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Clinical Trials and Insurance Coverage - A Resource Guide
As you consider enrolling in a clinical trial, you will face the critical issue
of how to cover the costs of care. Even if you have health insurance, your coverage
may not include some or all of the patient care costs associated with a clinical
trial. This is because some health plans define clinical trials as "experimental"
or "investigational" procedures.
A growing number of states have passed legislation or instituted special agreements requiring health plans to pay the cost of routine medical care you receive as a participant in a clinical trial. For more information, see States That Require Health Plans to Cover Patient Care Costs in Clinical Trials 1.
Because lack of coverage for these costs can keep people from enrolling in
trials, the National Cancer Institute is working with major health plans and
managed care groups to find solutions. In the meantime, there are strategies
that may help you deal with cost and coverage barriers. This guide answers frequently
asked questions about insurance coverage for clinical trial participation and
directs you to additional information resources.
The material here is mainly concerned with treatment clinical trials, since
other types of trials (prevention, screening, etc.) are newer and generally
not covered by health insurance at all. However, this guide may become more
relevant for prevention and other types of trials as these trials grow more
common.
In 2000, Medicare began covering beneficiaries' patient care costs in clinical
trials. Up-to-date information about what Medicare will cover can be found on
the Web site of the Centers for
Medicare & Medicaid 2 (formerly the Health Care Financing Administration).
A summary of Medicare coverage as of January 2001 is included in this guide.
If you do not have any health insurance, you may find this section helpful
for understanding some of the costs that trials involve.
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