When Does Medicare Pay for Kidney Transplants?
- Medicare covers kidney transplant costs such as inpatient hospital care, transplant drugs and other services for transplant patients. Learn more about how Medicare covers kidney transplants and dialysis treatment for kidney disease (ESRD) and kidney failure.
A Medicare beneficiary receiving a kidney transplant can receive a bundle of coverage throughout the process.
Below is a look at how Medicare covers a kidney transplant and other treatments for beneficiaries with End-Stage Renal Disease (ESRD) and kidney failure.
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Medicare Part A Covers Inpatient Costs for a Kidney Transplant
Medicare Part A will cover the following inpatient hospital costs and services related to a kidney transplant:
- The health care costs associated with your hospital room, meals, general nursing, drugs administered by a doctor and other hospital services and supplies
- Kidney registration fee
- Laboratory tests and other clinical tests to evaluate your medical condition of that of your kidney donor
- Fees for finding an appropriate kidney if there is no immediate donor
- The full cost of care for your kidney donor, including their health care before, during and after the procedure and any additional inpatient stays required if there are complications
- The costs for blood you need during a transfusion (hospitals typically get blood for free from a blood bank but will charge you for the first 3 pints of blood if they cannot)
Medicare Part B Pays for Doctor Costs and Transplant Drugs
Medicare Part B covers the following health care costs and services for a kidney transplant:
- All doctor’s services needed for the transplant surgery, including care before, during and after the procedure
- All doctor’s services needed for your kidney donor during their stay in the hospital
- Transplant drugs, or immunosuppressive drugs, for a limited time following your release from the hospital after the transplant
- The costs of blood needed for a transfusion, in the same way as outlined above as part of Part A coverage
How Long Does Medicare Last After a Kidney Transplant?
If you are a Medicare beneficiary suffering from End-Stage Renal Disease or kidney failure, you should keep the following information in mind regarding a kidney transplant.
- If you only became eligible for Medicare because of kidney failure, your Medicare coverage will end 36 months after your kidney transplant.
- Medicare will only cover your kidney transplant if it’s performed in a hospital that is Medicare-certified to do kidney transplants.
- Medicare will continue to cover your transplant drugs with no time limit if you were already eligible for Medicare before you were diagnosed with kidney failure.
Your Medicare coverage of immunosuppressive drugs will also continue without a time limit if you became eligible for Medicare due to age or other disability after the transplant took place or if you had private insurance that paid primary to your Part A coverage.
How Does a Kidney Transplant Cost With Medicare?
Your inpatient hospital stay for a kidney transplant will be covered by Part A, which requires a deductible of $1,484 per benefit period in 2021. After satisfying your deductible, you will not owe any coinsurance for the first 60 days of your hospital stay during that benefit period. You typically won’t need to stay in the hospital longer than 60 days for a kidney transplant if you haven’t experienced any serious complications.
Your doctor’s services and the operation itself will be covered by Part B, which requires a $203 annual deductible in 2021 followed by a 20% coinsurance payment for the remaining cost of covered care.
Here are some additional factors you may want to keep in mind regarding Medicare kidney transplant costs:
- You will not owe anything for Medicare-approved laboratory tests.
- If your hospital is not able to get blood for free from a blood bank, the first three pints of blood needed for a transfusion are not covered by Medicare and you will need to pay the hospital for those costs. All Medicare Supplement (Medigap) plans include full or partial coverage for the costs of those first three pints of blood.
- Your kidney donor will not owe a Medicare deductible, coinsurance, copayments or any other Medicare costs for their hospital stay for the donation process.
- If a doctor or other health care provider does not accept Medicare assignment, they may charge you up to 15% more than the Medicare-approved amount for their service. These are called Medicare excess charges. Some Medicare Supplement plans also cover these costs.
- If you are enrolled in a Medicare Advantage plan, your coverage services will be the same as they would be for Medicare Part A and Part B, but the amount you owe for deductibles and coinsurance or copayments may be different according to your plan’s terms. While Original Medicare doesn’t include an out-of-pocket spending limit, Medicare Advantage plans are required to have an annual spending limit. This could potentially help you save money, depending on the total out-of-pocket costs of your kidney transplant.
To ask any specific questions about Medicare coverage of kidney transplants, you can call 1-800-MEDICARE (1-800-633-4227). Contact your plan carrier directly if you are enrolled in a Medicare Advantage plan.