Medicare and Medicaid coverage of care for study participants varies

Medicare

Medicare covers the following routine clinical trial costs:

• Drugs, procedures, and services that Medicare would cover if you were not enrolled in the clinical trial.
• Medical care needed for the treatment that the clinical trial is studying. For example, Medicare would cover medical care related to chemotherapy, but it would not cover the new chemotherapy drug.
• Medical care related to health problems from the clinical trial. One example is the prevention and management of side effects.

Special rules apply for people enrolled in Medicare Advantage plans. If you have one of these plans, traditional Medicare covers routine costs of clinical trial participation. Then, the Medicare Advantage plan pays any difference in your out-of-pocket costs between traditional Medicare and the Medicare Advantage plan.

Read your plan materials or call your plan directly for more information about your coverage and benefits. You can also visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Medicaid

Federal law does not require state Medicaid programs to cover routine care for people enrolled in clinical trials but some states provide coverage, including: Alaska, California, District of Columbia, Indiana, Iowa, Maryland, Montana, North Carolina, Texas, Vermont and West Virginia. Other states may have unwritten policies. 

Contact your state Medicaid office to learn more about the cancer-related clinical trial benefits in your state.