Cancer Centers.

What cancer drugs cost: published prices and how Medicare pays

4 published list prices

OnCo records a list price only where a manufacturer, CMS or a federal agency has published one with a year; there are 4 such records, shown here from highest to lowest. Net prices after rebates are usually lower and what you pay depends on the plan. For everything else, the public price files are linked below.

Product	List price	Per	Source
TisagenlecleucelKymriah	$475,000 2017	one-time treatment for paediatric/young adult B-ALL, launch list price	National Cancer Institute, Cancer Currents, September 2017 (reporting Novartis's announced price)
Axicabtagene ciloleucelYescarta	$373,000 2017	one-time treatment, launch list price	National Cancer Institute, Cancer Currents, October 2017 (reporting Kite/Gilead's announced price)
IbrutinibImbruvica	$14,934 2023	30-day supply, 2023 list price; negotiated Medicare price $9,319 from 2026	CMS fact sheet, Medicare Drug Price Negotiation Program negotiated prices for 2026
PembrolizumabKeytruda / Keytruda Qlex (SC)	$11,115 2024	200 mg dose every 3 weeks (manufacturer list price)	Merck, KEYTRUDA cost and financial support page

How the price becomes a bill

2025Part B pays for clinician-administered drugs at the average sales price plus 6%, published quarterly in the ASP pricing files; the patient's 20% coinsurance is 20% of that amount. CMS: ASP pricing files (Part B drugs)
2025Infusion, imaging and radiotherapy delivered in a clinic are priced by the Medicare Physician Fee Schedule; the same service in a hospital outpatient department is priced by the Outpatient Prospective Payment System, usually higher. CMS: Physician Fee Schedule look-up tool
2021Hospitals must publish machine-readable files of their standard charges and negotiated rates for every item and service, including cancer drugs and infusions. CMS: Hospital Price Transparency
2026Part D plans place oral cancer drugs on a specialty tier with coinsurance of 25% to 33% until the annual cap is reached, then pay in full. Medicare.gov: Costs for Medicare drug coverage

Manufacturer and charity programmes for each product are in the financial help browser; the per-product coverage record is on Paying for care (US).

United Kingdom: NHS entitlement against private medical insurance

5 rows

In the UK the NHS is the baseline everyone has; private medical insurance buys speed, choice of consultant and hospital, and sometimes drugs NICE has not recommended. Insurers use the phrase "full cancer cover" differently, so each row quotes what the insurer's own documents say and links to them. The Association of British Insurers publishes consumer guidance on reading a private medical insurance policy.

Route	How cancer treatment is paid for	Limits	Options	Documents
NHS (England, Scotland, Wales, Northern Ireland) NHS · 2026	Free at the point of use for diagnosis, surgery, radiotherapy, chemotherapy and any drug NICE (or the SMC in Scotland) has recommended for the indication. Drugs NICE has not recommended are available only through the Cancer Drugs Fund, an individual funding request or a trial.See What the NHS offers for the NICE and Cancer Drugs Fund record of every product.	No financial or time limit on funded treatment. In England, people being treated for cancer are exempt from prescription charges with a medical exemption certificate; prescriptions are free in Scotland, Wales and Northern Ireland.	Private medical insurance can run alongside NHS care; several insurers sell cover that pays only for treatment the NHS will not fund.	NHS Business Services Authority: medical exemption certificates
Bupa UK Private medical insurance · 2026	Comprehensive policies include cancer cover: diagnosis, surgery, radiotherapy, chemotherapy and licensed drugs including biological and targeted therapies, in Bupa's network of consultants and hospitals.	Bupa describes its cancer cover as having no time limit and no financial limit on eligible treatment for as long as the policy is held; check the policy wording for exclusions such as pre-existing conditions and experimental treatment.	NHS Cancer Cover Plus: the NHS provides treatment and Bupa pays for licensed cancer drugs or radiotherapy the NHS will not fund for the member, at a lower premium.	Bupa: health insurance and cancer cover
AXA Health Private medical insurance · 2026	Personal Health policies include full cancer cover as standard: diagnosis, surgery, radiotherapy, chemotherapy, licensed drugs and reconstructive surgery, with hospital and consultant options set at quote.	Full cancer cover is described without a financial cap on eligible treatment; exclusions and the hospital list are in the policy handbook.	NHS cancer support: NHS treatment with AXA paying for licensed cancer drugs or treatments the NHS does not fund, plus a cash benefit for NHS stays, at a reduced premium.	AXA Health: health insurance
Aviva Private medical insurance · 2026	Healthier Solutions includes cancer cover as standard: diagnosis, treatment and licensed drugs, with out-patient and hospital options chosen at quote.	Aviva publishes its cancer-cover terms in the policy wording; check the current document for limits and the position on unlicensed or experimental treatment.	Out-patient limits and hospital lists can be varied to reduce premiums; the cancer pathway itself is set out in the policy wording.	Aviva: private health insurance
Vitality Private medical insurance · 2026	Personal Healthcare includes Full Cancer Cover as standard: diagnosis, surgery, radiotherapy, chemotherapy and biological therapies for as long as the consultant recommends them.	Vitality describes Full Cancer Cover as having no limits on biological therapies; see the plan guide for the definition of eligible treatment.	Advanced Cancer Cover: an optional upgrade that widens cover to certain treatments and drugs outside the standard definition; the plan guide sets out what qualifies.	Vitality: health insurance

The NICE, Cancer Drugs Fund and SMC position on every product is on What the NHS offers.

