Does Medicare Cover Clinical Research Studies?

by Amy De Vore+ on Aug 14, 2015 | 2 Comments

Medical Research Studies, also known as Clinical Trials, determine whether a medical treatment or device is effective and safe (common studies are cancer treatment effectiveness). As well as, these studies explore which groups will benefit the most from the treatment. Now that Medical Research studies are defined, are you covered by Medicare? The answer isn’t simple.

Does Medicare cover Clinical Research Studies?

Medicare partially covers certain qualifying clinical research studies. You’ll have to check with Medicare and CMS whenever you doctor or hospital thinks you would be a good fit for a clinical trial to make sure Medicare approves the study. While, Medicare Part A (hospital costs) and Part B (doctors visits and out-patient care) can partially cover your cost, you’ll still owe your Part A deductible $1,340 and your Part B deductible ($183), copays, and coinsurance.

Remember Medicare does not cover all clinical research studies.

Medicare Pays Toward these Clinical Trial Services:

  • Medicare will partially cover a hospital stay, even if you weren’t in a covered clinical research study.
  • Medicare will partially cover operation to an implant a device that is being tested.
  • Medicare will partially cover the care of side effects and complications resulting from the clinical trial.

Medicare Won’t Pay for these Clinical Trial Services:

  • Medicare will not pay a new service or device, unless Medicare would cover the service or device if you weren’t in the study
  • Medicare will not pay for services designed to only collect data and not used for your specific health needs.

Does Medigap Cover Clinical Research Studies?

Medigap plans fill in the gaps of Original Medicare; however, if Medicare does not cover the clinical trial, neither will Medigap. So, the answer is that Medigap will ONLY cover clinical research studies approved by Medicare. Most Medigap plans will cover all or part of your Part A deductible, and all will cover all or part of your Part B copays and coinsurance. Remember, only Medigap C and F will also cover your Part B deductible ($183).

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Clinical Research Studies?

Medicare Advantage may cover a clinical research study. You will have to contact your Medicare Advantage provider to see how it and if it is covered.

Learn More about Medicare AdvantageGet a MA Quote

For further questions call a Senior65 agent at 800-930-7956.

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Reader Comments and Questions

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By Patti Osterberg on January 15, 2016

I didn't know that medicare could cover some clinical research studies. I've been having some health problems lately, and I'm interested in participating in research for new medications. I'm wondering if I can get covered for a study that I was offered, but I'm not sure how to figure out whether it qualifies. Do you know who I should talk to to find out if the study is approved by medicare?

Patti,
Medicare's website suggests that you contact the healthcare provider who is offering the study to see if they are working with Medicare. If they are, you should also ask them if there are any parts of the study that may not fall under Medicare's coverage. Once you have this information, you will want to contact CMS to confirm your coverage.
-Amy from https://www.senior65.com/


By Mae Lin on August 18, 2015

So what you are saying is that Medigap won't always cover a trial. It only covers it if Medicare does, and there still can be out of pocket costs?

Mae,
Medigap will only cover a clinical research trial if Original Medicare covers it. If you enroll in Medigap Plan C or F, you should not have any out of pocket expenses, after your premium, for medical services. Hope this helps.
-Amy from https://www.senior65.com/



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