Medicare coverage for stem cell therapy will only apply to services that the FDA approves. Further, treatment must be medically necessary for Medicare to cover it. In your research below, you’ll learn which services have coverage and which don’t. Also, we’ll go over supplemental Medicare options that can help cover the cost of stem cell treatments.
Does Medicare Cover Stem Cell Therapy?
Medicare covers a portion of several types of stem cell therapies. But therapy must be medically necessary and the procedure must have FDA approval. Part A will help cover inpatient costs while Part B will cover a portion of outpatient costs. The only treatments approved are those consisting of blood-forming stem cells.
Medicare Approved Options:
- Hematopoietic Stem Cell Transportation
- Autologous Stem Cell Transplantation
How Much Does Stem Cell Therapy Cost with Medicare?
Stem cell therapy prices usually range from around $5,000 – $50,000. If you receive Stem Cell Therapy in outpatient settings, this will fall under Part B. Part B covers 80% of the cost, you’re responsible for 20% of the cost. If you receive Stem Cell Therapy in inpatient settings, this will fall under Part A. Part A has a deductible as well as other cost-sharing you’re responsible for.
If you have a Medicare Supplement, the above-mentioned coinsurance would be covered as well as the cost-sharing under Part A. Depending on which Medigap letter plan you enrolled in, you may have zero cost-sharing to pay for Stem Cell Therapy.
Does Medicare Cover Stem Cell Injections?
As long as the injections are FDA approved, Medicare covers treatments. Stem cell therapy treatment is an inpatient hospital stay. Inpatient therapy for stem cells is 3-4 weeks long. Yet, outpatient stem cell therapy will fall under Part B and have a shorter duration.
Does Medicare Cover Hematopoietic Stem Cell Transplantation?
Medicare partially covers Hematopoietic Stem Cell Transplantation. But, coverage only applies to those with specific conditions. Some of these conditions are Leukemia and Severe Combined Immunodeficiency Disease.
Does Medicare Cover Autologous Stem Cell Transplantation?
Yes, Medicare will cover Autologous Stem Cell Transplantation. Autologous therapy can help treat Acute Leukemia that’s in remission and Advanced Hodgkin’s Disease.
Do Medicare Advantage Plans Cover Stem Cell Therapy?
Advantage plans must provide the same coverage as Part A and B. However, they decide how much you’ll pay out of pocket in the form of cost-sharing. Advantage plans also require you to use their in-network doctors. If you go out of network, you’ll have to pay 100% of the cost. You’ll pay more out of pocket as you go with an Advantage plan vs a Medigap plan.
Do Medigap Plans Cover Stem Cell Therapy?
When Medicare approves the service, Medigap will always pay. You can take the guesswork out when it comes to predicting your out of pocket costs. When you know what to expect, you can focus on treatment instead of finances. If you’re on the fence about which plan to choose, compare the differences between Advantage and Medigap.
Does Medicare Cover Stem Cell Therapy for Knees?
It makes sense that people look for alternatives to knee replacements. Many suffer from osteoarthritis in their knees and look for solutions to help with the pain. Medicare won’t cover stem cell therapy for knees because it doesn’t have FDA approval. You’d have to pay for this treatment. The average cost for stem cell therapy of your knees is about $3,000 – $5,000 per knee.
Does Medicare Cover Stem Cell Therapy for Back Pain?
Medicare won’t cover stem cell therapy for back pain since there’s no FDA approval. Costs for stem cell treatments for back pain are around $5,000 to $7,000. But, Medicare does cover other back pain treatments.
Does Medicare Cover Stem Cell Injections for Shoulders?
Like other forms of stem cell therapy, the use within your shoulders doesn’t have FDA approval. Medicare won’t cover stem cell injections for shoulders. Further, shoulder injections can range in price from $1,500 – $10,000.
