Will my Insurance Cover a Clinical Trial?

It is important to talk with your health care team and your insurance company to find out if your insurance cover a clinical trial and what out-of-pocket costs you might have to pay.

• The Patient Protection & Affordable Care Act (ACA) requires most private insurance companies to cover the routine costs of your care when you participate in a clinical trial. Routine costs include office visits, blood tests, and imaging scans that you would receive if you were getting the standard of care. Insurance companies cannot drop your coverage or refuse to let you take part in the clinical trial.
• Insurance companies are not required to cover the research costs of the clinical trial, such as extra blood tests or imagining scans. Most clinical trials will cover those costs. Insurance companies are also not required to cover care that you receive from doctors or hospitals that are outside the insurance company's network, if your plan does not normally cover out-of-network providers. Some insurance companies will cover out-of-network providers, but at a lower rate, so you will have higher out-of-pocket costs.
• Some states may have laws that offer additional protections for you .
• Different rules apply for government programs such as Medicare, TRICARE, and VA plans.
• Since 1/1/22, Medicaid will cover routine patient costs associated with clinical trials. Medicaid cannot deny coverage based on the state where the clinical trial is conducted, or whether the provider is in-network for Medicaid. Learn more at Medicaid.gov .