Does Medicare Cover Autologous Stem Cell Transplant?

Autologous transplantation involves the use of stem cells taken from your own body. Because the cells are extracted from your blood or bone marrow, your immune system is less likely to attack them. They can be used to treat a wide variety of conditions and diseases.

If this is a treatment that could potentially help you or a loved one, you likely have the question, “Does Medicare cover Autologous Stem Cell Transplant?”

In this article, we answer the question in clear, plain English. You will also find the average costs of going through an autologous stem cell transplant if you don’t have insurance and other helpful info.

Does Medicare Cover Autologous Stem Cell Transplant?

The short answer is yes; Medicare will cover the cost of autologous stem cell transplants. But this is not true 100% of the time.

As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your autologous stem cell transplant. Below we look at what these are so you know what to expect.

Original Medicare Coverage of Autologous Stem Cell Transplant

Original Medicare (Medicare Part A and Part B) provides coverage for autologous stem cell transplants.

This plan provides autologous stem cell transplant coverage if it is considered medically necessary. Your healthcare provider must first order the operation for Original Medicare to provide coverage.

There are some conditions that are always covered. So what are they?

Which Conditions are Covered for Stem Cell Therapy?

Original Medicare will provide coverage for stem cell therapy in general for the following medical conditions:

Aplastic anemia
Hodgkin lymphoma
Leukemia
Myelodysplastic syndromes
Neuroblastoma
Non-Hodgkin lymphoma
Primary amyloid light chain amyloidosis
Severe combined immunodeficiency disease (SCID)
Wiskott-Aldrich syndrome

When does Part A Cover Autologous Stem Cell Transplant?

Coverage for autologous stem cell transplant is provided by Medicare Part A if your autologous stem cell transplant takes place in an inpatient setting.

In these cases, Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

From the 61st day to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each day you are hospitalized. After 90 days, Medicare Part A will no longer provide coverage.

However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but again, you will be responsible for a daily copayment.

When does Part B Cover Autologous Stem Cell Transplant?

On the other hand, coverage for autologous stem cell transplant is provided by Medicare Part B if it takes place in an outpatient setting.

Once approved, Medicare Part B covers 80 percent of autologous stem cell transplant costs. You will pay for the remaining 20 percent.

Medicare Advantage Coverage of Autologous Stem Cell Transplant

Moreover, the Medicare Advantage plans (Medicare Part C) also provide autologous stem cell transplant coverage. They must cover everything Original Medicare covers but offer additional benefits as well.

The extra coverage and benefits Part C plans offer depend on the plan you sign up for.

Part D plans provide coverage for medications that you need during stem cell therapy. Medicare Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Stem Cell Therapy Cost?

The cost of stem cell therapy can range between $5000 to $50,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.