Medicare Coverage for Stem Cell Therapy

There is Medicare coverage for stem cell therapy, although at this time it’s very limited. Pain doesn’t discriminate. It doesn’t care about your age, religion, sex or race. The causes of the pain can vary from a sporting injury to a car accident to degeneration over time.

There are various treatment options determined 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 approved by Medicare will be covered under Part A and Part B. Unlike most other transplants, stem cell transplants can be done at facilities that Medicare hasn’t approved.

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 is now approved by the FDA yet, it’s not covered for knee pain management.

What are Stem Cells

Stem cells are formed 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. Arthritis is usually categorized as mild, moderate, or severe and will progress over time.

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

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 included 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 extracted from the patients’ fatty tissue, bone marrow or blood.

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

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 that can be purchased and without a 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 usually considered opioid pain relievers. These medications are used to control discomfort that most practitioners agree are not a long-term care solution.
• Physical therapy is a stretching and strengthening program utilized to enhance 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 can be given to control inflammation and pain.
  Surgical Intervention usually used as a last resort when conservative treatment has been tried and failed.

Until the FDA Approves Stem Cell Therapy

Prior to receiving any stem cell therapy, you should double check that it’s FDA-approved. 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.

All of us working in the Medicare space are eager to see more stem cell therapies covered by Medicare. 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.