Does Medicare Cover a Kidney Transplant?

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 09/10/2018

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People with kidney failure and end-stage renal disease (ESRD) often have two options: dialysis or kidney transplant. According to the National Kidney Foundation, many people feel that a kidney transplant offers more freedom and a better quality of life than dialysis. A kidney transplant can come from a living donor or a deceased donor. To get a deceased donor kidney transplant, you will be placed on a waiting list. Learn more about kidney disease.

Does Medicare Part A and Part B cover kidney transplant surgery?

The medical expenses involved in a kidney transplant can be extensive and you will need medical care before and after your surgery. Medicare generally covers you for all stages of your kidney transplant. If you have a living donor, generally Medicare will cover his medical expenses involved with organ donation as well. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) generally cover different expenses involved in a kidney transplant.

Medicare Part A coverage of kidney transplants typically includes:

  • Kidney registry fee
  • Kidney procurement if there’s no kidney donor
  • Tests, labs and exams prior to surgery including tests needed to evaluate potential kidney donors
  • Inpatient services in a Medicare-certified hospital
  • Follow-up care after the kidney transplant
  • Full cost of care of your kidney donor if you have a living donor
  • Blood

Medicare Part B coverage of a kidney transplant typically includes:

  • Immunosuppressive prescription drugs that lower the body’s ability to reject the kidney transplant
  • Doctor’s care for all stages of the kidney transplant surgery
  • Doctor’s care for your donor during his hospital stay
  • Blood
  • Follow-up care after the kidney transplant

Medicare Part B coverage of immunosuppressive prescription drugs is generally for a limited time after you leave the hospital following a kidney transplant. For long-term coverage of immunosuppressive prescription drugs you may need Medicare Part D coverage.

Does Medicare Part D cover kidney transplant surgery?

According to the U.S. National Library of Medicine, you will have to take prescription drugs for the rest of your life following a kidney transplant to prevent your body from rejecting the new kidney. These prescription drugs may be covered by a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.

A stand-alone Part D Plan works alongside your Original Medicare (Part A and Part B) coverage. A Medicare Advantage plan is another way to get your Original Medicare benefits. Medicare Advantage plans must cover everything Original Medicare covers with the exception of hospice care, which is still covered by Part A. As well as prescription drug benefits, Medicare Advantage plans may provide other additional benefits that Original Medicare doesn’t cover.

Does Medicare Supplement cover kidney transplant surgery?

Although Medicare Part A and Part B generally cover most medical and hospital costs associated with a kidney transplant, many services are not covered at 100%. A Medicare Supplement plan can cover some costs not covered by Medicare Part A and Part B, such as the Medicare Part A coinsurance and hospital cost and the Medicare Part B coinsurance or copayment. A Medicare Supplement plan may also cover your Medicare Part A and Medicare Part B deductible costs.

What is the kidney transplant cost?

According to the actuarial company Milliman, the estimated U.S. average billed charges for a kidney transplant in 2017 was $414,800.

  • Under Medicare, you may pay nothing for a living donor for a kidney transplant.
  • You pay 20% of the Medicare-approved amount for doctor’s services and the Part B deductible applies
  • You pay various amounts for transplant facility charges, such as an inpatient hospital stay copayment
  • You may pay nothing for Medicare-certified laboratory tests.

Do you have more questions about Medicare coverage for kidney transplants?

I’m happy to discuss your options with you. You can schedule a phone call or request information to read in an email by clicking the appropriate link below. To view some plans in your area you may qualify for, click the Compare Plans button.

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