Kidney transplants (children)

Kidney transplants (children)

Part A covers these transplant services: 

  • Inpatient services in a Medicare-certified hospital 
  • Kidney registry fee 
  • Laboratory and other tests to evaluate your child’s medical condition and the condition of potential kidney donors 
  • The costs of finding the proper kidney for your child’s transplant surgery (if there's no kidney donor)
  • The full cost of care for your child’s kidney donor (including care before, during, and after the surgery)
  • Any additional hospital care for your child's donor, in case of problems due to the surgery
  • Blood

 

Part B helps pay for these transplant services: 

  • Doctors’ services for kidney transplant surgery (including care before, during, and after the surgery)
  • Doctors’ services for your child's kidney donor during their hospital stay 
  • Immunosuppressive drugs (generally for a limited time after your child leaves the hospital following a transplant) 
  • Blood

 

Important: Find out if your child is eligible for Medicare

 

Your costs in Original Medicare
  • Inpatient hospital services — Generally, Part A pays for these services. You pay a deductible. 
  • Doctor's services — Generally, Part B pays 80% of the Medicare-approved amount, after you pay the Part B yearly Deductible [glossary] . You pay the remaining 20% Coinsurance . This is in addition to the Part B monthly Premium
  • Prescription drugs -- To get Medicare drug coverage for your child, your child must have Part A or Part B, and you must enroll your child in a Medicare drug plan during an enrollment period. This would cover immunosuppressive and oral only drugs, but only if Part B doesn’t cover them. If your child joins a Medicare Advantage Plan with drug coverage, they'll get their drug coverage through their Medicare Advantage Plan, and can't enroll in a separate drug plan.

 

Note

If your child has ESRD, they can enroll in a Medicare Advantage Plan during Open Enrollment (October 15 – December 7, 2020) for coverage starting January 1, 2021. If your child is in a Medicare Advantage Plan, what you pay may be different. Learn more about Medicare Advantage Plans if your child has 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 child’s kidney transplant only if it’s done in a hospital that’s Medicare-certified to do kidney transplants. 

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).

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