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.
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; however, they only pay a portion of the expense.
When Medicare approves stem cell therapy, coverage is available under Part A, and Part B. Stem cell transplants are allowable at non-Medicare facilities.
Since Medicare only pays a portion of your stem cell therapy costs, you should expect high out-of-pocket expenses. Since these therapies can cost thousands, a Supplement plan could protect your finances from being drained.
Hematopoietic stem cell transplantation is one that Medicare helps you pay, 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 coverage includes:
- Myelodysplastic Syndromes (MDS)
- Wiskott-Aldrich Syndrome
- Severe Combined Immunodeficiency Disease (SCID)
Autologous Stem Cell Transplantation
AuSCT usually includes:
- Advanced Hodgkin’s Disease
- Acute Leukemia in remission
- Recurrent Neuroblastoma
- Resistant non-Hodgkin’s Lymphomas
Stem Cell Therapy Not Covered by Medicare
Medicare won’t cover stem cell therapy to treat the following conditions:
- Spine Arthritis
- Multiple Sclerosis
- Spine Degeneration
- Hip Arthritis
- Ligament Tears
- Meniscus Tears
- Torn Rotator Cuffs
- 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
Unfortunately, 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 an excellent alternative to knee replacement since it could regrow cartilage.
Stem cell therapy for the knees happens in the doctor’s office, and patients are at work by the next day: meaning, 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 only approves when the FDA approves.
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 is that they can change into other types of cells found throughout the body. They can even regenerate and help the other cells.
They 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 four main types:
- Induced Pluripotent
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. Either way, Arthritis can affect the spine and other joints in the body.
The most common signs of Arthritis are a 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 beneficiaries experience chronic pain due to arthritis and require this type of treatment. It’s important to know what 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 can extract stem cells from the body and then reuse them for pain relief.
Stem cells benefit joint(s) and surrounding tissues as it enhances the natural repair of the area.
Minimally invasive procedures are always the route to go when facing pain, whether from an injury or degeneration.
The most common for arthritis are mesenchymal stem cells. These types come 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 medically necessary things and with FDA approval.
The big reason therapy stem cells for arthritis won’t have coverage 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.
- 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 include ointments, gels, and creams; these reduce inflammation and pain. Prescription pain relievers are opioids. 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 are both oral and injectable; they 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
Before receiving any stem cell therapy, you should check that it has FDA approval. 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 its 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 procedure may have coverage.
Will Medicare Insurance Cover Lipogems
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.
Sign the Petition to Get All Stem Cell Therapies & Treatments Covered
If you would like to take action in getting all Stem Cell therapies & treatments covered, you can sign this petition!
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 have coverage. 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. You can even fill out an online rate form to better understand what the rates and coverage options in your area.