Does Health Insurance Cover Stem Cell Therapy?

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Stem cell therapy is utilized to treat patients with conditions related to cancer, autoimmune diseases, and blood disorders. Occasionally, medical professionals administer stem cell therapy to patients who have Alzheimer’s disease and arthritis. Despite stem cells’ potential to offer a life-changing treatment to the immunocompromised, the medical practice is still unregulated in the United States of America and most other developed countries.

Does health insurance cover treatment cost?

The FDA, a United States regulatory authority, doesn’t endorse stem cell therapy in most cases, as these officials don’t believe there’s enough evidence to support that these treatments won’t cause harmful side effects in its patients. It’s precisely for these reasons that most health insurance companies don’t cover stem cell therapy.

Besides the FDA’s influence, another primary reason that many individuals don’t undergo stem cell therapy is the high cost associated with this type of treatment. According to reputable sources, the average cost of a stem cell therapy can range from $5,000 to $25,000. It’s also not unusual to see patients paying more than $100,000 for the medical procedure. 

Given the high cost of stem cell therapy and the inconsistency with which insurance companies cover it, it’s important to keep this in mind when you’re selecting your health insurance. If your primary plan doesn’t cover it, you could try to supplement coverage with a short term plan, which you can find on a healthcare exchange like AHiX Marketplace.

Does Medicare cover treatment costs?

Medicare and Medicaid may only cover stem cell therapy in specific cases, as insurance companies typically refuse to cover any procedure or service not approved by the FDA. Since the FDA doesn’t recommend stem cell therapy, you may have to pay out-of-pocket if you want to undergo stem cell therapy in the United States.

On a positive note, Medicare will cover cell therapy in two cases: in the instance of Allo-SCT (Allogeneic Stem Cell Transplantation) and Au-SCT(Autologous Stem Cell Transplantation). 

The Allo-SCT treats patients suffering from Acute Myelogenous Leukemia, a type of blood cancer that originates in the bone marrow’s blood-forming cells. Due to the deficiency of red blood cells and white blood cells, the body can’t perform everyday functions. Medical professionals inject healthy donor stems into a cancer patient through an intravenous infusion to restore these functions.

The Au-SCT also aids those patients experiencing blood disorders. Unlike Allo-SCT, the person doesn’t receive donor cells. Instead, doctors remove stem cells from the body and administer a high dose of chemotherapy to the patient. After conducting this procedure, the body will then accept the stem cell, which was earlier removed and frozen.

The FDA regulates both of these procedures, meaning Medicare will cover the cost. Still, you need to remember that your coverage percentage will depend on your Medicare plan.  For instance, you may have to cover out-of-pocket costs based on Medicare Part A, Part B., or Part D. Note that these out-of-pocket costs can accumulate quickly, potentially leading to thousands of dollars in incurred debt.

Are there any other healthcare coverage options?

To offset the cost, visit countries such as the Cayman Islands, where it’s legal to offer stem cell therapy. Here, it may cost less than $10,000 for more basic procedures that address medical issues such as shoulder arthritis, rotator cuff injuries, and other joint-related medical problems. Depending on the patient’s circumstances, some private US companies will finance such medical tourism trips, making it easier for patients to pay for costly treatment services without incurring debt.

In recent years, several private clinics have also started to offer stem cell therapy in the United States. As you may have already guessed, these clinics haven’t received official approval. Unfortunately, the high costs associated with private treatment in the United States often deter patients.

Another option for patients is to ask their employers if they cover such treatments. Private companies like Meredith Corp. offer their employees the option to pay stem cell treatment costs. Unbeknownst to most, more than 100 companies partner with private stem cell companies to reduce healthcare costs nationwide.

If your employer doesn’t offer stem cell treatment compensation, you can look elsewhere for coverage. An increasing number of patients are choosing to participate in stem cell research groups. Participating in such studies can help cover the costs of treatment. While some question the success of stem cell therapy, as it’s still in the experimental stage, findings continue to show that treatment is effective for immunocompromised patients. 

Conclusion

In the end, it’s up to the patient to decide the treatment path they take to treat their health conditions. Whatever route you take, just make sure to consult with both private and public healthcare insurance providers.

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