Does Medicare Cover Stem Cell Therapy?

Stem cell therapy has excellent potential. And it could be a game changer for the treatment of many diseases and injuries.

However, at the moment, there’s still a lot of research that needs to be done into stem cell therapy. Only a few stem cell therapies are approved by the FDA.

Because of the excitement around these therapies, a common question more people are asking is “does Medicare cover stem cell therapy?” In this article, we answer this question in clear, plain English. You will also find the average costs of stem cell therapy, as well as other helpful info.

Does Medicare Cover Stem Cell Therapy?

The short answer is yes; Medicare may cover the cost of stem cell therapy. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your stem cell therapy. Below we look at what these are so you know what to expect.

Right now, Medicare will cover stem cell therapy in limited situations. This is because stem cell therapy is still considered largely experimental. There are 2 FDA stem cell therapies that Medicare does cover. They are:

allogeneic hematopoietic stem cell transplantation (HSCT)
autologous stem cell transplantation (AuSCT)

If a doctor says that it is medically necessary for you to have one of these stem cell treatments, then Medicare will likely pay for it.

If you get the treatment while you are in the hospital, Medicare Part A provides coverage for inpatient procedures for stem cell therapy. On the other hand, Medicare Part B may cover any outpatient stem cell procedure. And stem cell therapy is more common in an outpatient setting.

Medicare Advantage plans (Medicare Part C) also provides coverage for stem cell therapies stated above. Medicare Advantage plans cover everything Original Medicare cover along with some additional benefits.

How Much Does Stem Cell Therapies Cost?

Stem cell therapy is very expensive. Allogeneic hematopoietic stem cell therapies may cost between $140,000 to nearly $290,000 in an inpatient setting. However, different factors affect the procedure’s costs. These factors include the number of days the patient stayed in the hospital and more.

What Is Stem Cell Therapy?

Stem cells can generate specialized cells. Specialized cells are cells that have a particular function in our bodies. Some examples of specialized cells include nerve cells and blood cells.

Aside from dividing themselves into specialized cells, stem cells can also generate other stem cells. However, they can only divide themselves if they are kept under the right conditions inside a human’s body or a laboratory.

There are two main sources of stem cells in a human’s body. These sources are adult stem cells and embryonic stem cells.

Adult stem cells are found in the bone marrow and fat. Originally it was thought they were capable of generating similar cells. However, researchers recently found that they, too, can produce specialized cells. On the other hand, it is confirmed that embryonic stem cells can produce specialized cells.

The stem cells used for treatment can repair damaged, dead, or dysfunctional tissues. They are used to treat a number of ailments. Some of them include repairing damaged tissues/organs, treating cancers such as non-Hodgkin’s lymphomas, recurrent neuroblastoma and acute leukemia.

Allogeneic hematopoietic stem cell transplantation (HSCT) is the process of transfusing a healthy donor’s stem cells to the patient.

On the other hand, autologous stem cell transplantation (AuSCT) is the use of the patient’s stored stem cells.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.