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
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.
- 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 .
- 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.