Your Medicare Coverage

Is my test, item, or service covered?

Kidney transplants (adults)

How often is it covered?

Medicare Part A (Hospital Insurance) covers these transplant services and pays part of the costs:

  • Inpatient services in an approved hospital
  • Kidney registry fee
  • Laboratory and other tests needed to evaluate your medical condition and the medical condition of potential kidney donors
    Note

    These services are covered whether they're done by the Medicare-approved hospital where you'll get your transplant, or by another hospital that participates in Medicare.

  • The costs of finding the proper kidney for your transplant surgery (if there's no kidney donor)
  • The full cost of care for your kidney donor (including care before surgery, the actual surgery, and care after surgery)
  • Any additional inpatient hospital care for your donor in case of problems due to the surgery
  • Blood (whole or units of packed red blood cells, blood components, and the cost of processing and giving you blood)

Medicare Part B (Medical Insurance) covers the following transplant services and pays part of the costs:

  • Doctors' services for kidney transplant surgery (including care before surgery, the actual surgery, and care after surgery)
  • Doctors' services for your kidney donor during their hospital stay
  • Immunosuppressive drugs (for a limited time after you leave the hospital following a transplant)
  • Blood (whole or units of packed red blood cells, blood components, and the cost of processing and giving you blood)

Who's eligible?

All people with Medicare are covered.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount for doctor services.

You pay various amounts for transplant facility charges. You pay nothing for a living donor for a kidney transplant.

You pay nothing for Medicare-approved laboratory tests.

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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