Stem cell therapy promises a longer life expectancy for many. However, there are immense cost for this treatment. Luckily, with Medicare insurance that cost could significantly be covered or fully paid.
Read on to learn more about Medicare and find out which Medicare Supplement options are best for you.
What is Stem Cell Therapy?
Your body has specialized cells like blood cells, cancer cells, bone cells, and more. Your body also has stem cells, these cells are not confined to a specific role. For example, Embryonic stem cells can transform into any other type of cell. Adult stem cells can transform into specialized cells.
Through stem cell therapy this treatment repairs blood-forming stem cells. It then uses those cells to replace damaged cells.
What is a Hematopoietic Stem Cell Transplantation?
Hematopoietic Stem Cell Transplantation is used to treat medical conditions that affect the immunity system, blood, or bone marrow.
Adult stem cells called Mesenchymal cells are therapeutic stem cells used to facilitate the injection of hematopoietic cells. These cells can then develop into new white blood cells, red blood cells, and platelets.
Are you or a loved one is considering HSCT, but aren’t sure of the costs? Here are the main things to consider.
Does Medicare Cover Stem Cell Therapy?
Medicare may cover some or all of the stem cell therapy expenses. To qualify for Medicare coverage the treatment must meet these requirements:
1. The treatment must have FDA approval.
2. The treatment must be deemed “medically necessary.”
Types of Stem Cell Therapies That Medicare Covers
Only blood-forming autologous and hematopoietic stem cell treatments (HSCT) are eligible for Medicare assistance.
Looking at an HSCT treatment option? Good news! Medicare may partially cover the costs of this treatment for certain conditions.
Medicare may also cover Autologous Stem Cell Transplantation. Has chemotherapy or radiation caused damage to blood-producing cells? Do you have a blood-related condition? Then this treatment option might be best for you.
Medicare Part A
Does your stem cell therapy treatment require a hospital stay or inpatient procedure?
If so, you will receive assistance from Medicare Part A.
- You pay a $1,408 deductible (in 2020). Medicare covers the remaining inpatient cost for up to 60 days.
Your 2020 Part A coinsurance cost depends on the length of your hospital stay.
- From 61-90 days you must pay a $352 co-insurance fee.
- After 90 days, each “lifetime reserve day” costs $704 for each benefit period.
- Beyond the “lifetime reserve days,” you are responsible for the total cost.
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Get in touch with a Medicare specialist today and learn more about your Medicare Part A insurance options. Call us at 800-208-4974!
Medicare Part B
Most stem cell therapy treatments require medical services while you are in the hospital. Part B covers some of these services, including surgeries, chemotherapy, physical exams, blood work, or medical equipment.
It is important that you met these following conditions in order for Medicare to approve your stem cell therapy and pay 80% of the bill.
- Your stem cell treatment deemed “medically necessary.”
- You have paid your Part B deductible.
Even though 80% coverage with Medicare Part B is significant, that still leaves your 20% of the bill that you have to pay out of pocket. In these cases having a Medicare Supplement could benefit you.
Medicare Part D
Medicare Part D does not cover stem cell therapy. However, Part D may help pay for your prescription medications.
If you require prescription medications, the average monthly premium is $30 and may be higher if you have a higher income. Part D also has 4 phases: deductible, initial, donut hole, and catastrophic.
- The deductible phase requires you to pay for all prescription drug costs up to the $435 deductible amount in 2020.
- In the initial phase, you must pay the co-payment. However, Part D Medicare assists with prescription drugs up to $4,020.
- The donut hold phase does not cover the cost of prescription drugs. However, it does offer a 75% discount on brand name drugs and a 63% discount on generic drugs.
- In the catastrophic phase, after the initial $6,350 out-of-pocket cost:
Generic drugs are $3.50, brand-name drugs are $8.95, or 5% of the total medication cost – depending on which is higher.
Interested in finding the most cost-effective Medicare insurance options? You may consider Medicare Advantage or Medicare Supplement plans.
Medicare Advantage (Part C)
Medicare Advantage plans provide, at a minimum, equivalent coverage to Original Medicare. This may include qualified stem cell therapy treatments. Medicare Advantage plans may also include expanded coverage, including prescription medications.
Contact us at 800-208-4974 to learn if Medicare Advantage may reduce your share-of-cost and out-of-pocket expenses for stem cell therapy.
Can a Medicare Supplement (Medigap) Help?
While a Medicare Advantage Plan can help you get Medicare benefits, a Medigap policy only supplements your Original Medicare benefits.
Medigap is Medicare Supplement Insurance is sold privately and can assist with paying some of the remaining healthcare costs such as copayments, coinsurance, and deductibles.
It’s best to work with a qualified Medicare specialist to ensure the most cost-effective insurance plan.
FAQ About Stem Cell Therapy & Coverage Options
You may be eligible for Medicare assistance if the transplant assists with the growth of healthy blood cells. If you need a blood stem cell transplant, you may receive full or partial coverage.
The FDA has not approved the use of stem cells for any disorder. Thus, certain diseases do not qualify for stem cell therapy Medicare coverage. Medicare will not cover stem cell therapy for neuropathy or other non-blood-related disorders.
Every patient and all stem cell therapies are unique. On average, each stem cell injection produces new cells for up to a year. Stem cell protocols can last for weeks, with multiple injection sessions.
Treatment times vary depending on your individual condition and various factors. Additionally, your doctor may prescribe additional treatment options following stem cell injections depending on prescription needs or complications, such as infection.
Next Steps
Ready to discover the best Medicare benefits that work for you? Call Bluewave Insurance at 1-800-208-4974 today for a FREE consultation!
