Medicare covers FDA-approved stem cell therapies for bleeding disorders and certain cancers, though out-of-pocket costs can still be high. Medicare Advantage or supplement plans may help with the cost.

Stem cells are the body’s “master cells” and can become many different types of cells. They can also help repair or rebuild damaged cells.

Medicare covers stem cell therapy for specific uses, mostly for treating certain types of cancer or bleeding disorders, such as sickle cell disease.

Although the research on uses for stem cell therapies is expanding, Medicare will pay for only 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 hematopoietic stem cell transplants. These therapies promote the growth of healthy blood cells.

They are sometimes used to treat certain cancers, including:

  • lymphomas
  • acute myeloid leukemia
  • Waldenstrom macroglobulinemia
  • testicular germ cell cancer

These therapies can also help treat sickle cell disease.

Medicare covers two types of stem cell transplants: allogeneic stem cell transplantation and autologous stem cell transplantation.

The following sections provide more details regarding the different types of stem cell therapies.

Allogenic stem cell transplantation

This approach involves taking a healthy donor’s stem cells and preparing them for intravenous 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:

Autologous stem cell transplantation

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:

Medicare coverage is divided into Original Medicare (Parts A and B), Medicare Advantage (Part C), and Part D, which covers prescription drugs. The following overviews explain what each part can cover when it comes to stem cell therapy.

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, Medicare will cover the remaining portion of the inpatient costs for up to a 60-day stay. The Part A deductible for 2024 is $1,632.

Medicare Part B

Medicare Part B covers outpatient procedures, which include some 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, you’ll pay 20% of the Medicare-approved amount for stem cell therapy. The Part B deductible is $240 for 2021.

Medicare Advantage

Medicare Advantage plans, also known as Medicare Part C, cover the same components as Original Medicare and may offer expanded coverage, including prescription drugs.

Medicare Advantage will cover the same stem cell treatments as Original Medicare.

Medigap

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’re charged. You can call your plan provider to confirm whether treatment will be covered.

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 increase overall costs.

In a 2017 study of 1,562 inpatients who received hematopoietic stem cell transplantation, the average costs were:

  • $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
  • the costs negotiated between Medicare and health professionals each year

Remember that Medicare won’t 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, since some may have out-of-pocket spending limits.

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, stem cell research is done on embryonic stem cells, which are created in a lab through in vitro fertilization, or somatic (“adult”) stem cells, which usually come from bone marrow, the bloodstream, or umbilical cord blood.

Learn more: .

How do you qualify for stem cell therapy?

When deciding if stem cell therapy may be beneficial to you, your doctor will evaluate several factors. These include your health and the results of any medical tests, whether you have any illnesses, such as cancer, the kind of cancer you have, what other treatments you’ve had, and what the chance of success of the treatment might be. Another factor can be whether you can use your own stem cells or those of a compatible donor.

Does Medicare pay for stem cell therapy for the knees or other joints?

Researchers have studied the possibility of injecting stem cells into cartilage and other damaged tissue to reduce the effects of knee osteoarthritis. According to a 2020 journal article, encouraging results have been seen in clinical trials. However, data is limited.

Since Medicare requires significant research and FDA approval to cover treatments, it doesn’t cover the costs of these treatments. Similarly, it likely won’t cover stem cell treatments for other joints, such as the hips or the shoulders. As of yet, it also isn’t likely to cover other experimental stem cell procedures used to treat other problems like back pain.

Does Medicare cover stem cell transplants for multiple myeloma?

Medicare covers stem cell transplants only for stage 2 or stage 3 multiple myeloma when:

  • the disease is newly diagnosed
  • the disease has at least partially responded to other treatments
  • your heart, kidneys, lungs, and liver are functioning normally.
  • You’re younger than age 77.

Stem cell therapy for myelodysplastic syndromes (MDS)

Medicare has reevaluated its coverage of allogenic therapy for people with high risk MDS. People who fall into this category can now get coverage without being part of a clinical trial.

This includes procedures like bone marrow transplants, peripheral blood stem cell transplants, and umbilical cord blood procedures. If you don’t meet this criteria, Medicare might still grant coverage on a case-by-case basis.

Medicare currently covers stem cell therapy only for hematopoietic transplants. This therapy is also used to treat blood-related cancers and other blood conditions, such as sickle cell disease.

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.