Kidney transplants (children)

Part A usually 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 (if a transfusion is needed)

 

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 (usually for a limited time after your child leaves the hospital following a 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. Get details about the new program.
  • Blood (if a transfusion is needed)

Important: Find out if your child is eligible for Medicare. 

 

Your costs in Original Medicare
  • Inpatient hospital services — Part A usually pays for these services after you pay a one-time yearly deductible. 
  • Doctor's services — Part B usually pays 80% of the Medicare-approved amount, after you pay the Part B yearly deductible [glossary] . You pay the remaining 20% coinsurance .
  • For Part B-covered dialysis services, your costs will vary based on your child’s age and dialysis type. 
  • 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, you can choose either Original Medicare or a Medicare Advantage Plan when deciding how to get Medicare coverage. 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
  • 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 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 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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