Certain diseases or medical conditions can be treated or prevented with the use of stem cell therapy. If your needs meet certain requirements for approved treatment options with stem cell therapy, Medicare coverage may be available.
Understanding Stem Cell Therapy
Stem cells are biological building blocks that divide and become either more stem cells or transform into specialized cells that perform unique functions within the body, such as developing into blood cells, bone cells or the cells that form the layers of the skin, the brain and heart muscles. As a therapeutic tool, stem cells are a form of regenerative medicine and can be used to regrow or repair damaged tissues and organs and treat some medical conditions, such as cancer or heart disease.
Discovery of stem cell sources in the human body is ongoing, but these are a few of the known types of naturally occurring stem cells:
- Embryonic. This type of stem cell is typically considered the most versatile since these stem cells can transform into any other type of cell found in the human body. Artificially fertilized eggs are matured into blastocysts, or 3-5 day-old embryos, allowing scientists to gather stem cells for further use and research.
- Adult. Stem cells in adult tissue are generally drawn from the bone marrow or found in fat. These cells may only be capable of transforming into specialized cells with limited application for treatment.
- Perinatal. Stem cells have also been found in umbilical cord blood and in the amniotic fluid of pregnant women during certain prenatal tests. Although umbilical cord blood stem cells show a similar diversity of use as embryonic stem cells, the use of those cells found in amniotic fluid is not as well understood.
Ethical complications and the difficulty of gathering certain stem cells in large enough quantities for effective research have led researchers to experiment with artificial stem cell development. These scientists have had success with reprogramming the genetic code of adult stem cells so that they behave more like embryonic stem cells.
Medicare Coverage for Stem Cell Therapy
Due to the experimental nature of most stem cell therapies and the ethical complications associated with certain types of stem cells, coverage through Medicare insurance for treatment with stem cell therapy is limited.
Examples of commonly approved stem cell therapies for Medicare recipients include:
- Hematopoietic stem cell transplantation for severe combined immunodeficiency disease (SCID), myelodysplastic syndromes (MDS), leukemia and Wiskott-Aldrich syndrome.
- Autologous stem cell transplantation for resistant non-Hodgkin’s lymphomas, advanced Hodgkin’s disease, recurrent neuroblastoma, and acute leukemia when in remission.
Generally speaking, the type of stem cell therapy must also be approved by the FDA for use and must be shown to be medically necessary in order for Medicare to approve coverage. Proving medical necessity usually requires documentation that shows all other treatment options for the qualifying medical condition have been tried and have not been successful at reducing pain, reversing symptoms or preventing symptoms from worsening.
FDA approval and coverage terms can change from year to year, so you may need to verify if the treatment you’re seeking is currently approved by the FDA and covered by Medicare. Even with Medicare coverage, stem cell treatment can be costly for patients. Medicare Advantage or Medicare supplement plans that help mitigate your share-of-cost obligations may be able to help you reduce your out-of-pocket expenses when you’re in need of stem cell therapy. Contact your plan directly for specific information.
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