Does Medicare Cover Stem Cell Therapy?

Does Medicare cover stem cell therapy?
Yes—but only in very narrow cases. Medicare covers two types of FDA-approved stem cell procedures—allogeneic and autologous hematopoietic stem cell transplants—when deemed medically necessary for treating certain blood cancers and blood disorders. It does not cover experimental or regenerative stem cell applications such as those for joint, neurological, or degenerative conditions (e.g., knee osteoarthritis). Coverage depends on Medicare plan and medical necessity documentation.

Key Points

• Covered Procedures
  Medicare covers:

  • Allogeneic hematopoietic stem cell transplantation (using donor cells)

  • Autologous stem cell transplantation (using the patient’s own cells)
    For eligible conditions like leukemia, lymphoma, aplastic anemia, severe combined immunodeficiency, Wiskott-Aldrich syndrome, multiple myeloma (under specific staging and study conditions), and high-risk myelodysplastic syndromes (MDS) under revised criteria.

• Excluded Procedures
  Medicare does not cover regenerative or experimental uses—such as stem cell injections for arthritis, joint degeneration, back pain, neurological or autoimmune diseases.

• Medicare Parts & Supplement Plans

  • Part A (inpatient hospital care) may cover transplant procedures requiring hospitalization.

  • Part B covers outpatient treatments when prescribed as medically necessary. You’re responsible for the deductible and typically 20% coinsurance.

  • Medicare Advantage (Part C) covers the same as Original Medicare, sometimes with lower out-of-pocket costs depending on the plan.

  • Medigap (Supplemental plans) can help pay deductibles, coinsurance, and other cost-sharing for covered services.

• Why Most Stem Cell Therapies Aren’t Covered
  Medicare follows FDA approval and evidence-based guidelines. Most regenerative stem cell therapies remain classified as experimental or investigational, lacking sufficient clinical evidence or regulatory approval. Without this, Medicare coverage is denied.

Frequently Asked Questions (FAQ)

Q1: What types of stem cell therapy are covered by Medicare?
Only allogeneic and autologous hematopoietic stem cell transplants for specific blood-related conditions.

Q2: Can Medicare cover stem cell therapy for arthritis or knee pain?
No. Such applications are considered experimental and aren’t FDA-approved, so Medicare does not cover them.

Q3: What about coverage for neurological or degenerative diseases like Parkinson’s or MS?
Medicare does not cover stem cell treatments for these conditions—they remain investigational.

Q4: Are clinical trials covered?
Coverage may be available if the stem cell transplant is part of an FDA and Medicare–approved clinical trial, subject to specific criteria.

Q5: What costs should patients expect even when covered?
Out-of-pocket costs vary: e.g., Part A deductible ($1,676 in 2025), Part B deductible ($257 in 2025), plus ~20% coinsurance. Medigap can mitigate these.

Q6: How can I confirm whether my case is covered?
Talk to your doctor about medical necessity and your plan’s coverage. Check if your condition aligns with coverage criteria and whether Medigap or Medicare Advantage reduces costs.

Before pursuing any stem cell therapy, consult your healthcare provider to determine medical necessity. Contact your Medicare plan provider to confirm whether a specific stem cell transplant is approved under your coverage. Consider speaking with a Medicare representative for clarifications on deductibles, coinsurance, or supplemental plan benefits.