Your Medicare Coverage

Is my test, item, or service covered?

Clinical research studies

How often is it covered?

Medicare covers clinical research studies, which test different types of medical care, like how well a cancer drug works. These studies help doctors and researchers see if a new treatment works and it's safe. Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover some costs, like office visits and tests, and in certain qualifying clinical research studies.

Who's eligible?

All people with Part A and/or Part B are covered, in qualifying studies.

Your costs in Original Medicare

You may pay 20% of the Medicare-approved amount, depending on the treatment you get. The Part B deductible may apply.

Medicare will help pay for some of your costs if you join a covered clinical research study.

Medicare pays routine costs for items and services, including:

  • Room and board for a hospital stay that Medicare would pay for even if you weren't in a covered research study.
  • An operation to implant an item that’s being tested.
  • Treatment of side effects and complications that may result from the study.

Medicare won't pay for:

  • The new item or service the study is testing (except for certain medical devices) unless Medicare would cover the item or service even if you weren't in a study.
  • Items and services the study gives for free. Many times the study sponsor will give the treatment for free.
  • Items or services given only to collect data and not used in your direct health care, like monthly CT scans for a condition that usually requires only a yearly scan.
  • Coinsurance and deductibles.

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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