A common question I hear from readers of The Niche is some version of, “Is stem cell therapy covered by insurance?” Sometimes they also ask about Medicare coverage.
To be clear, I’m talking about unproven stem cell “therapies” here. The type clinics sell. It’s not FDA approved so generally insurance companies and Medicare will not cover it.
By contrast, insurance does generally cover bone marrow and hematopoietic stem cell transplantation. These are proven methods that have saved tens or hundreds of thousands of lives.
Is stem cell therapy covered by insurance?
Unfortunately the fact that insurance does not provide any coverage often leads people to take extreme financial measures.
These steps can include fundraising from family, friends, their church, or on sites like GoFundMe.
Do some employers cover stem cell therapies at clinics?
The Regenexx brand seems to have made a big deal out of how some employers contribute towards the costs of their clinic offerings. I’m not so clear on where that stands today in 2022, but it doesn’t seem super common to me.
Does Medicare cover stem cell therapy?
Medicare will also generally cover the cost of established bone marrow transplantation type therapies. However, it does not cover stem cells of the type sold by clinics.
Why doesn’t Medicare or insurance cover stem cell therapy from clinics?
The basic answer is that the injections sold by clinics are considered experimental and unproven.
In short, they often probably do not work. Some of them are not safe either.
Medicare does cover proven stem cell therapies that are FDA approved such as bone marrow transplantation.
Claims about stem cell therapy covered by insurance
Most stem cell clinics admit that insurance doesn’t cover their offerings. However, I found some examples where clinics seem to claim insurance does cover their offerings.
A Regenexx firm called Stem Cell Arts suggests possible insurance coverage on their website. They say, “StemCell ARTS participates in numerous insurances, health plans and provider networks.” Then they list more than 20 insurers.
Kaiser? United Healthcare? AIG and Aetna? The list goes on.
In general I couldn’t find evidence on the web of these insurers covering PRP or bone marrow cell treatments at clinics.
There is another clinic site claiming they accept some of these insurers.
I think what might be going on here is that certain insurers do cover the consultation or just a general office visit with Regenexx clinics. Not necessarily the stem cells or PRP that they sell. I’m going to dig more into this to try to clarify things.
When will insurance cover stem cell therapy?
Since insurance generally will not cover stem cell clinic offerings, when might that happen?
I don’t predict that’s not going to happen any time soon. The clinics just don’t generally have the data needed to get FDA approval and most aren’t even doing clinical trials to get to that point.
Alternatively, the FDA could really loosen its standards. For instance, it could define some specific offering such as unmodified autologous MSCs to not be drugs. Even though, I don’t see insurers suddenly covering such therapies. There still just won’t be the data to make them accepted standards of care.
Stem cell therapy cost since insurance generally won’t pay
To sum up, for the question, “Is stem cell therapy covered by insurance?” the answer is nearly 100% “no” when we are talking about stem cell clinic offerings. I mean the actual stem cell or PRP procedures that are common.
There may be rare exceptions. What this means is that if you go to a for-profit clinic and get stem cells or some other supposed regenerative therapy, you’ll have to pay big bucks. See my post on stem cell therapy cost.