Kidney transplants

Kidney transplants

Medicare Part A (Hospital Insurance)

 covers these transplant services:

  • Inpatient services in an approved hospital 
  • Kidney registry fee 
  • Laboratory and other tests needed to evaluate your medical condition, and the conditions of your potential kidney donors 
  • The costs of finding the proper kidney for your transplant surgery 
  • The full cost of care for your kidney donor 
  • Blood (if an transfusion is needed)

 

Medicare Part B (Medical Insurance)

 helps pay for these transplant services:

  • Doctors’ services for kidney transplant surgery 
  • Doctors’ services for your kidney donor during his or her hospital stay 
  • Transplant drugs, also called immunosuppressive drugs (generally for a limited time after you leave the hospital following a transplant) 
  • Blood (if a transfusion is needed)
     

Transplant drugs
If you’re only eligible for Medicare because of End-Stage Renal Disease (ESRD) (you’re not 65 or older, or have a disability), Part B will only cover your transplant drugs if both of these conditions are met:

  • You already had Medicare Part A at the time of your transplant.
  • Your transplant surgery was performed at a Medicare-approved facility.


Part B will only cover your transplant drugs after you’re enrolled in Part B. There won’t be retroactive coverage. 

Medicare will continue to pay for your transplant drugs with no time limit if one of these conditions applies:

  • You were already eligible for Medicare because of age or disability before you got ESRD.
  • You became eligible for Medicare because of age or disability after getting a transplant that was paid for by Medicare, or paid for by private insurance that paid primary to your Medicare Part A coverage, in a Medicare-certified facility.
Note

If you’re only eligible for Medicare because of ESRD, your Medicare coverage will end 36 months after the month of the transplant.

Your costs in Original Medicare

Important: There’s a limit on the amount your doctor can charge you, even if your doctor doesn’t accept 

Assignment

If you’re in a 

Medicare Advantage Plan (Part C)

, your costs may be different. Call your plan to get information about your costs.

Note

To find out how much your test, item, or service will cost, talk to your doctor or 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
  • 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. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Things to know

These services are covered if they’re done by the Medicare-certified hospital where you’ll get your kidney transplant or another hospital that participates in Medicare. 

Note

If you have a problem with the care that you’re getting for your transplant or with getting a referral for a transplant work-up, you have the right to file a complaint (grievance).

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