Does Medicare Cover Stem Cell Therapy?

Medicare may help cover bone marrow transplants and other stem cell therapies when considered medically necessary by a doctor.

Medicare Advantage (Part C) plans also cover certain limited stem cell therapies if they meet the qualifications for Medicare Part A or Part B coverage.

A doctor speaks with his patient in the doctors office

How much does it cost for stem cell treatment?

If your stem cell therapy is considered an outpatient procedure, it may be covered by Medicare Part B (medical insurance). You are typically responsible for paying the Part B coinsurance, which is 20 percent of the Medicare-approved amount for your services.

You pay the Part B coinsurance after you meet the Part B deductible, which is $185 per year in 2019.

If your stem cell therapy is considered an inpatient procedure that requires a hospital stay, it is typically covered by Medicare Part A (hospital insurance).

You are required to pay the Medicare Part A deductible (which is $1,364 per benefit period in 2019) before Part A coverage kicks in.

You typically pay a Part A coinsurance based on how long you are in the hospital. With Part A coverage, you typically pay:

  • $0 coinsurance for days 1-60 spent in a hospital
  • $341 coinsurance for days 61-90 in 2019
  • $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2019

Beyond lifetime reserve days, you are responsible for all costs.

Because Medicare will only pay for a portion of approved stem cell treatment, you should expect high out-of-pocket costs.

We recommend talking to your doctor for specific pricing information related to your stem cell therapy.

What is stem cell therapy?

Stem cell therapy is used to help restore stem cells that were destroyed in patients with various types of blood-related cancers. High doses of chemotherapy or radiation therapy are typically used.

Stem cell therapy may also be used to treat certain genetic diseases and anemias.

Hematopoietic stem cell transplantation (HSCT) is a form of stem cell treatment that can be accomplished through a bone marrow transplant.

Medicare Advantage plans may help cover your stem cell treatment

Medicare Advantage plans cover everything that Original Medicare covers, including qualified stem cell therapy.

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare, and they often include additional benefits such as prescription drug, dental and vision coverage.

A licensed insurance agent can help you find Medicare Advantage plans in your area and get you enrolled in a plan that works for you.

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