Kidney Transplants with Medicare

February 23, 2017

Original Medicare covers most of the costs associated with kidney transplants.  People who are enrolled with Medicare Part A and Part B are eligible for this coverage.

Medicare Part A (Hospital Insurance) that includes inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care, pays part of your transplant costs.  These include costs pertaining to inpatient services in a Medicare-certified hospital, kidney registration fees, and laboratory and other tests needed to evaluate your medical condition, and the medical condition of your potential donor.  In cases where a donor is not already available, the costs of finding the proper kidney for your transplantation surgery are also covered, as well as costs of care for the donor, including care before surgery, the actual surgery, and care after surgery. In addition, Medicare also covers the costs of procuring whole or units of packed red blood cells, blood components, and the cost of processing and giving blood, required for the transplant.

Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies and preventive services.  For kidney transplants, it covers doctors’ services for kidney transplant surgery, including care before surgery, the actual surgery, and care after surgery, for both you and the donor.  It also covers transplant drugs for a limited time period after you leave the hospital following a transplant, as well as whole or units of packed red blood cells, blood components, and costs of processing and giving blood required for the transplant.

In the case of children, if a child gets Medicare because of permanent kidney failure, and not for any other reason, Medicare coverage will only last for a certain time.  Coverage will usually end 12 months after the last month of dialysis treatments, and/or 36 months after the month of a kidney transplant.  Coverage may reassume under some conditions, for instance, in cases where the dialysis treatment starts again, or if the child gets a kidney transplant within 12 months after the last month of dialysis treatment.  This may also apply if dialysis treatment restarts, or transplant has to be carried out again after 36 months of getting a kidney transplant.

Your costs with the help of Medicare insurance plans are shared with Medicare.  Usually Part A pays for inpatient services, after you have paid a one-time annual deductible.  This is the amount you must pay before your insurance plan starts sharing your costs.  For part B services, you pay 20% of the Medicare-approved amount for doctor services, after you have paid the Part B annual deductible.  The Medicare-approved amount refers to the amount that Medicare pays the doctor or supplier who has accepted the transplant assignment.  It may be less than the actual amount the doctor or supplier charges.  Part B also charges an additional monthly premium.  This is a periodic payment to Medicare for its insurance services.

The amount you will be charged may depend on factors like other insurances you may have, the charges of your doctor, type of facility, and/or the location of your tests and services.  For children, the costs may vary based on age, and type of dialysis they need.  Costs are usually incurred for the transplant facility, but not for a living donor or laboratory tests for the transplant.  In most cases, Medicare does not pay for transportation to dialysis facilities.  You should always talk to your doctor or health care provider to be sure about the costs you may incur.

Please note that your doctor may recommend services that are not covered by Medicare.  You may have to pay for these services yourself.  In such cases, it is important that you make relevant inquires about the procedure, and the reasons for the recommendations.  You should also inquire about alternative treatments or services that may be covered by Medicare.

This is not a complete description of Medicare or kidney transplant coverage.  For more information and to speak with a Medicare specialist, contact Medigap, Inc. at 1-855-214-4404

Sources: Medicare.Gov

https://www.medicare.gov/coverage/transplants-kidney-adults.html

https://www.medicare.gov/coverage/transplants-kidney-children.html

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