Does Medicare Cover Clinical Research Studies?

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 $1,676 and your Part B deductible ($257), 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 ($257).

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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.

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For further questions call one of our licensed agents at 800-930-7956.