Medicare.gov

Kidney transplants

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. 

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. Medicare offers a benefit that may help you, if you lose Part A coverage 36 months after a kidney transplant and you don't have certain other types of other health coverage (like a group health plan, TRICARE, or Medicaid that covers immunosuppressive drugs). Learn more about this 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 .

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).

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