Stem cell therapy has been a hot topic in the press lately. With more and more medical providers offering stem cell treatments, patients around the country have been wondering, ”Is Stem Cell Therapy covered by Medicare.”
Stem Cell research has shown that it’s an effective treatment for chronic joint pain and arthritis sufferers and more recent studies are starting to show the benefit for treatment of neurological disorders as well. (M.S., Parkinsons, and Stroke)
So the team at Stem Cell: The Magazine, have put together some information to answer this question of insurance coverage for potential medical enrollees seeking stem cell and regenerative treatments.
So what is the answer to “Does Medicare cover Stem Cell therapy?”
However, it depends on the condition that the patient is seeking stem cell treatment for.
From the research that we have pulled up regarding Medicare Insurance Coverage for stem cell therapy; medicare does cover stem cell treatments, but not for some of the chronic degenerative conditions that regenerative treatments (stem cell therapy) can help them with.
For example, here is link for BCBS of North Caroline’s Medicare part C Coverage of Stem Cell:
You can see in this publication from BCBS that stem cell therapy is covered for the following conditions:
INDICATIONS FOR COVERAGE
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) eligible for coverage in the following:
a) The treatment of leukemia
b) The treatment of severe combined immunodeficiency disease (SCID) and for the treatment of Wiskott-Aldrich syndrome.
c) The treatment of Myelodysplastic Syndromes (MDS) pursuant to Coverage with Evidence Development (CED) in the context of a Medicare-approved, prospective clinical study.
3. Autologous Stem Cell Transplantation(AuSCT) is eligible for coverage in the following:
a) Acute leukemia in remission who have a high probability of relapse and who
have no human leucocyte antigens (HLA)-matched;
b) Resistant non-Hodgkin’s lymphomas or those presenting with poor prognostic
features following an initial response;
c) Recurrent or refractory neuroblastoma;
d) Advanced Hodgkin’s disease who have failed conventional therapy and have no HLA-matched donor.
You can see that outside of the listed conditions above, Medicare does not cover stem cell therapy for treatments joint conditions or neurological conditions that patients are more commonly seeking treatment for.
Another reference source from Blue Regence, BCBS of Oregon & Utah, reviews the use and coverage of stem cell therapy for orthopedic (joint) conditions:
In this article, it clearly states that stem cell therapy for the coverage of orthopedic conditions is not covered:
The orthopedic application of stem-cell therapy is not addressed within the stem cell transplantation NCD. (NCD = National Care Determinations)
What this means for any patient that is looking to receive regenerative and stem cell treatments for orthopedic conditions such as:
Knee & Hip Arthritis
Torn Rotator Cuff Injuries
Spine Arthritis and degeneration
Or neurological conditions such as..
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Medicare will not cover treatment for these conditions. In fact, most major medical carriers will not provide coverage for these treatments either.
Many chronic joint pain sufferers wonder why Medicare and most major carriers don’t provide coverage for these treatments if they are so effective, but there is a simple answer for why this is.
Medicare and most major health insurance are for emergency conditions. Regenerative medicine is still considered an elective treatment, close to wellness care. Insurance carriers are not in the business of providing wellness for coverage for their participants.
We found a great video that explains more about this by John R Hoffman at Arcadia University. In it he describes the challenges of Medicare coverage for Stem Cell Therapy.
Our hope at Stem Cell: The Magazine is that as more and more patients continue to seek out treatment of their orthopedic and neurological conditions using stem cell and regenerative treatments, that Mediare and major health insurances will accept stem cell as the first treatment for these chronic conditions.
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