Kidney transplants (children)

Your Medicare Coverage

Is my test, item, or service covered?

Kidney transplants (children)

 and 

 cover different items and services related to children’s kidney transplants.

Part A usually covers these transplant services:

  • Inpatient services in an approved hospital
  • Kidney registry fee
  • Laboratory and other tests needed to evaluate your child's medical condition and the condition of possible kidney donors
  • The costs of finding the proper kidney for your child's transplant surgery
  • The full cost of care for your child's kidney donor
  • Blood (if a transfusion is needed)

Part B helps pay for these transplant services:

  • Doctors' services for kidney transplant surgery
  • Doctors' services for the kidney donor during his or her hospital stay
  • Immunosuppressive drugs (generally for a limited time after your child leaves the hospital following a transplant)
  • Blood (if a transfusion is needed)

Note

If your child gets Medicare because of permanent kidney failure (and doesn’t qualify for another reason), their coverage will end:

  • 12 months after the last month of dialysis treatments
  • 36 months after the month of a kidney transplant

Your child's Medicare coverage will resume if:

  • Your child starts dialysis again or gets a kidney transplant within 12 months after the month they stopped getting dialysis.
  • Your child starts dialysis or gets another kidney transplant within 36 months after the month they get a kidney transplant.
How often is it covered?
Your costs in Original Medicare
  • Generally, Part A pays for inpatient hospital services, and you pay a one-time yearly . Learn more about Part A costs.
  • For Part B services, Medicare generally pays 80% of the , after you pay the Part B yearly deductible. You pay the remaining 20% . This is in addition to the Part B monthly . Learn more about Part B premiums and deductibles.
  • For dialysis services covered under Part B, the amount you pay may vary based on these:
    • Your child’s age
    • The type of dialysis your child needs
  • In most cases, Medicare doesn't pay for transportation to dialysis facilities.

If your child has other insurance, your costs may be different.

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

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).

Related resources

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