Is Stem Cell Therapy Covered By Medicare?
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Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Mary West — Updated on November 22, 2024- Original medicare
- Medicare Advantage
- Medigap
- Medicare Part D
- Types of therapy
- Cost of treatment
- Summary
Original Medicare and Medicare Advantage plans both cover certain types of approved stem cell therapy.
Medicare Parts A and B, also known as Original Medicare, provide coverage for approved stem cell treatments and the associated out-of-pocket costs. However, coverage varies between the different Medicare options.
The purpose of Food and Drug Administration (FDA)-approved stem cell therapy is to restore typical blood production and development in a person whose body has lost this function.
This article discusses this type of stem cell therapy, examines the coverage and costs of each part of Medicare, and describes the specific procedures that Medicare covers. It also looks at the costs of inpatient stem cell therapy for people who do not have Medicare.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person needs to self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Stem cell therapy with Original Medicare
Share on PinterestMedicare covers part of the costs of two types of FDA-approved stem cell therapy or transplants. The coverage applies to transplants, whether doctors perform them as an inpatient or an outpatient procedure.
Medicare Part A, which is hospitalization insurance, covers inpatient transplants. However, Part A pays only for admissions that fall under a regulation called the Two-Midnight rule. According to this rule, the admitting doctor expects a person to require a stay in the hospital for at least two midnights.
Although Part A is generally not appropriate for shorter hospital stays, Medicare may grant coverage on a case-by-case basis, depending on the admitting doctor’s judgment.
The cost relating to Part A in 2025 is a $1,676 deductible. There is a $0 coinsurance for the first 60 days of a hospital stay.
Part B, which is medical insurance, covers outpatient transplants that healthcare professionals consider medically necessary.
In 2025, the yearly deductible of $257 applies. Once a person meets the deductible, they usually pay 20% of the Medicare-approved amounts for doctor services and other costs involved in the therapy.
Stem cell therapy with Medicare Advantage
Medicare Advantage (Part C) provides the overage for parts A and B, while most plans also include prescription drug coverage.
Private insurance companies administer Medicare Advantage policies, and because of this, the out-of-pocket costs are different from those of Original Medicare.
Out-of-pocket costs may also vary among plans, but all policies have a yearly cap on expenses. Additionally, an individual with Medicare Advantage must go to an in-network provider.
Read about the advantages and drawbacks of Medicare Advantage plans.
Stem cell therapy with Medigap
Medigap is Medicare supplement insurance. People who have Original Medicare may buy a Medigap plan, which helps them pay out-of-pocket costs relating to parts A and B. The costs that this plan generally covers can include:
- deductibles
- copays
- coinsurance costs
Learn more about Medigap plans and costs.
Stem cell therapy with Part D
Someone with original Medicare is eligible to enroll in a Part D plan for prescription drug coverage, which includes medications necessary for stem cell therapy. Part D deductibles, copayments, and coinsurance costs vary according to the policy a person has purchased.
Learn more about Medicare Part D costs.
Types of stem cell therapy Medicare covers
Medicare only covers two stem cell procedures: allogeneic hematopoietic stem cell transplantation (Allo-SCT) and autologous stem cell transplantation (Au-SCT).
Allo-SCT
In Allo-SCT, a healthcare professional delivers healthy donor stem cells to a person through an intravenous infusion via the veins. The purpose is to restore typical blood production in someone whose body cannot perform this function.
A candidate for the transplant may be an individual with a deficiency in blood production, which can either be an inherited or acquired deficiency. An example could be someone with severe aplastic anemia.
Before the transplant, an individual will receive treatment to weaken the immune system — such as chemotherapy, radiation therapy, or both — so their body will not reject the donor cells. This treatment also allows the donor cells to reach the bone marrow, where they grow and make new blood cells.
This procedure may have complications, including rejection of the donor cells despite the treatment to weaken immunity. Another possible complication is that the donor’s immune cells may attack a person’s healthy cells.
In addition to helping the beneficiary with costs, Medicare also assists the donor with costs. Covered donor expenses include doctor services, hospital care, and follow-up care.
Au-SCT
An Au-SCT procedure restores stem cells without the help of a donor. The transplant aims to enable the body to resume blood production and development after the organs and tissues sustain damage.
Candidates for the transplant include those with blood cancers, such as lymphoma or leukemia.
Before an Au-SCT transplant, a health professional will remove a person’s stem cells and freeze them. Afterwards, the individual will receive high dose chemotherapy with or without radiation therapy. The healthcare professional then returns the collected stem cells to the body.
If the procedure is effective, the transplanted cells make new blood cells within the bone marrow.
Au-SCT has a higher relapse rate than Allo-SCT, but because it does not involve donor cells, Au-SCT does not carry the risk of a healthy cell attack.
Stem cell therapy cost
Stem cell therapy can be expensive. According to Hope Stem Cell Network (HSCN), the cost of stem cell therapy can range from $5,000 to $50,000. The cost generally depends on the type of stem cell therapy and the dosage.
The HSCN also states that the average cost of stem cell site injections is $2,000 to $5,000. The average cost for expanded or increased dosage cell products is $20,000 to $55,000.
Individuals can contact Medicare to find out more information on the coverage for stem cell therapy.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Summary
People with Medicare are eligible for coverage of two types of stem cell transplants. Candidates for these therapies may include individuals with a blood disorder, such as aplastic anemia, or someone with blood cancer, such as lymphoma.
A person with Original Medicare can enroll in a Medigap plan, which helps with out-of-pocket expenses. An individual with a Medicare Advantage plan will have out-of-pocket costs that differ from those of Original Medicare.
Note that stem cell therapy is costly. Before undergoing one of the transplants, a person may wish to check their Medicare plan to get an estimate of both covered and out-of-pocket costs.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
- Stem Cell Research
- Health Insurance / Medical Insurance
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- Medicare / Medicaid / SCHIP
How we reviewed this article:
SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.- Allogenic stem cell transplantation. (n.d.).https://www.lls.org/treatment/types-treatment/stem-cell-transplantation/allogeneic-stem-cell-transplantation
- Approved cellular and gene therapy products. (2024).https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products
- Autologous stem cell transplant. (n.d.).https://www.cancer.gov/publications/dictionaries/cancer-terms/def/autologous-stem-cell-transplant
- Autologous stem cell transplantation. (n.d.)https://www.lls.org/treatment/types-treatment/stem-cell-transplantation/autologous-stem-cell-transplantation
- Costs for Medicare drug coverage. (n.d.).https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage
- Frequently asked questions related to coverage criteria and utilization requirements in CMS Final Rule (CMS-4201-F). (2024).https://www.aha.org/system/files/media/file/2024/02/faqs-related-to-coverage-criteria-and-utilization-management-requirements-in-cms-final-rule-cms-4201-f.pdf
- Hancock R J. (2023). Stem cell therapy cost: What you need to know (2023).https://www.hscn.org/post/stem-cell-therapy-cost
- Medicare & You 2025: The official U.S. government Medicare handbook. (2024).https://www.medicare.gov/publications/10050-medicare-and-you.pdf
- Medicare Advantage plans. (n.d.).https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Webinar-Archive-Documents/MedicareAdvantageFactSheet.pdf
- Medigap overview. (n.d.).https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/supplemental-insurance-for-original-medicare-medigaps/medigap-overview?utm_source=pocket_mylist
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Medically reviewed by Meredith Goodwin, MD, FAAFP — Written by Mary West — Updated on November 22, 2024Latest news
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