How cancer drugs are paid for in nine countries

9 countries

Funding model, what the patient typically pays as the source states it, and who decides whether a new drug is funded. Appraisal verdicts per product and country are on the HTA decisions page.

Country	Funding model	Typical patient share	Who decides	Source
United States2026	Mixed: Medicare (Part B for infused drugs at ASP+6%, Part D for oral drugs), Medicaid, employer and Marketplace plans; list prices set by manufacturers, with Medicare negotiation for selected drugs from 2026.	Part B: 20% coinsurance, uncapped without Medigap. Part D: capped at $2,100 in 2026. Marketplace plans: out-of-pocket maximum $10,600 in 2026.	Each payer; CMS national and local coverage determinations for Medicare.	Medicare.gov: Costs for Medicare drug coverage
United Kingdom2026	Tax-funded NHS. NICE appraises cost-effectiveness against a threshold; a recommendation obliges NHS England to fund within 90 days. Uncertain drugs enter the Cancer Drugs Fund under managed access (since 29 July 2016).	Nothing at the point of use; cancer patients in England are exempt from prescription charges.	NICE (England, Wales, Northern Ireland); SMC (Scotland).	NHS England: Cancer Drugs Fund
Germany2025	Statutory health insurance (GKV) covers about 90% of residents. New drugs are reimbursed from launch at the manufacturer's price; the G-BA assesses added benefit within a year (AMNOG) and the price is then negotiated.	10% of the pack price, minimum 5 euros and maximum 10 euros, with all co-payments capped at 2% of gross household income a year (1% for people with a chronic illness).	Gemeinsamer Bundesausschuss (G-BA) with IQWiG assessments.	Gemeinsamer Bundesausschuss: benefit assessment of medicinal products (AMNOG)
France2025	Statutory health insurance (Assurance Maladie). HAS rates clinical benefit (ASMR) and CEPS negotiates the price; early access allows funded use before pricing is settled.	Cancer is a long-term condition (ALD); care related to it is reimbursed at 100% of the statutory tariff, so the patient pays nothing for listed treatment.	Haute Autorité de Santé (HAS) and the Comité économique des produits de santé (CEPS).	Assurance Maladie: affection de longue durée (ALD)
Japan2025	Universal statutory insurance; every approved drug is listed on the national price list within about 60 to 90 days at a price set by the ministry, then revised down over time.	30% coinsurance for working-age adults (10% to 20% over 70), with the High-Cost Medical Expense Benefit capping monthly out-of-pocket spending by income band.	Ministry of Health, Labour and Welfare with the Central Social Insurance Medical Council (Chuikyo).	MHLW: High-Cost Medical Expense Benefit
Australia2026	Pharmaceutical Benefits Scheme subsidises listed drugs after PBAC finds them cost-effective; chemotherapy given in public hospitals is free under Medicare.	PBS co-payment of A$25.00 per prescription for general patients and A$7.70 for concession-card holders from 1 January 2026, with a safety net after which scripts are cheaper or free.	Pharmaceutical Benefits Advisory Committee (PBAC).	PBS: patient co-payment and safety net
Canada2025	Provincial single-payer systems fund drugs given in hospital or cancer centre. Canada's Drug Agency (formerly CADTH) reviews new drugs and the pan-Canadian Pharmaceutical Alliance negotiates one price; each province then decides to list.	Nothing for hospital-administered drugs. Take-home oral drugs depend on the province: fully funded in the west, partly through public plans with deductibles or private insurance elsewhere.	Canada's Drug Agency (reviews) and the pan-Canadian Pharmaceutical Alliance (prices); provinces list.	Canada's Drug Agency: reimbursement reviews
India2025	Mostly out-of-pocket, with public hospitals charging little and Ayushman Bharat PM-JAY paying hospitals for cancer packages for the poorest 40% of the population. Prices are controlled by the NPPA, which capped trade margins on 42 anticancer drugs at 30% in 2019; a compulsory licence on sorafenib (2012) is the landmark precedent.	PM-JAY covers hospital treatment up to 5 lakh rupees per family per year; outside it, patients pay the price of the drug, so generics and manufacturer programmes decide access.	NPPA for prices; state and PM-JAY schemes for funding; CDSCO for approval.	National Health Authority: PM-JAY
China2025	Basic medical insurance covers nearly everyone. The National Healthcare Security Administration negotiates prices for the National Reimbursement Drug List every year, and volume-based procurement sets prices for off-patent drugs.	Once listed, insurance reimburses a share that varies by province and by whether the drug is inpatient or outpatient; before listing the patient pays the full price, which is why the annual negotiation matters.	National Healthcare Security Administration (NHSA).	National Healthcare Security Administration

Method and gaps

Ranking uses one metric at a time; the reader picks it and the page orders rows by that number alone. Where a plan has no published figure for the chosen metric it appears below the ranked rows, unranked and blank. Nothing is imputed, weighted or averaged.

Metrics not on this page because no per-insurer figure could be found in a primary source: NCQA ratings (published per regional plan product, not per parent organisation; use the NCQA report card), inclusion of NCI-designated centres in each insurer's networks (not published systematically), cancer-specific prior authorisation denial rates, and patient-reported measures for cancer care. If you know a published source for any of these, tell us through the issue form.