As medical technology advances, we have begun to get questions from Medicare beneficiaries wanting to know: Does Medicare cover stem cell therapy?
Stem cells are part of what every organ and tissue in a person’s body is made up of. They provide certain characteristics needed for each organ or tissue to operate properly.
Humans gain four main types of stem cells throughout their life. These stem cells exist in many different parts of a body. Each stem cell type forms at different periods of time during a person’s life. The four main types of stem cells are,
- Embryonic stem cells
- Tissue-specific stem cells
- Mesenchymal stem cells
- Induces Pluripotent stem cells
The two main characteristics of all stem cells are that they are self-renewable and that they differentiate and develop into more specific and specialized cells. Because they have the ability to change, the type of stem cells in a person’s body is always advancing. Also, as a person ages, the number of stem cells they have is continually changing.
One of the more specialized types of stem cell is the tissue-specific stem cells. These stem cells continue to live in a person’s body throughout their life, while others aren’t constant. Depending on which organ or tissue in which they live, will determine which type of cell these tissue-specific stem cells create.
For instance, tissue-specific stem cells within the bone marrow of a person’s body are hematopoietic stem cells that create specific cells that the bone marrow needs.
What are Hematopoietic Stem Cells?
Hematopoietic stem cells can become additional bone marrow cells or any type of blood cells. These blood-forming stem cells can help raise red blood cell count, white blood cell count, and platelets.
If a person has abnormal hematopoietic stem cells, this can cause the blood cells that they create to be abnormal as well. Abnormal hematopoietic stem cells usually form from certain cancers, like Leukemia. In a case like this, one might consider a stem cell transplant.
Hematopoietic Stem Cell Transplantation
Since 1973, doctors have been performing bone marrow transplants between unrelated patients. A stem cell transplant is a form of therapy in which the goal is that transferred stem cells will create healthy, normal blood cells.
Hematopoietic stem cell transplantation (HSCT) is also used to help replace cells that have been lost due to injury, cancer, or even the chemotherapy and radiation used as a treatment for cancer. In fact, these transplants most often treat patients with leukemia and lymphoma.
However, doctors also use transplants to treat other types of blood diseases, such as sickle cell anemia, aplastic anemia, and thalassemia.
Are Stem Cell Therapies Covered by Medicare?
Although there are other stem cell therapies out there, hematopoietic stem cell transplantation (HSCT) is one of very few therapies that Medicare covers even a part of. However, it depends on what condition your healthcare provider is treating.
A few conditions that are treated by HSCT and are usually covered by Medicare are,
- Severe Combined Immunodeficiency Disease (SCID)
- Wiskott-Aldrich Syndrome
- Myelodysplastic Syndromes (MDS)
Another type of stem cell therapy that Medicare might cover is Autologous Stem Cell Transplantation (AuSCT). Doctors use AuSCT to treat conditions like:
- Acute Leukemia in remission
- Resistant non-Hodgkin’s Lymphomas
- Recurrent Neuroblastoma
- Advanced Hodgkin’s Disease
Other stem cell therapies used to treat join conditions and neurological conditions, however, are not covered by Medicare. These include stem cell therapies that help treat and manage the following conditions:
- Knee Arthritis
- Hip Arthritis
- Spine Arthritis
- Spine Degeneration
- Ligament Tears
- Meniscus Tears
- Torn Rotator Cuffs
- Parkinson’s Disease
- Multiple Sclerosis
As you can see, the list of what is not covered by Medicare is substantially longer than the list of what is covered by Medicare. This is because, in order for Medicare to approve coverage for a procedure, it must be considered both medically necessary and FDA approved.
The main reason why stem cell therapy for arthritis and the other items aren’t covered is that the stem cell therapies used to treat those issues are not FDA approved yet. The only stem cell therapies currently approved for use in the United States by the FDA are therapies consisting of blood-forming stem cells, like the hematopoietic stem cell transplantation.
What Part of Medicare Covers Stem Cell Therapy?
If Medicare has approved stem cell therapy, Part A will provide coverage for that therapy. It’s important to note that there is a possibility that not all costs for the therapy will be paid for by Medicare. You might be looking at some out-of-pocket expenses as well.
Also, unlike organ transplants where you must have the procedure done at a Medicare-approved facility, patients can pursue stem cell transplants from centers that Medicare has not approved.
Cost of stem cell therapy varies from patient to patient. Factors that could change the price of your treatment are things like your specific doctor’s charge, the type of facility you receive the service in, and if you have supplemental insurance or not.
Medigap plans are supplement plans that give Medicare beneficiaries extra coverage. After Original Medicare Part A and Part B pay their portion of your treatment, Medicare will send your claim to your Medigap plan to pay some or all of the rest (depending on which Medigap plan you have chosen.)
Stem cell therapies usually cost thousands of dollars so having a Medigap plan could benefit you tremendously.
What You Should Do If You’re Considering Stem Cell Therapy
The road to FDA approval on all stem cell therapies is a long and winding road. The International Society for Stem Cell Research (ISSCR) still faces many challenges. They must overcome these before they can get additional approval on other stem cell therapies.
One challenge is finding and growing the correct type of stem cell needed for each particular therapy. Another is being able to create stem cell lines that won’t lead to rejection of the host. Lastly, there is a challenge in being able to deliver the stem cells to the correct body part.
Because the majority of stem cell therapies aren’t FDA-approved, it’s smart that you make sure your therapy is FDA-approved or not prior to receiving treatment. It’s also good for you to know whether the FDA has not yet approved a treatment but that treatment is under the study of an Investigational New Drug Application (IND).
Hopefully, in the future, more stem cell therapies will be better covered by Medicare. However, in the meantime, be cautious about where and how you receive stem cell therapy. Ask your doctors whether your stem cell therapy will be covered by Medicare before they perform any procedure.