Kidney transplants

Medicare Part A (Hospital Insurance)

 covers these transplant services:

  • 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 
  • 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, during, and after the surgery)
  • Any additional inpatient hospital care for your donor in case of problems from surgery
  • Blood

 

Medicare Part B (Medical Insurance)

 covers these transplant services:

  • Doctors’ services for kidney transplant surgery (including care before, during, and after the surgery)
  • Doctors’ services for your kidney donor during their hospital stay
  • Transplant drugs (also called immunosuppressive drugs) for a limited time after you leave the hospital following a transplant 
  • Blood
     

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


Part B will only cover your transplant drugs after you’re enrolled in Part B. There won’t be any 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 (in a Medicare-certified facility) that Medicare paid for, or you had private insurance that paid primary to your Part A coverage.
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
  • Hospital services
  • Doctors’ services
  • You pay nothing for Medicare-approved laboratory tests
  • In most cases, Medicare Part A and Medicare Part B help pay for blood services
  • Kidney donor: 
    • Medicare will pay the full cost of care for your kidney donor. You don’t have to pay a  deductible [glossary] , coinsurance , or other costs for your donor’s hospital stay.
    • Your kidney donor doesn’t have to pay a deductible, coinsurance, or any other costs for their hospital stay.

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)

 what you pay may be different. Learn more about Medicare Advantage Plans if you have ESRD.

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

Medicare will cover your kidney transplant only if it’s done in a hospital that’s Medicare-certified to do kidney transplants.

note:

If you have a problem finding a dialysis facility that’s willing to take you as a patient, you have the right to file a complaint (grievance).

Is my test, item, or service covered?

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