Stem Cell Therapy

Michael T Braden December 12, 2023 MEDICARE NEWS MEDICARE

STEM CELL THERAPY AND OTHER CUTTING-EDGE REGENERATIVE PROCEDURES

In this article, we look at stem cell therapy and the procedures covered by Medicare. As many of you have heard, Stem Cell Therapies and Regenerative Therapy are gaining popularity for treating mobility-related ailments. Two of the most well-known companies offering these treatments are QC Kinetix and Regenesis.

Many companies have clinic locations across the US offering advanced biological treatments for Knee, Hip, and Shoulder Pain. Even though commercials you may have heard on the radio, in other print advertisements, or on television sound terrific, not all of them have been approved by the United States Food and Drug Administration.

There are several different "types" of Stem Cells. Some Stem Cells can only be used as Blood Cells, while others can be used as fresh, new cells that can be injected into different parts of your body; they may grow new cartilage that has worn down in our bodies' joints over time, particularly with athletes. The hope is to eliminate the need for hip and knee replacements by using "Our Bodies Natural Healing Powers" with injections of stem cells, either our own, taken from our bone marrow, or plant-based stem cell cultivation.

Companies such as QC Kinitix and Regenexx make impressive claims in their advertising and report positive results; however, there are no guarantees the procedures will work for everyone. This is the #1 reason these therapies aren't covered by health insurance, except through HSAs (Health Savings Accounts). This leaves the success and viability of these companies to their patients paying out-of-pocket for these treatments, which can be great if they work but can be quite costly if they do not.

These companies and hundreds more continue to apply to the FDA for approval of case studies, so there will be more thorough, quantitative data to evaluate and make further recommendations.

STEM CELL THERAPY

STEM CELL THERAPY

STEM CELL THERAPY TREATMENTS THAT ARE COVERED BY MEDICARE

Yes, Medicare Covers Stem Cell Therapy, but only in specific cases. First, Medicare covers stem cell therapy only if your doctor deems the procedure medically necessary. Medicare coverage for stem cell therapy applies only to services approved by the Food and Drug Administration (FDA).

Your Medicare Part A benefits help cover inpatient costs, while Medicare Part B will cover a portion of your outpatient costs, but the only treatments approved are those consisting of blood-forming stem cells.

Here are the Medicare-approved options available for your healthcare:

• Hematopoietic Stem Cell Transplantation (HSCT)

• Autologous Stem Cell Transplantation (AuSCT)

  
  

While such therapies are FDA-approved for certain cancers, blood disorders, and autoimmune disorders, they are not approved for other health issues. This includes stem cells from your own body. The Office of Tissues and Advanced Therapies (OTAT) lists the FDA-approved stem cell therapy options your plan may cover.

Having stem cell therapy covered by Medicare is possible in certain situations to treat only a few disorders at present. Ongoing stem cell treatments are emerging for osteoarthritis, particularly for damaged cartilage in the knee, shoulders, and hips. However, the Food and Drug Administration (FDA) has not approved these treatments. This does not mean they will not approve new therapies in the future, but there is no concrete timetable for approvals.

Because Medicare strictly approves only FDA-approved procedures and treatments, it has not approved Stem Cell Treatments on a large scale.

Patients may need stem cell therapy for many reasons, and the procedure involves different methods. Furthermore, it’s vital to understand which healthcare providers offering stem cell therapy accept Medicare benefits. Learn more about how to cut your costs and receive the benefits that fit your individual needs by having Medicare pay for stem cell therapy.

STEM CELL THERAPY

STEM CELL THERAPY IS MOST POPULAR FOR PEOPLE EXPERIENCING MOBILITY ISSUES WITH THEIR KNEES, SHOULDERS, AND HIPS

Because the FDA does not approve knee stem cell therapy, your Medicare benefits won’t cover it. It makes sense that people look for alternatives to knee replacements, since many people with knee osteoarthritis want solutions to relieve pain. Still, until the FDA approves this treatment, your benefits won’t cover it.

Did you know that many treatments will be in the neighborhood of $500 - $15,000 with absolutely no guarantees whether they are going to help you relieve your pain?

Medicare only approves treatments, medications, and therapies approved by the Food and Drug Administration (FDA). Currently, there are no FDA-approved procedures/treatments for treating Osteoarthritis of the Knee, Hip, or Shoulder.

WILL MEDICARE APPROVE STEM CELL THERAPY FOR CHRONIC BACK PAIN?

The FDA doesn’t approve stem cell therapy for back pain, so Medicare benefits won’t cover these medical expenses. However, Medicare does cover other types of back pain treatments. Considering the cost of stem cell treatments for back pain, which is around $5,000 to $7,000, and the risk that can come with receiving non-FDA-approved healthcare, alternatives are essential to consider.

