Clinical Trials: State Laws About Insurance Coverage

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Medicare and Medicaid coverage

Medicare

Medicare will help pay for most cancer treatment clinical trials that are funded by the National Cancer Institute (NCI) or other parts of the Federal Government. If you take part in an approved clinical trial, Medicare covers routine costs for items and services, such as:

  • Doctor visits and tests
  • Room and board for a hospital stay that Medicare would pay for even if you weren’t in a study
  • An operation to implant an item that is being tested
  • Treatment of side effects and problems caused by the new treatment

In most cases, Medicare does not pay for these things:

  • The experimental item or service being tested – unless Medicare would cover it even if you weren’t in a clinical trial
  • Items and services the study gives you for free
  • Items or services used only to collect information for the trial and not needed as part of your direct health care, such as monthly CT scans for a condition that usually requires one scan
  • Co-insurance and deductibles

Keep in mind that you will have to pay the part of the charge that you would normally pay for Medicare covered services.

For more information, please call 1-800-633-4227 (1-800-MEDICARE).

Medicaid

Many state Medicaid programs cover all or some of the costs of clinical trials. Coverage is determined by each state, but many follow guidelines much like the Medicare guidelines. Contact your State Department of Health to find out the coverage in your state.

You can find the number of your state’s health department in the blue pages of your phone book or at the Centers for Disease Control and Prevention website at www.cdc.gov/mmwr/international/relres.html.


Last Medical Review: 01/22/2014
Last Revised: 02/05/2014