Kidney transplants
and
cover the cost of different items and services related to kidney transplants.
Part A provides coverage for kidney transplant services and pays part of the costs for these:
- Inpatient services in a Medicare-certified hospital
- Kidney registry fee
- Laboratory and other tests needed to evaluate your medical condition and the medical condition of potential kidney donors
- 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 units of packed red blood cells, blood components, and the cost of processing and giving you blood)
Part B provides coverage for kidney transplant services and pays part of the costs for these:
- 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
- Transplant drugs, also called immunosuppressive drugs (for a limited time after you leave the hospital following a transplant)
- Blood
Medicare will only pay for your kidney transplant drug therapy for 36 months after the month of the kidney transplant surgery if you're entitled to Medicare only because of permanent kidney failure.
This is because your Medicare kidney transplant coverage will end 36 months after a successful kidney transplant surgery if you only have Medicare due to permanent kidney failure.
Medicare will continue to pay for your transplant drugs (also called immunosuppressive drugs) with no time limit if either of these apply:
- You were already entitled to Medicare because of age or disability before you got
End-Stage Renal Disease (ESRD) . - You became eligible for Medicare because of age or disability after getting a transplant.
You pay:
- 20% of the
Medicare-approved amount . - Various amounts for transplant facility charges.
- Nothing for a living donor for a kidney transplant.
- Nothing for Medicare-approved laboratory tests.
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.
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).