- Medicare covers most medical and hospital services related to organ transplantation.
- Cornea, heart, intestine, kidney, liver, lung, pancreas, and stem cell transplants are all covered under Medicare.
- All Medicare-covered transplants must be performed in a Medicare-approved hospital.
According to the Health Resources & Services Administration, more than 39,000 transplants were performed in 2019. In addition, more than 112,000 candidates are currently on the national transplant waiting list, and 2/3 of them are older than age 50.
Although organ transplantation can be expensive, individuals who have Medicare are generally covered.
In this article, we’ll discuss when Medicare covers organ transplants and what you need to know about Medicare coverage and costs for organ transplantation.
Medicare covers medically necessary services related to the prevention, diagnosis, and treatment of health conditions.
While Medicare doesn’t set any criteria for covered organ transplants, organ transplant programs generally do have eligibility requirements.
Once a doctor has determined that a Medicare beneficiary requires an organ transplant, Medicare will cover the following transplants:
Medicare covers only transplants performed through Medicare-approved transplant programs. These approved organ transplant programs must exist within hospitals that are contracted to provide services under Medicare.
The only exception to this rule is that cornea and stem cell transplants don’t need to be performed in a Medicare-approved transplant center.
Between doctor’s visits, laboratory testing, surgery, and more, organ transplantation is quite expensive.
According to a 2020 research report of transplant costs in the United States, the average costs for organ transplants include:
- $1,664,800 for a heart transplant
- $1,295,900 for a double lung transplant or $929,600 for a single lung transplant
- $1,240,700 for an intestine transplant
- $878,400 for a liver transplant
- $442,500 for a kidney transplant
- $408,800 for a pancreas transplant
Medicare pays for most services and costs associated with Medicare-approved organ transplants. Services include:
- pretransplant services
- surgery
- follow-up services
- immunosuppressant and other necessary prescription drugs, in some cases
Medicare also pays for all costs related to finding a donated organ and all medical care for the organ donor, such as doctor’s visits, surgery, and other necessary medical services.
While Medicare covers almost all organ transplantation costs, you’ll still owe out-of-pocket costs for your services.
Possible out-of-pocket costs for organ transplant
| Type of cost | Medicare Part A | Medicare Part B | Medicare Part C | Medicare Part D |
|---|---|---|---|---|
| Premium | $0–$458, depending on your work history | $144.60+, depending on your income | depends on the plan you choose | depends on the plan you choose |
| Deductible | $1,408 per benefit period | $198 per year | depends on the plan you choose | $0–$435, depending on the plan you choose |
| Copay and coinsurance | coinsurance of 0% to 100% per day, depending on how many days you stay | 20% of the Medicare-approved amount for covered services | depends on the plan you choose | coinsurance or copays depend on the plan you choose |
Other costs may also be associated with your organ transplant surgery that Medicare doesn’t cover. These out-of-pocket costs may include:
- transportation and lodging for the surgery
- child care or other expenses at home
- potential loss of income
If you need an organ transplant in 2020, here’s what services each Medicare part will cover for your diagnosis, procedure, and aftercare.
Part A
Medicare Part A is hospital insurance. It covers any necessary services related to the following transplants:
- heart
- intestine
- kidney
- liver
- lung
- pancreas
- stem cell
Covered services under Part A include most inpatient services during hospitalization, such as laboratory testing, physical exams, room and board, and pre- and post-op care in the hospital.
Part A will cover these services for your organ donor, as well.
Part B
Medicare Part B is medical insurance. Part B covers any doctor’s services related to the following transplants:
- cornea
- heart
- intestine
- kidney
- liver
- lung
- pancreas
Services covered under Part B include those related to your diagnosis and recovery, such as doctor’s or specialist’s visits, laboratory testing, or certain prescription drugs.
Part B will also cover these same services for your organ donor, when necessary.
Part C
Medicare Part C (Medicare Advantage) covers all Part A and Part B services listed above. Some Part C plans also cover prescription drugs and possibly even additional health perks, like fitness memberships and meal services.
Medicare Advantage Special Needs Plans (SNPs) are a type of plan that offers coordinated services for people with chronic or disabling conditions.
These plans can be especially beneficial to people who have certain conditions, such as end-stage renal disease and chronic heart failure, that may require an organ transplant.
Part D
Medicare Part D helps cover prescription drugs needed for organ transplantation.
While Part D coverage varies by plan, all Medicare prescription drug plans must cover immunosuppressant drugs. These medications, which weaken your immune system to make it less likely that your body will reject a new organ, are required for transplantation.
Most prescription drug plans also cover other medications that may be necessary for organ transplant recovery, such as pain relievers, antidepressants, and more.
Medigap
Medigap helps cover out-of-pocket costs associated with your Medicare-covered organ transplant. These costs may include deductibles, copayments, and coinsurance.
Some Medigap plans also offer coverage for Part B excess charges and foreign travel costs.
- An organ transplant can be an expensive surgery, but Medicare generally covers beneficiaries for almost all services under their plan.
- Part A covers most hospital-related services, while Part B covers most medical-related services.
- Part D can help cover prescription drug costs for immunosuppressants, while Medigap can help tackle some of the out-of-pocket costs associated with each Medicare plan.
- For more information on what Medicare will cover for your organ transplant surgery and what to expect, reach out to your doctor or healthcare team.