Does Medicare Cover a Pancreas Transplant?

Last Updated : 09/10/20184 min read

The pancreas is a gland that produces insulin, according to the Mayo Clinic. Insufficient insulin can result in type 1 diabetes. Although not common, a pancreas transplant is sometimes performed as a treatment for people with severe type 1 diabetes, according to the U.

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S. National Library of Medicine. A pancreas transplant may also be performed on someone who has end-stage renal disease (ESRD). During a pancreas transplant, a healthy pancreas from a deceased donor is placed in a person whose own pancreas no longer functions properly. The pancreas transplant allows the person to give up insulin shots. A pancreas transplant is often done in conjunction with a kidney transplant, according to the Mayo Clinic.

Does Medicare Part A and Part B cover a pancreas transplant?

Medicare Part A (hospital coverage) generally covers a pancreas transplant under certain conditions at a Medicare-certified facility. Usually Medicare covers the pancreas transplant for end-stage renal disease (ESRD) patients if it’s done at the same time as a kidney transplant or if it’s done after a kidney transplant. In rare cases Medicare may cover a pancreas transplant even if you don’t need a kidney transplant. Medicare Part B (medical insurance) generally covers doctor services for a pancreas transplant. A pancreas transplant involves medical care before, during, and after the surgery. Medicare generally covers:

  • Tests, labs and exams before the pancreas transplant
  • Procurement of a pancreas
  • The actual pancreas transplant surgery
  • Follow-up care
  • Immunosuppressive drugs, under certain conditions, to prevent the body’s rejection of the pancreas transplant

How much does a pancreas transplant cost?

According to a Milliman research report, the estimated U.S. average for a pancreas transplant in 2017 was $347,000. This includes screening costs, such as hepatitis and HIV screening as well as blood and tissue typing. It also includes retrieval, preservation and transportation of the pancreas used in the pancreas transplant, hospital transplant admission, and post-transplant outpatient visits, among other costs.

For a pancreas transplant under Medicare you generally pay:

  • 20% of the Medicare-approved amount for doctor’s services and the Part B deductible applies
  • Various amounts for the transplant facility charges including Medicare Part A coinsurance
  • Nothing for Medicare-certified laboratory tests

Can a Medicare Supplement plan help with pancreas transplant cost?

Medicare will generally pay for a portion of your medical costs for all stages of a pancreas transplant, leaving you with a various out-of-pocket costs. A Medicare Supplement plan can help you pay for health care costs that Original Medicare (Part A and Part B) doesn’t cover, such as copayments, coinsurance, and deductibles. For example, all Medicare Supplement plans typically pay Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up. All Medicare Supplement plans also typically pay at least 50% of your Medicare Part B coinsurance or copayment and the first three pints of blood you may need in your pancreas transplant surgery. Learn more about Medicare Supplement.

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Will Part D prescription drug coverage help after a pancreas transplant?

According to the U.S. National Library of Medicine, after a pancreas transplant you will need to take prescription drugs for the rest of your life to keep your body from rejecting the new pancreas. Medicare Part B may cover these immunosuppressive drugs for as long as you need them if you continue to qualify for Medicare after your pancreas transplant.

For coverage of other types of prescription drugs you may need after a pancreas transplant, you might want Medicare Part D prescription drug coverage. You can get either a stand-alone Medicare Part D Prescription Drug Plan to go alongside Medicare Part A and Part B or you can get a Medicare Advantage plan with prescription drug coverage. A Medicare Advantage plan is an alternative way to get your Original Medicare (Part A and Part B) benefits. A Medicare Advantage plan must cover everything original Medicare covers with the exception of hospice care, which is still covered by Medicare Part A.

Do you need more information about Medicare coverage of a pancreas transplant?

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