Does Medicare Cover a Heart Transplant?

Last Updated : 09/10/20185 min read

Has a doctor recommend heart transplant surgery for you or someone you love? A heart transplant is a complicated procedure, but the good news is that your chances of survival are good, according to the Mayo Clinic. Knowing what to expect before and after the procedure, and understanding Medicare coverage of heart transplant surgery, can help you make the right decision about whether the surgery is a good choice for you.

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What is heart transplant surgery?

The American Heart Association describes heart transplant surgery as a procedure that replaces your diseased or damaged heart with a healthy heart from a donor. A heart transplant is sometimes performed at the same time as a lung transplant, a kidney transplant, or a liver transplant, according to the Mayo Clinic.

The Mayo Clinic breaks down heart transplant surgery like this:

  • You will be connected to a heart-lung bypass machine to keep blood flowing through your body
  • The surgeon makes an incision in your chest and opens the rib cage so he or she can access your heart.
  • Your doctor then removes your diseased heart and places the donor heart in your chest.
  • Blood flow is restored by connecting all the major blood vessels. Usually, your new heart will begin to beat on its own, although your doctor may need to administer an electric shock to get it beating properly.

The surgery takes several hours and you will be given general anesthesia for your heart transplant. You’ll be on a ventilator to help you breathe for a while after the surgery, and there will be drains in your chest to help remove fluids.

Most people stay in the ICU for a few days after heart transplant surgery, and then in a regular room for about a week or two, until your doctor feels you are ready to return home.

What happens after heart transplant surgery?

The monitoring and follow-up process after heart transplant surgery is fairly intense, according to the Mayo Clinic, and if you traveled to the heart transplant center, you may wish to make arrangements to stay close by for the first few months. Your care team will watch you carefully for signs of heart transplant rejection, which may include weight gain, fatigue, shortness of breath, and low urine production.

You will also have several tests, including frequent heart biopsies to be sure your body isn’t showing signs of rejecting the new heart, especially in the first few months after heart transplant surgery. As described in an article published by the U.S. National Library of Medicine, a heart biopsy is usually done on an outpatient basis; you will be awake for the procedure. You will have less frequent biopsies as time passes after your heart transplant surgery.

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You will also take medications known as immunosuppressants to help prevent your body from rejecting the new heart; you may take some of these for the rest of your life, according to the Mayo Clinic.

Your doctor will develop a life-long care plan to help you keep your new heart in good shape after the surgery. According to the Mayo Clinic, your care plan after heart transplant surgery may include:

  • Help with smoking cessation if you use tobacco products.
  • Eating a heart-healthy diet.
  • Exercising regularly.
  • Participation in a cardiac rehabilitation program.
  • Emotional support to help you manage your feelings before and after heart transplant surgery.

Most people have positive results from their heart transplant surgery, according to the Mayo Clinic, and return to the normal activities they enjoyed before the procedure.

How does Medicare cover heart transplant surgery?

If you meet the medical criteria for heart transplant surgery, Part A and Part B may cover allowable doctor and hospital charges for all tests and procedures performed at Medicare-approved transplant facilities. Your Part A and Part B deductibles, copayments, and/or coinsurance amounts may apply. Part B also generally covers immunosuppressive drugs after heart transplant surgery under certain conditions.

Medicare Part B generally covers comprehensive cardiac rehabilitation programs after a heart transplant; copayment and/or coinsurance amounts apply. It also covers allowable charges for any medically necessary counseling and support services your doctor recommends, including smoking cessation therapy, as long as they are given by an approved provider.

If you have Medicare Part D prescription drug coverage, other medications associated with your heart transplant surgery are usually covered, less any applicable deductibles, copayments, and/or coinsurance amounts. You can get Part D coverage through a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.

You may want a Medicare Supplement plan to help you pay heart transplant out-of-pocket costs, such as copayments, coinsurance, and deductibles. Medicare Supplement works alongside Original Medicare (Part A and Part B) but cannot be used with a Medicare Advantage plan.

Need more information about Medicare and heart transplant surgery?

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