FAQs
How to Get Coverage for Stem Cell Therapy Under Medicare
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Pretty stupid isn’t it. My two TKR costs over $150,000. That $150,000 would pay for 21 Stem Cell treatments. If only half of them worked it would save Medicare about
$1.5 million dollars. Now this also does not count the automatic rise in the price of Stem Cell treatments when Medicare approves the proceedure.
I have osteo-arthritis in both knees. Was recommended for bi-lateral knee replacement 20 years ago., but every time i hear a story of a positive outcome, i hear another from someone who wouldn’t do it again. I have been to 3-4 seminars on stem cell therapy and see it as a viable alternative to knee replacement surgery. My condition highly affects my quality of life. Under no circumstances can i afford to lay out $5,000 for each knee. I am on a fixed income. Stem cell therapy has been successfully utilized n Europe for the past 2-3 decades. WHY are we lagging so far behind? I have my suspicions, but that’s all they are at this time. What of TRT Therapy? Is that covered by Medicare? Any info would be very much appreciated. Thank you.
Hi Dennis! Yes, for some conditions Medicare will cover TRT. It would be something your doctor can help you determine and get you the appropriate documents to show it’s medically necessary.
I have been told stem cell can help with neuropathies, is it covered and do you know what health plans cover it, I called the Mayo Clinic and they would not talk to me because I was not on their plan
Hi Richard! Medicare covers many different types of stem cell therapy as long as it’s approved by the FDA & your doctor says it’s medically necessary. Medicare & Medigap will cover it, Medicare Advantage may not. It depends on the plan and carrier you enroll with. The Mayo Clinic does accept Medicare.
My husband is 74, and has COPD. His quality of life is poor. I have been investigating autogulus stem cell treatments for him, but the cost is extremely expensive. He has Medicare A & B and Plan G. He also has VA insurance. Will Medicare cover the costs for treatment?
Hi Josie! Yes, Medicare will cover autologous stem cell treatments for specific diagnoses. I would contact your husband’s primary care physician to make sure you have everything you need to present to Medicare so that it’s covered.
How do I sign the petition for stem cell therapy to be approved
Hi Robert! You can sign the petition here.
Hubby has spinal stenosis which can be treated by stem cell therapy. Will Medicare and Humana pay?
Hi Sharon! I would start by asking his doctor. Normally, they will be able to tell you if Medicare will pay for it. If Medicare does cover it, and you have a Medicare Supplement plan through Humana, then they will also cover it. However, if you have a Medicare Advantage plan through Humana, you’ll have to call them to find out if and how much they will cover. Advantage plans out of pocket expenses are much different than Medicare and Medigap. I did find some information on CMS for stem cell treatments that may be helpful to you.
Why does Medicare not pay for stem cell therapy for the lungs? It would improve my life so much.
So Medicare will Pay the bills for having both of my knee icompletely replaced at tens of thousands of dollars expense but they won’t cover eight hundred dollars For PRP injection into my knee that could heal them.
Yes they should cover stem cells because there are so many people out there that would benefit greatly from this, & many lives saved.
Yes, the FDA needs to approve these types therapies. There are so many alternatives to help people, PEMF therapy, cold laser treatments, stem cell therapy. These therapies would greatly enhance quality of life for many patients, not to mention greatly reduce opioid use. We need to start somewhere and offer help and education for those suffering with pain and/or illness. I hope for you, Donna, that it happens soon.
How do I sign the petition my doctor has recommended a knee replacement within the next year
Hi Frank! You can sign the petition here!
Hi, my name is Faith. I’m diagnosed with OA of the left hip. I have Medicare and Medicaid. I’m also diagnosed with multiple sclerosis, over 20 years. Will this stem research be beneficial to my left hip if approved?
Hi Faith! That’s something you would have to speak to your primary physician about. I hope it’s beneficial for you!
Medicare should absolutely pay for stem cell therapy. Aferall, stem cell therapy is less invasive to our bodies and the recovery time is faster. Any ideas on what we can do to get SCT covered by Medicare?
Hi Wanda! Yes, you can sign this petition to get CMS to cover all Stem Cell therapy treatments!