Medicare Coverage for Stem Cell Therapy

There is Medicare coverage for stem cell therapy; although, there are limits to coverage. Pain doesn’t discriminate. It doesn’t care about your age, religion, sex or race. Although, the causes of the pain can vary from a sporting injury to a car accident to degeneration over time.

There are various treatment options will be by the location of your pain and the severity of the condition. Medicare may help pay for a portion of some of these treatments. We’ll discuss this further in detail below.

Does Medicare Cover Stem Cell Therapy

There are only a few stem cell therapies out there that Medicare will cover. Those that Medicare does pay for, they only pay a portion of the expense.

Therapies Medicare approves provide coverage under Part A and Part B. Stem cell transplants are allowable at non-Medicare facilities.

Since Medicare will only pay a portion of your stem cell therapy costs, you should expect high out-of-pocket expenses. Since these therapies can cost thousands, a Medicare Supplement plan could protect your finances from being drained.

Hematopoietic stem cell transplantation is one that Medicare will help you pay for, but only for specific conditions. Another type of stem cell therapy that Medicare may pay a portion of is Autologous Stem Cell Transplantation.

Hematopoietic Stem Cell Transplantation

HSCT generally covered by Medicare include:

• Myelodysplastic Syndromes (MDS)
• Leukemia
• Wiskott-Aldrich Syndrome
• Severe Combined Immunodeficiency Disease (SCID)

Autologous Stem Cell Transplantation

AuSCT generally covered by Medicare include:

• Advanced Hodgkin’s Disease
• Acute Leukemia in remission
• Recurrent Neuroblastoma
• Resistant non-Hodgkin’s Lymphomas

Stem Cell Therapy Not Covered by Medicare

Medicare will not cover stem cell therapy to treat the following conditions:

• Spine Arthritis
• Multiple Sclerosis
• Spine Degeneration
• Hip Arthritis
• Ligament Tears
• Meniscus Tears
• Torn Rotator Cuffs
• Stroke
• Parkinson’s Disease

The reason Medicare won’t cover treatment by stem cell therapy for these conditions is that it’s not yet FDA approved.

As of 2019, the only stem cell treatments approved by the FDA are those made of blood-forming stem cells.

Does Medicare Cover Stem Cell Therapy for Knees

This is an extremely common question among our clients. Unfortunately, since stem cell therapy doesn’t have FDA approval; so, it’s not covering knee pain management.

Stem cell therapy is a popular treatment for osteoarthritis of the knee. It’s a nice alternative to knee replacement since it could regrow cartilage.

Stem cell therapy for the knees is often done in the doctor’s office and patients are at work by the next day. This means less time off work and a quicker healing process than knee surgery.

Does TRICARE Cover Stem Cell Therapy for Knees

TRICARE covers safe and proven treatments; however, TRICARE doesn’t cover things the FDA doesn’t approve.

So, since stem cell therapy for knees doesn’t have FDA approval, it won’t have TRICARE approval.

What are Stem Cells

Stem cells form at birth. The uniqueness of Stem Cells is that they can change into other types of cells found throughout the body. These cells can then regenerate and help the other cells. These cells are vital to producing organs, muscles, tendons, ligaments, bones, joints and skin.

Types of Stem Cells

According to the International Society for Stem Cell Research, there are 4 main types of stem cells we make throughout our life.

1. Induced Pluripotent stem cells
2. Mesenchymal stem cells
3. Tissue-specific stem cells
4. Embryonic stem cells

Arthritis Pain and Symptoms

Most people have heard of the term, “Arthritis”. There are more than 100 different types of Arthritis or Arthritis related conditions. Regardless of the type, Arthritis affects the spine or major joints in the body.

The most common signs of Arthritis are pain, edema, stiffness and decreased range of motion. Although, arthritis is usually mild, moderate, or severe and will progress over time.

One of the many treatments available is stem cell injections. Stem cells can go directly into the arthritic joint to repair the damage. They’re able to divide and duplicate themselves, or develop into different cells.

Many Medicare beneficiaries experience chronic pain due to arthritis and are in need of this type of treatment. It’s important to know what Medicare coverage for stem cell treatments is in your benefits.

Stem Cells and Arthritis

Stem cell injections are a great alternative to surgical intervention. Due to today’s technology, we are able to extract stem cells from the body and then reuse them for pain relief.

This benefits the injured joint(s) and surrounding tissues as it enhances the natural repair of the affected area.

Minimally invasive procedures are always the route to go when facing pain whether from an injury or from degeneration.

The most common stem cells used for arthritis are mesenchymal stem cells. These types of cells are from the patients’ fatty tissue, bone marrow or blood.

Bone marrow is mostly from the pelvic bone after given a local anesthetic. Also, the process of collecting cells is called harvesting.

Does Medicare Cover Stem Cell Therapy for Arthritis

Medicare only covers things that are medically necessary and with FDA approval. The big reason therapy stem cells for arthritis won’t have coverage through Medicare is because the treatments haven’t had FDA approval.

Other Arthritis Treatment Options

There are multiple treatment options for those suffering from Arthritis pain including:

• NSAIDs (Non-steroidal Anti-inflammatory Drugs) which help to decrease inflammation at the arthritic site.
  

  There are multiple treatment options for those suffering from Arthritis pain

• Over the counter pain, analgesics are pain relievers people can buy without an RX.
• Vitamin supplements such as Glucosamine and Chondroitin which are natural supplements that help reduce stiffness and prevent joint damage from worsening.
• Topical medications including ointments, gels, and creams. These topical solutions help reduce inflammation and pain. Prescription pain relievers are generally opioid pain relievers. These medications can control discomfort; also, most practitioners agree this isn’t a long-term care solution.
• Physical therapy is a stretching and strengthening program that enhances physical function.
• Hot and cold compresses when applied to the affected area they help to decrease inflammation and in turn pain.
• Durable Medical Equipment: a brace or splint helps to provide stability and takes the pressure off the affected area.
• Corticosteroid Medications/Injections both oral and injectable medications that control inflammation and pain.
  Surgical Intervention usually used as a last resort when conservative treatment has been tried and failed.

Does Medicaid Cover Stem Cell Therapy

Prior to receiving any stem cell therapy, you should double check that it’s FDA-approved. Also, insurance companies don’t cover things that aren’t medically necessary.

If it’s not FDA-approved, the therapy may be under the study of an Investigational New Drug Application and on it’s way to being approved by the FDA. If a medication or treatment doesn’t have approval, the care likely won’t have coverage.

Although, if the treatment has approval from the FDA, then the treatment may have coverage.

Will Lipogems be Covered By Medicare Insurance

This kind of treatment is innovative and doesn’t have FDA approval. While scientific evidence supports this technology, most insurance companies don’t cover new technology.

If you have a Health Saving Account (HSA) using funds from your HSA account could be possible.

Until the FDA Approves Stem Cell Therapy

Once the FDA approves treatment, more insurance companies could have the requirement to offer coverage.

All of us working in the Medicare space are eager to see more stem cell therapies with coverage by Medicare. Also, if you would like rates on Medicare Supplement plans in your area to help protect you against high out-of-pocket costs, contact us today.