Does Medicare Cover a Lung Transplant?

Last Updated : 09/10/20184 min read

Lung transplant surgery replaces a diseased lung with a healthy lung from a deceased donor. Some people get one lung during a lung transplant and some people get two. According to the National Institute of Health, you may be eligible for a lung transplant if you have severe lung disease that does not respond to other treatments.

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Diseases that may make you eligible for a lung transplant include cystic fibrosis, chronic obstructive pulmonary disease (COPD) and severe bronchiectasis, according to the Mayo Clinic. Lung transplant is not usually a treatment for lung cancer, according to Johns Hopkins Medicine.

How does Medicare Part A and Part cover a lung transplant?

A lung transplant is a complicated medical procedure that may require extensive medical and hospital care. Medicare Part B generally covers doctor’s care for a lung transplant and Medicare Part A generally covers the actual surgery under certain conditions at Medicare-certified facilities.

Medicare Part A and Part B coverage of lung transplant generally includes:

  • Tests, labs, and exams before the lung transplant
  • Procurement of organs
  • The lung transplant surgery
  • Follow-up care
  • Immunosuppressive drugs so the body does not reject the lung transplant

How does Medicare Part D cover a lung transplant?

According to the National Institutes of Health, you will need to take prescription medications for the rest of your life after a lung transplant to suppress your immune system and help prevent your body from rejecting your new lung or lungs. Medicare Part B may cover these prescription drugs for the rest of life, as long as you meet certain conditions.

For coverage of other prescription medications leading up to or following your lung transplant, you may need Medicare Part D coverage. You can get Medicare Part D prescription drug coverage through either a:

  • Stand-alone Medicare Part D Prescription Drug Plan
  • A Medicare Advantage Prescription Drug plan

A stand-alone Part D Plan works alongside your Original Medicare (Part A and Part B) coverage. A Medicare Advantage plan is an alternative way to get your Medicare benefits through a plan offered by a private insurance company. Medicare Advantage plans usually include Part D prescription drug coverage. Medicare Advantage plans also cover everything Original Medicare covers, with the exception of hospice care which is still covered by Medicare Part A.

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How does Medicare Supplement cover a lung transplant?

According to the Cleveland Clinic, you can expect to stay in the hospital two or three weeks after a lung transplant. Medicare may charge you a portion of the cost of your hospital stay. A Medicare Supplement plan can help you pay some of out-of-pocket costs of a lung transplant that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles. Some Medicare Supplement plans even come with out-of-pocket spending limits while Original Medicare has no out-of-pocket maximum. Learn more about Medicare Supplement plans that might benefit lung transplant patients.

What is the lung transplant cost?

According to Milliman, an actuarial company, the average cost for a single lung transplant in 2017 was $861,700. A double lung transplant on average cost over a million dollars, $1,190,700 to be exact. With Original Medicare you typically pay:

  • 20% of Medicare-approved amounts for doctor services (the Part B deductible applies)
  • Various amounts for transplant facility charges
  • Nothing for Medicare-certified laboratory tests

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