Does Medicare Cover a Stem Cell Transplant For Lymphoma?

Are you wondering, Does Medicare cover a stem cell transplant For Lymphoma?

Lymphoma is cancer that starts in the immune system’s infection-fighting cells called lymphocytes. The lymph nodes, spleen, thymus, bone marrow, and other areas of the body contain these cells.

Lymphoma causes lymphocytes to alter and grow out of control. One of the ways to treat lymphoma is through stem cell therapy.

In this article, we answer your question as to whether medicare covers stem cell transplants in clear, plain English.

Does Medicare Cover a Stem Cell Transplant For Lymphoma?

The short answer is yes; Medicare will cover the cost of a stem cell transplant for lymphoma. 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 transplant. Below we look at what these are so you know what to expect.

Original Medicare Coverage of Stem Cell Transplants

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

Both Part A and Part B will provide coverage for stem cell transplants if it is considered medically necessary. Your healthcare provider must first order the treatment for Original Medicare to provide coverage.

This plan will also provide coverage for stem cell therapy in general for the following medical conditions:

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

Original Medicare (Medicare Part A and Part B) only provides coverage for two FDA-approved stem cell therapies. Those two FDA-approved stem cell therapies are:

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

Medicare Part A Coverage of Stem Cell Transplants

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

Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

Starting from the 61st day, up to 90 days, Medicare Part A will still provide coverage. Be aware that you will pay a copayment each day. 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 you will have a daily copayment you are responsible for.

Medicare Part B Coverage of Stem Cell Transplants

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

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

Medicare Advantage Coverage of Stem Cell Transplants

Medicare Advantage plans (Medicare Part C and Part D) also provide coverage for stem cell transplants for lymphoma. They cover everything Original Medicare covers, as well as some additional benefits.

Precisely what these plans cover and how much the out-of-pocket costs will vary depending on your plan’s specifics.

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.

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