Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) cover different items and services related to kidney transplants. Medicare covers these services if they’re done by the Medicare-certified hospital where you’ll get your transplant or another hospital that participates in Medicare.
Part A covers transplant services and pays parts of the costs for:
- Inpatient services in a Medicare-certified hospital
- Kidney registry fee
- Laboratory and other tests to evaluate your medical condition, and the condition of potential kidney donors
- Finding the proper kidney for your transplant surgery (if there's no kidney donor)
- Any additional inpatient hospital care for your donor in case of problems from surgery
- Blood (whole units of packed red blood cells, blood components, and the cost of processing and giving you blood)
Part A also covers the full cost of care for your kidney donor (including care before surgery, the actual surgery, and care after surgery). You and your donor won’t have to pay a deductible, coinsurance, or any other costs for their hospital stay.
Part B covers transplant services and pays part of the costs for blood, and doctors' services for:
- Kidney transplant surgery (including care before, during, and after the surgery)
- Your kidney donor during their hospital stay
Part B also covers immunosuppressive drugs (transplant drugs) if Medicare paid for the transplant. You must have Part A at the time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs (or qualify for the immunosuppressive drug benefit).
Your costs in Original Medicare
For the transplant and related services, you pay:
- 20% of the Medicare-approved amount.
- Various amounts for transplant facility charges.
- Nothing for Medicare-approved laboratory tests.
- Nothing to the living donor for a kidney transplant.
In 2023, you’ll pay a monthly premium of $97.10* and $226 deductible if you sign up for the immunosuppressive drug benefit. Once you’ve met the deductible, you’ll pay 20% of the Medicare-approved amount for your immunosuppressive drugs.
* You may pay a higher premium based on your income.
Important: There’s a limit on the amount your doctor can charge you, even if your doctor doesn’t accept assignment .
Things to know
- Medicare will cover your kidney transplant only if it’s done in a hospital that’s Medicare-certified to do kidney transplants.
- If you’re thinking about joining a Medicare Advantage Plan and are on a transplant waiting list or think you need a transplant, check with the plan before you join to make sure your doctors, other health care providers, and hospitals are in the plan’s network. Ask for information about covered drugs and their costs. Also, check the plan’s coverage rules for prior authorization and coverage for your living donors.