Pancreas transplants

Medicare covers pancreas transplants under certain conditions. If you have 

End-Stage Renal Disease (Esrd)

 and need a pancreas transplant, Medicare covers the transplant if one of these applies:

  • It's done at the same time you get a kidney transplant.
  • It's done after a kidney transplant.

In some cases Medicare may also cover a pancreas transplant even if you don't need a kidney transplant.

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 doctors' services.
  • Various amounts for transplant facility charges.
  • Nothing for Medicare-approved 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

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.