Clinical Studies and Medicare: What You Need to Know

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Picture this: You are in your doctor's office seeking treatment for a disease or illness and your provider mentions that you are perfect candidate for joining a clinical research study that their practice will be running. What would you say?

This isn't all that far-fetched of a scenario, as clinical research studies -- which are also called clinical trials -- happen all the time and often involve new surgical treatments, drugs, types or patient care, or diagnostic tests. Clinical research studies help providers and researches test out new treatments and methods to determine if there could be a better way to deliver healthcare compared to current treatment options.

If you find yourself in this situation, then it's likely that you have dozens of questions running through your mind. Here are a few answers that you might find useful.

Should I join a clinical research study if asked?
Like any other medical decision, there are pros and cons to joining a study. On the plus side, you could be gaining access to cutting edge drugs or treatments, and you will likely have access to top-notch doctors or facilities that will monitor your health closely. Being involved in a study also gives you an opportunity to take a more active role in your own healthcare and contribute to finding a new technique that could one day help other people who have the same condition.

On the downside, you may be putting yourself at risk of experiencing serious side effects from new drugs and treatments that your providers might not be aware of. It's also possible that you will get a drug or treatment that is less effective than current approaches. Clinical trials are often time consuming to participate in, because they require frequent trips to the study site.

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If you are asked to join a study and you are leaning toward participating, you should make sure you ask plenty of questions so you understand what you are getting yourself into.

Will Medicare pay for my costs?
If you decide to move forward and enroll in a covered clinical research study, then Medicare will likely help pay for some of your costs. For example, Medicare would cover room and board for a hospital stay even if you weren't in a study, an operation to implant an item that's being tested, or it would cover the costs of treating any side effects or complications that might occur.

However, Medicare doesn't pay for everything, as it won't cover the new item or service that the study is testing (unless Medicare would have covered it if you weren't in a study), extra tests that are not used in your direct healthcare, or regular coinsurance and deductibles.

These general rules also apply even if you are enrolled in a Medicare Advantage Plan (such as a HMO or PPO) and if you have Medicare Supplement Insurance (also known as Medigap). However, if you are also enrolled in a group health plan through an employer, then the details of whether Medicare will pay or not gets a bit more nuanced. The primary question in this situation is whether Medicare or your employer plan is the primary provider of coverage. If your employer plan is the primary provider, then it's best to check with your benefits administrator to find out what they will or will not cover.

Even if Medicare won't cover all of the costs of being in the study, that doesn't necessarily mean you'll be on the hook financially if you choose to participate. Often, many of the additional costs associated with being in the study will be provided for free by whoever is running the study. That can be another nice benefit to joining a study.

Where can I get more information?
The best way to find out additional details about a clinical research study is to talk to your doctors office directly as they will likely have answers to many of your questions. Another great resource is ClinicalTrials.gov, which is a government run website that lists all of the government and private studies being run across the country. Patients who are asked to join a research study involving cancer should also visit cancer.gov/clinicaltrials, or they can call 1-800-422-6237 for free to have many of their questions answered.

The article Clinical Studies and Medicare: What You Need to Know originally appeared on Fool.com.

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