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.
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 $198 per year in 2020.
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 $1,408 per benefit period in 2020) 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:
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.
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 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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