• Stem cell therapy uses stem cells to treat bleeding disorders and certain types cancer.
  • Medicare will pay for certain FDA-approved treatments.
  • Even with Medicare coverage the out-of-pocket expenses can be very high. These costs may be reduced by Medicare Advantage and supplement plans.

Stem cells can be transformed into many types of cells and are considered the “master cells” of the body. They are also capable of rebuilding or repairing damaged cells.

Medicare covers stem cell therapy only for specific purposes. This includes treatment of certain types or bleeding disorders such as sickle cell disease.

While stem cell research is growing, Medicare will only pay for a select few FDA-approved treatments that comply with certain requirements.

Continue reading to learn more about the Medicare coverage for stem cell therapies.

Is Medicare eligible for stem cell therapy?

Medicare covers stem cell therapy that is FDA-approved. These treatments are usually for hematopoietic stem cells transplants. These stem cell therapies promote healthy blood cells growth.

These therapies can be used to treat certain types of cancer, such as:

  • Lymphoma
  • Acute myeloid leukemia
  • Waldenstrom macroglobulinemia
  • Testicular germ cell carcinoma

These therapies may also be used to treat sickle cell diseases.

Medicare Part A

Medicare Part A, which covers inpatient services, is the Medicare Part that provides skilled nursing care. You may require stem cell therapy to treat your condition while you are in the hospital.

Medicare Part A might cover you if your doctor has admitted to you as an inpatient.

After you have paid your Medicare deductible for Part A Medicare will pay the rest of the inpatient charges for up to 60 days. For 2021, the Part A deductible is $1,484.

Medicare Part B

Medicare Part B provides coverage for outpatient procedures. This includes stem cell therapy in certain instances.

Your doctor must sign off that stem cell treatment is medically required. Once you have met your Medicare Part Bdeductible, you will pay 20% of the Medicare-approved amount. For 2021, the Part B deductible will be $203.

Medicare Advantage

Medicare Advantage plans also known as Medicare Part C cover all the same components of original Medicare. Some plans may offer additional coverage, such as prescription drugs.

Medicare Advantage will provide the same stem cell treatment coverage as Original Medicare.

Medigap

Medigap or Medicare Supplement plans can reduce your out-of-pocket expenses related to Medicare. These plans are standardized by Medicare, so you can choose the one that best suits your needs.

Medigap may also be able to help you pay for Part A, Part B, or a portion thereof.

The cost of stem cell treatment covered by Medigap depends on the policy you have and how much you are charged. To confirm whether treatment is covered, you can contact your plan provider.

What stem cell therapies are covered by the FDA?

Medicare covers stem cell transplantation in two ways: autologous stem cell transformation and allogeneic stem cells transplantation.

Although there are many stem cell therapies being studied by researchers, FDA approved treatments for the following are currently available:

  • Cancer
  • Blood disorders
  • Immune system disorders

These sections give more information about the various types of stem cell therapies.

AllogeneicStem cell transplantation

This involves using stem cells from a healthy donor to prepare them for intravenous injection.

If you have an underlying condition that limits your ability to make new blood cells, this therapy might be recommended. This is known as an allogeneic transfer.

This approach can be used to treat:

  • Myelofibrosis
  • Leukemia
  • Wiskott-Aldrich syndrome
  • Sickle cell disease

Transplantation of autologous stem cells

This involves using stem cells that you have already stored. If you are suffering from cancer, this treatment might be recommended.

These conditions are examples of them:

  • Non-Hodgkin’s lymphoma
  • Recurrent neuroblastoma
  • amyloidosis