Does Medicare Cover Bone Marrow Transplants?

A bone marrow transplant is a treatment your doctor may prescribe if you have lymphoma or leukemia to help treat your cancer and give your body support to withstand chemotherapy. Additionally, bone marrow transplants can be helpful against other types of cancer, and Medicare benefits may extend to these transplants in certain conditions.

Defining a Bone Marrow Transplant

A bone marrow transplant is a standard medical procedure. When you have a bone marrow transplant, your doctor replaces stem cells that you’ve lost due to disease or damage from radiation or chemotherapy.

Many people mistakenly think a bone marrow transplant is the same thing as a stem cell transplant, but they’re different. When you get a bone marrow transplant, your doctor will extract cells from your bone marrow. With a stem cell transplant, the stem cells can come from different sources. So, you can use platelets, white blood cells, and red blood cells instead of just bone marrow for stem cell therapy.

Types of Bone Marrow Transplants

There are three main types of bone marrow transplants that your doctor may recommend for your treatment. The final choice will depend on what your doctor prescribes the bone marrow transplant for. They are:

• Allogeneic Transplant – With this transplant, you don’t use your own bone marrow. Instead, the hospital will match you with a donor, and they’ll harvest the donor’s bone marrow. Then, they’ll give you the donor’s bone marrow.
• Autologous Transplant – As one of the most common bone marrow transplants, an autologous transplant uses your own stem cells. The doctor will harvest your bone marrow and store it. When you finish chemotherapy or radiation, they’ll inject the bone marrow back in.
• Syngeneic Transplant – The final common procedure is a syngeneic transplant. You can have this transplant if you have an identical twin, and the doctor harvests bone marrow from your twin before giving it to you.

When you get a bone marrow transplant, you have to go through a process that suppresses your immune system. This suppression process gets your body ready for the new bone marrow. During this process, it’s common to feel sick or weak and have fatigue, bleeding, and vomiting. To combat these side effects, your doctor may prescribe you medications.

Medicare Benefits for Bone Marrow Transplants

Part A may cover bone marrow and stem cell transplants if you meet eligibility requirements. Medicare may help cover bone marrow transplant and treatment for the following:

• Aplastic anemia, leukemia, or leukemia that is in remission.
• Wiskott-Aldrich syndrome and Severe Combined Immunodeficiency Disease (SCID)
• Myelodysplastic Syndrome (MDS). However, there has to be a Medicare-approved clinical study to go along with your bone marrow transplant for Medicare to cover the cost.

You’ll have medications after your bone marrow transplant as well. Your doctor may require you to take antibacterial, antifungal, and antiviral medications to combat potential infections alongside your immunosuppressive medications.

Since Medicare Part A and B don’t cover medications in most instances, you’ll need Part D prescription drug coverage to help cover the costs.

Additionally, you will want to think about your out-of-pocket costs associated with bone marrow transplants. You could end up paying copays, coinsurance, and your deductible amount. Medicare’s coinsurance is 20%. This means that if you have Original Medicare and don’t have a secondary insurance to pick up what your Medicare benefits don’t cover, you’ll pay for it yourself. If you have Original Medicare, you can consider purchasing a Medigap policy to help cover some of your costs. You may also consider enrolling in a Medicare Advantage plan that provides an annual out-of-pocket limit.