What's the likelihood of Medicare covering gene therapy as it becomes more common?

Question

Leslie Helene Sussman · Accepted Answer

Yes - I am sure the likelihood is good of coverage to become more common. 

Medicare sometimes offers coverage for certain high cost treatments through specialized programs.

Medicare is likely to expand coverage for gene therapy as more evidence supporting its benefits and effectiveness emerges and as the treatments become more common and potentially more affordable.

Also have your Doctor submit an authorization for treatment to confirm coverages.

Andrew Zurbuch, MBA · Answer

Please contact 1800MEDICARE & speak with a representative about it. Discuss with them if it would be under Medicare Part A or Part B or is it being reviewed.


Thank you.

Andrew J. Zurbuch, MBA
Licensed Broker
Integrated Financial
azurbuch@i-f-s-inc.com

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Kim Kirsch · Answer

As a broker, I am to help clients with their Medicare needs. Unfortunately, we are not privy to the information on what Medicare will cover in the future. CMS would likely be the one to contact for that.

Answered by Kim Kirsch on May 1, 2025

Broker Licensed in FL, AK, AL & 46 other states

Answered by Kim Kirsch Medicare Insurance Agent

Timothy Brown · Answer

I'm sorry say but I have no idea. That decision will be determined by CMS (Centers for Medicare & Medicaid Services)

Gregg Matheny · Answer

The likelihood that Medicare will cover something like gene therapy In my opinion is getting increasingly better. I’ve been in this field for about eight years and I’ve seen A lot of growth and adaptation from Medicare. I think in the near future Holistic medicine, naturopathy, gene therapy, Stem cell Based procedures will all have some kind of benefit that will be covered by Medicare.

Answered by Gregg Matheny on March 25, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Diana Salisbury · Answer

That is a question for Medicare to answer.  The government will have to determine how they want Medicare to proceed with new technology.

Robert Simm · Answer

This is a interesting question because I do believe this is a interesting question because I do believe in DNA results to treat future possible diseases. In which MediCare at this time is not covering that particular test so I don't think in the near future we will see gene therapy as a cover procedure by Medicare.

Answered by Robert Simm on April 9, 2025

Broker Licensed in NC, AL, AR & 15 other states

Answered by Robert Simm Medicare Insurance Agent

Hector Vazquez · Answer

The likelihood is high as the FDA approves more procedures and Medicare updates their policies to include more treatments and protocols while increasing reimbursements.

Al Saponar · Answer

That questions requires speculation. 

As a Licensed Agent, we are not allowed to speculate.

We can only interpret the Medicare rules when they are in place. 

We can look at new plans after October 1st, once they are released for the next year,

Christian Marti Del Campo · Answer

The likelihood of Medicare covering gene therapy as it becomes more common is moderate to high, but with significant conditions and constraints. Here’s a breakdown of how this is evolving:

What's the likelihood of Medicare covering gene therapy as it becomes more common?

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What's the likelihood of Medicare covering gene therapy as it becomes more common?

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