Your Medicare Coverage
Is my test, item, or service covered?
Pancreas transplants (adults)
How often is it covered?
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 rare cases Medicare may cover a pancreas transplant even if you don't need a kidney transplant.
Medicare will only pay for your transplant drug therapy for 36 months after the month of the kidney transplant if both of these apply:
- You're entitled to Medicare only because of permanent kidney failure.
- you have the pancreas transplant after the kidney transplant.
This is because your Medicare coverage will end 36 months after a successful kidney transplant if you only have Medicare due to permanent kidney failure.
Medicare will continue to pay for your transplant drugs (also called immunosuppressive drugs) with no time limit if either of these apply:
- You were already entitled to Medicare because of age or disability before you got ESRD.
- You became eligible for Medicare because of age or disability after getting a transplant.
All people with Medicare Part A and/or Part B are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for doctor services.
You pay various amounts for transplant facility charges. You pay nothing for a living donor for a kidney transplant.
You pay nothing for Medicare-approved laboratory tests.
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
- Whether your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service