Does Medicare Cover Liver Transplants?
This article was updated on: 10/21/2018
When the liver is severely damaged, it can result in scarring, called cirrhosis. The Mayo Clinic notes that Cirrhosis is the leading cause of liver failure, a condition in which the liver is unable to heal itself and perform its many life-preserving functions. In addition to being a treatment for liver failure, liver transplant surgery is also used in the treatment of some forms of cancer that originate in the liver. Most liver transplants come from deceased donors, according to the American Liver Foundation, but sometimes a portion of a living person’s liver is used for a liver transplant.
How long you’ll wait for a liver transplant depends on many factors, including your geographic region. Every region has a different supply of livers and demand for liver transplants, according to the American Liver Foundation. According to the Mayo Clinic, in 2014, about half of the people on the liver transplant waiting list received liver transplants. Less than five percent of these liver transplants came from living donors.
What coverage may Medicare provide for a liver transplant?
Medicare Part A (hospital insurance) covers some of the costs of a liver transplant if the patient meets certain conditions, and the liver transplant is performed at a Medicare-certified hospital. Medicare Part B (medical insurance) covers some of the costs of physician services, outpatient laboratory tests, and other medically necessary outpatient services for a liver transplant.
If your condition meets Medicare’s criteria for liver transplant coverage but you have not yet paid your full deductible for Medicare Part A, you generally must pay that amount before Medicare will cover its portion of your hospital charges. The Medicare Part B deductible also applies. Therefore, you will also be responsible for paying that for your liver transplant before Medicare will begin paying its portion (usually 80% of the Medicare approved amount) for doctor services and Medicare-certified laboratory tests. Medicare also typically covers pre- and post-operative services for a liver transplant, including any tests, labs and medications required before the liver transplant surgery, as well as the procurement of the liver from a live or deceased donor and follow-up care after your liver transplant.
If you have a Medicare Supplement plan, it may pay a portion of the Medicare covered services related to a liver transplant that are not paid by Medicare Part A and Part B, such as Medicare deductibles or coinsurance amounts. The amount your Medicare Supplement plan pay depends upon the Medicare Supplement plan you selected and its standardized benefits.
Perhaps you chose to receive your Medicare coverage through a Medicare Advantage plan. In this case, it’s important to remember that a Medicare Advantage plan is required to provide at least the same level of coverage as Medicare Part A and Part B provide for liver transplants and other benefits (with the exception of hospice care, which continues to be covered by Medicare Part A). Medicare Advantage plans have maximum out-of-pocket limits that members pay for covered services each year before the plan pays 100% for covered services.
What other Medicare coverage is there for liver transplants?
The Mayo Clinic advises that people who have successful liver transplants must take anti-rejection medications the rest of their lives to help prevent the body from rejecting the new liver. They may include prescription drugs that help prevent infection, also, if your immune system is weakened after a liver transplant. A stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan that has these medications on its formulary (list of covered prescription drugs) may help you with the cost of these prescription drugs. The formulary could change at any time, but the plan will let you know when necessary.
Do you have more questions on Medicare coverage of liver transplants?
If you have questions about Medicare coverage or liver transplants or your options for Medicare coverage, I would like to help you. To get Medicare plan options to review, use the links below:
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