Does Medicare Cover Stem Cell Therapy?

• by Christian Worstell
• November 10, 2023
• Reviewed by John Krahnert

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.

Does Medicare pay for stem cell therapy?

Medicare may pay for stem cell therapy when it's considered medically necessary by a doctor.

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 $240 per year in 2024.

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 $1,632 per benefit period in 2024) 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
• $408 coinsurance for days 61-90 in 2024
• $816 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2024

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 can cover benefits not included in Original Medicare. 

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.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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