- Stem cell therapies use blood-forming cells that can help treat bleeding disorders and certain types of cancer.
- Medicare will cover specific FDA-approved therapies.
- Even with Medicare coverage, out-of-pocket costs may be high, but Medicare Advantage or supplement plans may help reduce these costs.
Stem cells are the body’s “master cells” and can become many different types of cells. Stem cells can also help repair or rebuild damaged cells.
Medicare covers stem cell therapy for very specific uses, mostly for treating certain types of cancer or bleeding disorders, such as sickle cell anemia. Although the research on uses for stem cell therapies is expanding, Medicare will only pay for a few FDA-approved treatments that meet certain requirements.
Keep reading to find out more about what stem cell therapies Medicare will cover.
Medicare covers stem cell therapy for FDA-approved treatments, which are typically for hematopoietic stem cell transplants. These are stem cell therapies that promote the growth of healthy blood cells.
Medicare Part A
Medicare Part A is the inpatient portion of Medicare and covers hospital services and some skilled nursing care. When in the hospital, you may need stem cell therapy to treat your condition.
If your doctor has admitted you as an inpatient, Medicare Part A may cover this treatment. Once you’ve paid the Medicare deductible for Part A, which is $1,408 for 2020, Medicare will cover the remaining portion of the inpatient costs for up to a 60-day stay.
Medicare Part B
Medicare Part B covers outpatient procedures, which include most instances of stem cell therapy. A doctor must declare that your stem cell treatment is medically necessary, and once you’ve met your Medicare Part B deductible ($198 for 2020), you will pay 20 percent of the Medicare-approved amount for stem cell therapy.
Medicare Advantage plans, also known as Medicare Part C, cover the same components as original Medicare. Plans may also offer expanded coverage, including prescription drugs. Medicare Advantage will cover the same stem cell treatments as original Medicare.
Medigap, or Medicare supplement, plans can help reduce out-of-pocket costs related to Medicare expenses. Medicare standardizes these plans, and you can choose one that meets your coverage needs. Medigap could also potentially help pay costs for your Part A or Part B coinsurance or a portion of the Part A deductible.
Whether Medigap covers stem cell costs depends on your policy and the way you are charged. You can call your plan provider to confirm whether treatment will be covered.
Medicare covers two types of stem cell transplants: allogeneic hematopoietic stem cell transplantation (HSCT) and autologous stem cell transplantation (AuSCT).
While researchers are studying many other stem cell therapy approaches, the only current FDA-approved treatments are for cancers, blood disorders, and immune system disorders. The following sections provide more details about the HSCT and AuSCT types of stem cell therapies.
This approach involves taking a healthy donor’s stem cells and preparing them for infusion. This therapy would be used if you have an underlying condition that affects your ability to create new blood cells. This is called an allogeneic transplant.
Conditions this approach may treat include:
This approach involves using your own previously stored stem cells. This treatment may be recommended if you have cancer and require chemotherapy or radiation that may destroy blood-producing cells.
Examples of such conditions include:
- leukemia (in remission)
- non-Hodgkin’s lymphoma
- recurrent neuroblastoma
It’s important to know that stem cell therapies are still very expensive. A doctor may recommend different regimens based on your overall health, which are done in an inpatient setting and increases overall costs.
- $289,283 for a myeloablative allogeneic treatment regimen with an average inpatient stay of 35.6 days
- $253,467 for a non-myeloablative/reduced-intensity allogeneic regimen with an average inpatient stay of 26.6 days
- $140,792 for a myeloablative autologous regimen with an average inpatient stay of 21.8 days
These cost estimates are based on claims to private insurance companies, not Medicare. Costs could be different based on treatment types, your overall health, and the costs negotiated between Medicare and providers each year.
Remember that Medicare will not cover costs that don’t meet its current standards for coverage. Covered treatments must be FDA-approved and deemed medically necessary by your doctor.
Steps to research your costs
Because stem cell injections can be so expensive, you can take some steps before the treatment to make sure you can afford them.
- Ask your doctor for an estimate of treatment costs, including the doctor’s fees and materials costs for the injection.
- Contact Medicare or your Medicare Advantage plan administrator to get an estimate for how much Medicare will cover.
- Consider Medicare supplement plans (if applicable), which can help cover some of the out-of-pocket costs. Medicare Advantage plans may also be another avenue to explore, as some may have out-of-pocket spending limits.
Researchers have studied the possibility of injecting stem cells into cartilage and other damaged tissue to reduce or reverse the effects of knee osteoarthritis. According to a recent
Other recently published
Studies on stem cell therapy are ongoing and have not yet shown clear evidence that it will be helpful in treating knee osteoarthritis. Medicare requires significant research and FDA approval to cover treatments. Because the use of stem cells to treat knee arthritis is a relatively new therapy, Medicare doesn’t cover the costs of these treatments.
- nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium
- corticosteroid injections
- hyaluronic acid injections
- nerve blocks
- physical therapy
If these conservative treatments fail, Medicare may also cover surgical approaches to treating knee pain, including knee replacement.
For more than 50 years, doctors have injected hematopoietic stem cells into the body to promote the growth of new blood cells. However, other approaches are now being studied as well.
According to the National Institutes of Health, most stem cell research is on embryonic stem cells or somatic (“adult”) stem cells.
Embryonic stem cells
Embryonic stem cells come from embryos created in a lab through in vitro fertilization. These cells come from donors for research purposes.
Embryonic stem cells are like a blank slate for the body’s cells. They can become a blood cell or a liver cell or many other cell types in the body.
Somatic stem cells
Somatic stem cells usually come from bone marrow, the bloodstream, or from umbilical cord blood. These types of stem cells are different from embryonic stem cells because they can only become blood cells.
Stem cell delivery
Stem cell delivery is a multistep process that usually involves:
- “conditioning” or high-dose chemotherapy or radiation to kill the cancerous cells and make room for the new stem cells
- medication to suppress the immune system (if the stem cells come from another person) to reduce the chances of the body rejecting the stem cells
- infusion through a central venous catheter
- close monitoring during infusion and in the following days to reduce the risks for infections and stem cell rejection
Medicare currently only covers stem cell therapy for hematopoietic transplants. This therapy is used to treat blood-related cancers and other blood conditions like sickle cell anemia.
Like many other cancer treatments, stem cell approaches are costly. It’s important to ask for an explanation and estimate of costs, including those covered and not covered by your Medicare plan. You can then consider the costs versus the benefits when deciding if treatment is right for you.