Medicare coverage for stem cell therapy only applies to FDA-approved services. And the treatment has to be medically necessary for Medicare to pay for it. Nevertheless, this therapy can help people with various diseases or conditions, and clinical studies have been completed worldwide. Let’s talk about what services have Medicare coverage and which ones don’t. We’ll also discuss Medigap options that can help with the cost of stem cell treatments.
What Is Stem Cell Therapy?
Simply put, it’s the use of stem cells to prevent or treat a disease or condition. A form of regenerative medicine, this therapy can repair damaged cells within your body — by reducing inflammation and regulating the immune system. Stem cell therapy is a feasible treatment option for many medical conditions.
Who Benefits from Stem Cell Therapy?
You could benefit from stem cell therapies if you have:
- Heart disease
- Type 1 diabetes
- Spinal cord injuries
- Parkinson’s disease
- Alzheimer’s disease
- Amyotrophic lateral sclerosis (ALS)
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Medicare Coverage for Stem Cell Therapy
Medicare covers a percentage of many types of stem cell therapies. Part A helps cover inpatient expenses, and Part B covers some outpatient costs. Approved treatments consist of blood-forming stem cells.
Medicare-approved options are:
- Autologous Stem Cell Transplantation — helps treat acute Leukemia and Advanced Hodgkin’s Disease.
- Hematopoietic Stem Cell Transportation — This applies to those with Leukemia and Severe Combined Immunodeficiency Disease.
Stem Cell Therapy – Cost with Medicare
Prices for stem cell therapy typically range from $5,000 — $50,000. Yes, this is a broad range! It depends on the setting where you receive treatment.
If you receive it in outpatient settings, Medicare Part B covers 80% of the cost. You’ll pay the remaining 20%. If you receive the therapy in inpatient settings, it falls under Part A, which includes a deductible and other cost-sharing that are your responsibility.
If you have a Medigap policy, the coinsurance would be covered, and so would the cost-sharing under Medicare Part A. Depending on which plan you joined, you could have zero out-of-pocket costs for stem cell therapy.
What About Medicare Advantage Plans?
Advantage plans will provide the same coverage as Original Medicare. However, they determine how much you’ll pay out of pocket (cost-sharing), and they require the use of in-network doctors. If you go outside of the network, you’ll pay 100% of the cost. You’ll also pay more out of pocket if you choose a Medicare Advantage plan over a Medigap policy.
What About Stem Cell Injections?
As long as the FDA approves the injections, Medicare will cover them. Inpatient therapy for stem cells typically lasts for 3-4 weeks. Outpatient stem cell therapy will be shorter.
The use within shoulders doesn’t have FDA approval, meaning Medicare won’t pay for stem cell injections for shoulders.
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Need Medicare Coverage for Stem Cell Therapy?
Trusted Senior Specialists can help you find the best Medicare plans in your area. We’ll compare options and prices for you while ensuring that you get the coverage you need — and the care you deserve! It’s easy to set up a video chat or call. Our number is (855) 952-1941.