Does Medicare pay for a Kidney Transplant?
Original Medicare Part A and Part B pay for certain kidney transplant services. Furthermore, Medicare Advantage (Part C) plans also cover certain kidney transplant services. So what exactly is a kidney transplant?
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Kidney Transplant Surgery
Kidney transplant surgery is a medical procedure to remove a healthy kidney from a donor and transplant it into the receiver. The receiver’s non-functioning kidney remains in place, and the surgeon adds the new kidney to the receiver’s abdomen. Kidney donors can live with only one kidney. So what services does Medicare cover?
Medicare Part A Kidney Transplant Services
Medicare Part A covers kidney transplant services for you and your donor. Medicare pays for your inpatient hospital services, the kidney registry fees, blood, and the cost of finding a kidney donor. Furthermore, Part A covers laboratory tests and exams to evaluate your medical condition and potential kidney donors’ condition.
Kidney Donor Coverage
Medicare covers the full cost of care for your kidney donor. Specifically, Medicare covers donor care before, during, and after surgery. Furthermore, should your donor need additional hospital care after surgery, Medicare covers this care as well.
When you enrolled in a Medicare Advantage plan, did you check if a transplant specialist was in your plan’s network?
Medicare Advantage Kidney Transplant Specialist
If your Medicare Advantage plan does not include a kidney transplant specialist, you may be able to change your Medicare Advantage plan. However, if it’s past March 31, you may have to wait until the Annual Election Period starting October 15.
For people with Original Medicare, you have access to all transplant specialists who accept Medicare-assignment. Specifically, Medicare Part B covers doctor services for kidney transplants. What are other medical services covered by Part B?
Medicare Part B Kidney Transplant Service
In addition to doctor services during kidney transplant surgery, Part B may cover care before and after surgery. Furthermore, Part B may cover doctor services for your kidney donor. You may also be eligible for transplant drugs.
Kidney Transplant Drugs
Kidney transplant drugs are immunosuppressants that help prevent rejection of your new kidney. Furthermore, you may need to take these drugs for the rest of your life. If you are not age 65 but were eligible for Medicare because of an End-Stage Renal Disease (ESRD), please do the following:
- Enroll in Part A before your kidney transplant
- Have your kidney transplant surgery at a Medicare-approved facility
According to Medicare.gov, Part B only covers your transplant drugs when you meet the above conditions. Furthermore, ESRD Medicare coverage expires 36 months after the month of your transplant. If you happen to turn 65 during these 36 months, please enroll in Medicare again to avoid losing coverage. Moreover, if you were eligible for Medicare because you were 65 before you got ESRD, your transplant drug coverage has no time limit.
Now that you know the hospital (Part A) and medical (Part B) services covered by Medicare, what do these services cost?
Medicare Kidney Transplant Costs
According to an NPR.org article, the costs of kidney and related care costs about $100,000 per patient. Furthermore, people who lost Medicare coverage after 36 months bear the monthly cost of transplant drugs. If such a person loses their health insurance, these drugs may cost thousands per month!
However, if you have Medicare, Part B pays for your transplant drugs, and you pay the Part B premium. If you take other prescriptions, your Medicare Part D or Medicare Advantage plan may pay these costs. Furthermore, most drug plans charge you a monthly fee. So Medicare Part B pays for your kidney transplant medical costs, do you pay any donor costs?
Kidney Donor Costs
Medicare pays for all your kidney donor costs. Thus, neither you nor the donor pays any deductible, coinsurance, or other costs. However, you pay your share of hospital and medical costs.
Your Kidney Transplant Costs
When you get your kidney transplant surgery in a hospital, you pay the Part A deductible $1484 in 2021. However, you do not pay hospital coinsurance as long as your stay is 60 days or less. Furthermore, you can receive up to 20 days in a skilled nursing facility at no cost.
For Part B medical services, you may pay the Part B deductible $203 in 2021 and 20% coinsurance costs. Medicare may cover the cost of Medicare-approved laboratory tests. If a hospital can not procure blood from a blood bank, you pay for the first three blood units.
If you have a Medicare Advantage plan, what you pay may be different.
Last Updated on June 9, 2021 by Brian Kondas