Organ transplants

Medicare Part B (Medical Insurance)

 covers:

  • Doctors’ services associated with heart, lung, kidney, pancreas, intestine, and liver organ transplants 

Under certain conditions, Part B also covers:

  • Bone marrow and cornea transplants 
  • Cornea transplants
  • Immunosuppressive (or “transplant”) drugs associated with Medicare-covered transplants
     
Medicare Part A (Hospital Insurance)

covers:

  • Necessary tests, labs, and exams

Under certain conditions, Part A also covers:

  • Services for heart, lung, kidney, pancreas, intestine, and liver organ transplants
  • Immunosuppressive (or “transplant”) drugs, follow-up care, and procurement of organs
  • Stem cell transplants
Your costs in Original Medicare

You pay:

  • 20% of the  Medicare-Approved Amount  for your doctor's services after you meet the Part B  deductible [glossary]
  • Various costs for transplant facility charges.
  • Nothing to the living donor for a kidney transplant.
  • Nothing for Medicare-certified laboratory tests. 

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
Things to know

You must get an organ transplant in a Medicare-approved facility. Stem cell and cornea transplants aren’t limited to Medicare-approved transplant centers.

Medicare may cover transplant surgery as a hospital inpatient service under Part A. Medicare covers immunosuppressive drugs if the transplant was covered by Medicare or an employer or union group health plan was required to pay before 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.

You pay 20% of the Medicare‑approved amount for the drugs, and the Part B deductible applies. Medicare drug coverage covers immunosuppressive drugs if Part B doesn’t cover them.

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.
 

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