covers:
- Doctors’ services associated with heart, lung, kidney, pancreas, intestine, and liver organ transplants under certain conditions, but only in Medicare‑certified facilities
- Bone marrow and cornea transplants under certain conditions
- Immunosuppressive (or “transplant”) drugs, in certain conditions, associated with Medicare-covered transplants
covers:
- Services for heart, lung, kidney, pancreas, intestine, and liver organ transplants, in certain conditions.
- Necessary tests, labs, and exams.
- Immunosuppressive (or “transplant”) drugs, in certain conditions, follow-up care, and procurement of organs
- Stem cell transplants, in certain conditions.
You pay:
- 20% of the for your doctor's services, and the Part B applies.
- Various costs for transplant facility charges.
- Nothing to the living donor for a kidney transplant.
- Nothing for Medicare-certified laboratory tests.
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.
