Does My Health Insurance Cover the Costs of Participating in a Clinical Trial?
If you enroll in a clinical trial, some costs will be covered by the clinical trial sponsor (the organization that runs and pays for the trial), and other costs will be covered by your private insurance as required by the Affordable Care Act. But what if you have Medicare or Medicaid? Or what if your insurance does not cover all expenses or denies a trial-related claim? Can you participate in a clinical trial if you don’t have health insurance?
Click the links below for answers to these questions and for resources that support people in overcoming financial barriers to clinical trial participation.
Introduction to Trial-Related Costs
- National Cancer Institute (video): This video explains who pays for the different types of costs in a trial
- National Cancer Institute: The trial sponsor pays for the experimental treatments in a trial
- American Cancer Society: The Affordable Care Act requires health insurers to cover the cost of routine care for people enrolled in clinical trials (scroll to “What is my cost? Will my insurance cover it?”)
- Center for Information and Study on Clinical Research Participation: You do not need to have health insurance to participate in a clinical trial
Medicare
- Patient Power: Medicare covers routine care that is part of a trial
Medicaid
- Triage Cancer: Federal law requires Medicaid to cover routine costs involved in participating in a trial
- Florence Healthcare: Medicaid coverage of trial costs may increase clinical trial access for racially diverse participants and people with disabilities
Resources and Support for Insurance and Clinical Trials
- Patient Advocate Foundation (PAF): This article provides advice about talking to your insurance company
- PAF: PAF provides one-on-one case management that helps people with appeals of denied insurance claims and out-of-pocket expenses
- Triage Cancer: Triage Cancer’s Legal and Financial Navigation Program provides one-on-one help with health insurance and financial issues including financial considerations related to clinical trials