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Does Medicare cover bone marrow transplants?

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If you have leukemia or lymphoma, your doctor might order a bone marrow transplant to help treat your cancer. Bone marrow transplants might help treat other types of cancer as well. Medicare might cover bone marrow transplants if you meet certain conditions.

What’s a bone marrow transplant?

A bone marrow transplant is a procedure that replaces stem cells that are diseased or have been destroyed by chemotherapy or radiation, according to the American Cancer Society.

What’s the difference between a bone marrow transplant and a stem cell transplant?

A bone marrow transplant is a stem cell transplant that comes from the bone marrow, reports the Dana Farber Cancer Institute. Stem cells can develop into different types of cells. The stem cells in bone marrow can become red blood cells, white blood cells, or platelets.

What are the types of bone marrow transplant?

The American Cancer Society lists three main types of bone marrow transplant.

  • In an autologous transplant, a patient’s own stem cells are “harvested” or taken from his or her bone marrow, stored, and given back to the patient after chemotherapy.
  • In an allogeneic transplant, a compatible donor’s stem cells are taken for use in the patient.
  • In a syngeneic transplant, the patient’s identical twin donates stem cells.

Does Medicare cover bone marrow/stem cell transplants?

Medicare Part A (hospital insurance) may cover stem cell (bone marrow) transplants under certain conditions. Medicare might cover you even if the transplant center isn’t approved by Medicare. You may want to ask your doctor and/or contact Medicare to confirm your bone marrow transplant will be covered. You can reach a Medicare representative 24 hours a day, seven days a week, at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

How will I get the medications for bone marrow transplant covered?

Your bone marrow transplant will involve a conditioning process to suppress your immune system and prepare your bone marrow for new stem cells. This process may make you sick and give you side effects including vomiting, fatigue, and bleeding. Your doctor may prescribe medications to reduce these side effects, according to the Mayo Clinic.

After your bone transplant, your doctor may prescribe antifungal, antibacterial, and antiviral medications to prevent infections as well as immunosuppressive medications, according to the Mayo Clinic. Basic Medicare (Part A and Part B) generally doesn’t cover any prescription drugs you take at home, so you will most likely want Medicare Part D prescription drug coverage. You can get Medicare Part D bundled with your Medicare Part A and Part B benefits in a Medicare Advantage plan. You can also get Medicare Part D as a stand-alone plan which goes together with Original Medicare.

Can you get coverage for Medicare’s out-of-pocket costs for bone marrow transplants?

Even if Medicare covers your bone marrow transplant procedure, you may have to pay a deductible amount and/or coinsurance or copayments. A Medicare Supplement insurance plan may be able to help with these costs. Learn more about how Medicare Supplement insurance plans can help you save.

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