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Medicare and Stem Cell Therapy

Stem cell therapy has revolutionized the healthcare system. It has provided hopes for patients who suffer from diseases that were considered incurable and even some other acute and chronic diseases that had a lesser chance of recovery.

It can relieve the symptoms the patients are experiencing and also enhance the quality of their life. Here is a brief discussion about whether stem cell theory is covered by Medicare.

stem cell research

Will Medicare help cover stem cell therapy?

Medicare Plan A and B cover the costs of stem cell therapies when certain criteria are fulfilled. However, even in these cases, Medicare does not reimburse the full costs.

Stem cell therapies that involve blood-forming stem cells are approved by the FDA. And hence, only these therapies would be covered by Medicare. There are certain limits to the coverage of stem cells therapies depending on the types of stem cells used as discussed beneath:

What are Stem Cells?

Stem cells are the cells that are formed in the body at birth. The uniqueness of these cells is they can change into any type of cell found in any organ or tissue of the body. These cells have the ability to regenerate and form more cells of a similar type to heal the damaged tissues and organ. These cells play an important role in producing organs, ligaments, bones, muscles, tendons, joints and skin.

What are the different types of stem cells?

There are basically 4 main types of stem cells that the body can produce during its life.

  1. Mesenchymal stem cells
  2. Induced Pluripotent stem cells
  3. Embryonic stem cells
  4. Tissue-specific stem cells

HSCT or Hematopoietic Stem Cells are also a type of stem cell. Stem cell therapies using these cells would be covered by Medicare only when it is performed for conditions such as:

  • Myelodysplastic Syndromes
  • Wiskott-Aldrich Syndrome
  • Leukemia
  • Severe Combined Immunodeficiency Disease

Autologous Stem Cell Transplantation is covered by Medicare Plan A and B when it is recommended for the management of the following conditions:

  • Acute Leukemia in remission
  • Advanced Hodgkin’s Disease
  • Resistant non-Hodgkin’s Lymphomas
  • Recurrent Neuroblastoma

Stem Cell Therapy is not covered by Medicare to treat the following conditions:

  • Multiple Sclerosis
  • Spine Arthritis
  • Spine Degeneration
  • Ligament Tears
  • Hip Arthritis
  • Meniscus Tears
  • Stroke
  • Torn Rotator Cuffs
  • Parkinson’s Disease

When stem cell therapy is performed for the management of these conditions, it would not be covered by Medicare Plan A or B. For example; though Stem cell therapy is considered effective for the management of osteoarthritis of the knee joint, it is not covered by Medicare as it is not approved by the FDA,

Medicare beneficiaries who experience chronic pain due to osteoarthritis can check whether any other insurance plan covers the expenses of stem cell therapy.

They can check the coverage offered by Medicare Advantage Plans and sign up for one if they anticipate they might need to undergo the procedure in the future. They should also check the specific criteria that must be fulfilled in order to be eligible for the coverage.

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