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Many states now mandate coverage of clinical trial costs

A clinical trial is a research study in which doctors and researchers try to find ways to prevent, diagnose or treat a certain disease. Participation in such a trial may help patients seeking treatment and cures in the future. If you're considering participating in such a trial, find out first how the trial will affect your health insurance.

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States mandating coverage for clinical trials

Arizona
California
Connecticut
Delaware
Georgia
Louisiana
Massachusetts
Maryland
Maine
Minnesota
Montana
North Carolina
New Hampshire
New Mexico
Nevada
New York
Rhode Island
South Dakota
Tennessee
Virginia
Vermont
Wisconsin
West Virginia

Source: Council for Affordable Health Insurance

All the costs associated with a clinical trial are usually covered by the organization running the research. However, some health plans won't cover your "routine care" while you are a participant in a trial. This routine care would include doctor visits, X-rays, lab tests and hospital stays that you would have whether or not you were a participant in the trial.

According to the National Cancer Institute, "Lack of such coverage is a significant barrier to many patients who might otherwise enroll in a trial. Lack of coverage also makes it harder for researchers to successfully conduct trials that could improve prevention and treatment options."

A total of 23 states have enacted laws requiring coverage for routine care for those in clinical trials, according to the Council for Affordable Health Insurance (CAHI). These state mandates apply to certain group health plans offered through employers but not individual policies that you'd purchase on your own.

CAHI estimates that mandates for clinical trial coverage add less than 1 percent to the cost of a plan.

For those on Medicare, the federal program covers the routine costs of qualifying clinical trials, and "reasonable and necessary items and services" (with some exceptions) used to diagnose and treat complications arising from participation in all clinical trials.

To help you find out whether there's a clinical trial available in your area that relates to your particular disease or stage of disease, the U.S. National Institutes of Health provides current information about clinical research studies at www.ClinicalTrials.gov.

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