- Stem cell therapies use stem 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. 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. They 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 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 for hematopoietic stem cell transplants. These are stem cell therapies that promote the growth of healthy blood cells.
These therapies are sometimes used to treat certain cancers, including:
- acute myeloid leukemia
- Waldenstrom macroglobulinemia
- testicular germ cell cancer
These therapies can also help treat sickle cell disease.
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 2021 is $1,484.
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 percent of the Medicare-approved amount for stem cell therapy. The Part B deductible is $203 for 2021.
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’re charged. You can call your plan provider to confirm whether treatment will be covered.
Medicare covers two types of stem cell transplants: allogeneic stem cell transplantation and autologous stem cell transplantation.
While researchers are studying many other stem cell therapy approaches, the only current FDA-approved treatments are for:
- blood disorders
- immune system disorders
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:
- 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
- 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 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 then differentiate, meaning they can become a blood cell or a liver cell or many other cell types in the body.
Somatic stem cells
Somatic stem cells (adult stem cells) usually come from bone marrow, the bloodstream, or 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
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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.
Covered treatments include:
- physical therapy
- nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium
- corticosteroid injections
- hyaluronic acid injections, which are to lubricate the knee joint to reduce pain
- nerve blocks
- Voltaren Arthritis Pain, a topical gel available over the counter
Medicare may also cover surgical approaches to treating knee pain if these conservative treatments fail. Types of surgery include knee replacement.
Medicare currently covers stem cell therapy only for hematopoietic transplants. This therapy is used to treat blood-related cancers and other blood conditions like 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.