Stem Cell treatment is growing in popularity, but that doesn’t mean that Original Medicare will cover the procedure you want. Medicare Coverage for stem cell treatment is limited to FDA-approved procedures. These treatments are becoming more common for cancer and Medicare beneficiaries with compromised immune systems. Below we’ll discuss what stem cell treatments Medicare will cover and how the coverage works.
What is Stem Cell Therapy?
Stem cells can replicate themselves into new cells. There are two defining qualities, and they are continually self-replicating and can be discerned into a specialized adult cell type. These treatments, such as leukemia, were first used to treat blood diseases in the 1970s.
Medicare Coverage for Stem Cell therapy
Medicare does provide coverage for specific FDA-approved stem cell Therapies. For Medicare to cover stem cell treatment, it must meet two conditions.
- The Food and Drug Administration must approve the treatment.
- The treatment is Medically necessary.
The coverage for stem cell therapy will either be under Medicare Part A or Medicare Part B. Where the treatment occurs will determine which part of Medicare will pay.
Medicare-covered stem cell therapy options are Hematopoietic Stem Cell Transplantation and Autologous Stem Cell Transplantation.
Frequently, Healthcare coverage for stem cell therapy is an inpatient procedure. In this case, Medicare Part A will cover it because it’s occurring in an inpatient setting. An inpatient stem cell treatment is typically three to four weeks long. You will be required to pay the Medicare Part A deductible.
Suppose your treatment for stem cell therapy occurs as an outpatient procedure. In that case, Medicare Part B will provide the coverage. You’ll pay the 20% coinsurance of the Medicare-approved amount and any excess charges once you reach your Part B deductible.
Stem Cell Transplantation Uses
Hematopoietic Stem Cell Transplantation treats several kinds of blood cancer and immune disorders. This therapy produces white blood cells, red blood cells, and platelets. This treatment occurs in the bone marrow. Hematopoietic Stem Cell Transplantation treats the conditions listed below:
- Blood Disorders
- Anemias
- Sickle Cell Disease
- Thalassemia
- Cancers
- high-risk solid tumors
- leukemias
- lymphomas
- Immune Disorders
- Histiocytic Disease
- Severe Combined Immunodeficiency Disease
- Wiskott-Aldrich Syndrome
- Metabolic Diseases
- Hurler Syndrome
- Krabbe Disease
- Leukodystrophies
Medicare partly covers the transplantation of hematopoietic stem cells, and coverage only applies to certain conditions such as leukemia and severe combined immunodeficiency.
Autologous Stem Cell Transplantation uses your body’s healthy blood stem cells to replace damaged or diseased bone marrow. This Autologous Stem Cell Transplantation treats Hodgkin’s lymphoma, myeloma, non-Hodgkin’s lymphoma, and plasma cell disorders.
- Cancer
- Hodgkin lymphoma
- Multiple myeloma
- Non-Hodgkin lymphoma
- Certain types of solid tumors
- Germ-cell tumors, including testicular cancer
- Neuroblastoma
- Soft tissue sarcoma
- Autoimmune diseases
- Multiple sclerosis
- Scleroderma
Medicare will cover Autologous Stem Cell Transplantation.
FAQs
Does Medicare cover stem cell transplants?
Medicare covers stem cell transplants if it meets two conditions. The FDA must approve the procedure and be considered medically necessary.
Does Medicare cover stem cell knee injections?
The FDA doesn’t approve stem cell therapy for the knee. Medicare only covers procedures approved by the FDA. You can expect to pay an average of $3,000 to $5,000 per knee.
Is stem cell therapy covered by Medicare Part A?
Medicare Part A covers inpatient stem cell therapy. Medicare requires a hospital stay of three to four weeks for approval.
Is stem cell therapy covered by Medicare Part B?
Medicare Part B will cover stem cell therapy performed in an outpatient facility.
Is stem cell therapy covered by Medicare Part C?
Medicare Advantage insurance plans are required to cover the same services are Medicare. If Medicare approves the procedure, the Medicare Advantage plan will include it.
Medicare covers treatment only after the need is proven and authorized.
Is stem cell therapy covered by Medicare Part D?
Medicare Part D is the prescription drug portion of Medicare. Since stem cell treatments aren’t prescriptions, Medicare Part D insurance won’t cover them.
Does Medicare cover bone marrow transplants?
Yes! Medicare will cover bone marrow transplants.
Do Medicare Supplement plans cover Stem Cell Therapy?
Medigap plans pick up your out-of-pocket cost associated with Medicare’s cost-share. A Medicare supplement insurance plan will also provide coverage for any procedure that Medicare covers. Remember, different Medigap plans have different coverage levels.
Help with Medicare Coverage for Stem Cell Therapy
Stem cell treatments are making huge medical strides. They can be pretty expensive. We understand that certain health conditions can benefit greatly from this treatment style. Let our licensed insurance agents assist you in finding additional supplemental Medicare coverage to help with the additional costs of these therapies.
Our agents specialize in Medicare options and can help you navigate the process to ensure you receive the right coverage for your medical needs. Give us a call or fill out our online request form. We’re standing by to help you with your enrollment through this process.
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