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)
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.

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
Blood

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.

If you only have Medicare because of End-Stage Renal Disease (ESRD) , your Medicare coverage, including immunosuppressive drug coverage, ends 36 months after a successful kidney transplant. Beginning January 1, 2023, Medicare will offer a new benefit that helps continue to pay for your immunosuppressive drugs beyond 36 months, if you don't have other health coverage. This new benefit only covers your immunosuppressive drugs and no other items or services. It isn’t a substitute for full health coverage. To sign up, call Social Security at 1-877-465-0355.

Your costs in Original Medicare

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.

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
If 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 if, or how much, 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.
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. Also, check the plan’s coverage rules for prior authorization.

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).