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does medicare cover regenerative medicine

Does Medicare Cover Regenerative Medicine?

Regenerative medicine, or stem cell transplants, are promising form of treatment for many ailments. In some situations, they are even becoming an alternative to organ transplants.

If you’re considering this treatment option, a common question is, “does Medicare cover regenerative medicine?” In this article, we answer that question in clear, plain English. You will also find the average costs of regenerative, as well as other helpful info.

Does Medicare Cover Regenerative Medicine?

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

Medicare will only cover stem cell therapies that have approval from the FDA. In addition, your doctor must say that the treatment is medically necessary. Otherwise, Medicare will not cover it.

Currently, the only stem cell therapy treatments that they cover are the following:

  • Hematopoietic Stem Cell Transportation
  • Autologous Stem Cell Transplantation

Even in those situations, Medicare will not cover the treatment all the time. For example, Medicare will only cover Hematopoietic Stem Cell Transportation to treat conditions such as Leukemia and Severe Combined Immunodeficiency Disease.

In the case of Autologous Stem Cell Transplantation, Medicare will cover the therapy to treat Acute Leukemia that’s in remission and Advanced Hodgkin’s Disease.

If done in an outpatient setting, Medicare Part B will cover stem cell therapy. Medicare Part B will cover 80% of the costs. If done in an inpatient setting, Medicare Part A will cover the therapy.

Medicare Advantage (Medicare Part C) also covers FDA-approved stem cell therapies. They must cover everything Original Medicare covers but will also provide additional benefits.

How Much Does Regenerative Medicine Cost?

Stem cell therapies usually cost between $5,000 and $50,000.

What Are Stem Cells?

Stem cells can generate two types of cells – more stem cells and specialized cells. Specialized cells have special functions in our body, for example, nerve cells, blood cells, liver cells, etc.

Specialized stem cells can repair or replace damaged, dysfunctional, or dead cells. They can be used to replace cells that are affected by several conditions such as cancer, leukemia, lymphoma, neuroblastoma, and other blood-related diseases.

When kept under the right conditions in a laboratory or in a human’s body, a stem cell can divide itself. Researchers grow and manipulate stem cells in a laboratory. They turn the cells into specialized cells that the patient needs and inject them into the patient.

There are two common stem cell sources, and those are embryonic stem cells and adult stem cells. Embryonic stem cells can divide themselves into specialized cells. They are found on 3-5 days old embryos.

Adult stem cells are found in the bone marrow and fat. Though they are thought to only produce similar cells, researchers are working with them to see if they can also produce specialized cells. They are under clinical trials and are being tested in people with neurological conditions or heart disease.

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.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover orthotics for Plantar Fasciitis?

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