Many advances, including Using Sound Wave patterns and Electrical Impulse Patterns to confuse the nerves and significantly reduce certain back pain conditions, have either been approved or are approved for testing by the FDA and Medicare. Any Doctor who accepts Medicare will be able to inform you if you may be a candidate for one of these studies.

WHAT ABOUT STEM CELL THERAPY FOR ARTHRITIS?

Medicare won’t cover stem cell therapy for arthritis because the FDA has not yet approved this use. This means if you agree to receive such treatments, you are doing so at your own risk at your own risk, and you’ll be footing the bill yourself because Medicare does not cover these costs currently. While Medicare doesn’t cover stem cell therapy for arthritis, other treatments do exist. Furthermore, there may be available clinical trials that offer Medicare coverage, but you’ll need to ensure they are approved by the program beforehand.

ARE SOME STEM CELL INJECTIONS COVERED UNDER MEDICARE?

Yes, some stem cell injections are provided by your Medicare benefits. However, Stem cell therapy is an inpatient hospital stay that can last3 to 4 weeks. Medicare Part A covers these treatments. Outpatient stem cell therapy falls under Medicare Part B and is shorter in duration. You need to be sure that A) Your Doctor Accepts Medicare and that B) they attest that these procedures are Medically Necessary.

The main point to remember about stem cell injections is that Medicare coverage is granted only if the injections are FDA-approved. There are several applications for stem cell injections for therapy, but there are only certain applications that are covered by your Medicare coverage.

WHAT ABOUT AUTOLOGOUS STEM CELL TRANSPLANTS?

Yes, Medicare covers autologous stem cell transplantation (AUSCT). Autologous therapy can help treat acute leukemia that’s in remission and advanced Hodgkin’s Disease, along with assisting in replenishing stem cells destroyed while being treated for cancer via chemotherapy and radiation.

DOES MEDICARE COVER NEUROPATHY? WHAT ABOUT STEM CELL INJECTIONS TO KEEP NEUROPATHY FROM PROGRESSING?

Medicare approves peripheral neuropathy, but stem cell use is where the water gets muddy. That's because, to be covered by your Medicare coverage, the FDA must approve your healthcare procedure. While Medicare covers several applications for stem cell therapy, neuropathy does not fit the guidelines.

DOES MEDICARE COVER REGENERATIVE STEM CELL THERAPY?

Medicare does not cover regenerative stem cell therapy because the FDA has not yet approved it. There is a wide range of potential future applications, but the FDA has yet to support them. Please refer to this link about Regenerative Treatments in the FDA’s Consumer Alert on Regenerative Medicine, covering everything from the treatment of COVID-19 to epilepsy and much more.

IS STEM CELL THERAPY FOR SOME CANCER TREATMENTS APPROVED BY MEDICARE?

Yes, Medicare does cover some stem cell therapy; however, it does not cover every form.

Yes, some Stem Cell therapies have been approved by Medicare benefits for cancer, but so far, the FDA has only approved certain cancers, such as lymphoma and leukemia. There is growing optimism for expanding Stem Cell Therapy along with the availability of coverage through Medicare. Clinical trials continue to advance modern medicine even further every day.

IS HEMATOPOIETIC STEM CELL TRANSPLANTS COVERED OR ACCEPTED BY MEDICARE?

Yes, Medicare can cover Hematopoietic Stem Cell Transplantation (HSCT). However, coverage applies only to specific conditions, such as leukemia, severe combined immunodeficiency disease (SCID), or treatment of Myelodysplastic Syndromes (MDS). Coverage for HSCT for MDS is only available if the treatment is part of a Medicare-approved clinical study.

Whether or not the treatment is delivered through a study, strict guidelines dictate if and how you are covered. Before receiving HSCT, speak with your healthcare provider to confirm whether your treatment meets the guidelines.

STEM CELL THERAPY COST COMPARISON

WILL YOUR MEDICARE SUPPLEMENT PLAN COVER YOUR STEM CELL THERAPY?

A Medicare Supplement (Medigap) plan covers the same healthcare services as Original Medicare. Therefore, a supplemental policy will cover any FDA-approved, Medicare-approved stem cell therapy. A supplemental policy will cover any FDA-approved, Medicare-approved stem cell therapy.

Medicare Part B covers 80% of the cost, but you’re still responsible for the remaining 20%. Your Medicare Part A benefits will cover you if you receive stem cell therapy as an inpatient in an inpatient setting. However, it’s important to remember that Medicare Part A has a deductible and other cost-sharing expenses for which you’re responsible.

If you have a Medicare Supplement, you can cover these leftover healthcare costs. Depending on your Medigap plan, you may have zero cost-sharing for stem cell therapy.

Stem cell therapy prices can range from $5,000 to $50,000 if not more. If Medicare approves the service, Medigap will also always pay. This matters because it reduces guesswork when predicting out-of-pocket costs.

Every Medicare beneficiary should know that just because Medicare approves something, their Medicare Advantage plan may not approve it.