Organ 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 (transplant) drugs, follow-up care, and procurement of organs
  • Stem cell 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

Part B also covers immunosuppressive drugs (transplant drugs) if 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.

If you only have Medicare because of End-Stage Renal Disease (ESRD), your Medicare coverage, including immunosuppressive drug coverage, ends 36 months after a successful kidney 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. This new benefit only covers your immunosuppressive drugs and no other items or services. It isn’t a substitute for full health coverage. To sign up, call Social Security at 1-877-465-0355.
    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 .
    • 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. 
    • 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.