Kidney transplants
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) cover different items and services related to kidney transplants. Medicare covers these services if you get them from the Medicare-certified hospital where you’ll get your transplant or another hospital that participates in Medicare.
Part A covers transplant services and pays parts of the costs for:
- Inpatient services in a Medicare-certified hospital
- A kidney registry fee
- Laboratory and other tests to evaluate your medical condition, and the condition of potential kidney donors
- Finding the proper kidney for your transplant surgery (if there's no kidney donor)
- Any additional inpatient hospital care for your donor in case of problems from surgery
- Blood (whole units of packed red blood cells, blood components, and the cost of processing and giving you blood)
Part A also covers the full cost of care for your kidney donor (including care before surgery, the actual surgery, and care after surgery). You and your donor won’t have to pay a deductible, coinsurance, or any other costs for the donor's hospital stay.
Part B covers transplant services and pays part of the costs for blood, and doctors' services for:
- Kidney transplant surgery (including care before, during, and after the surgery)
- Your kidney donor during their hospital stay
If Medicare paid for the transplant, Part B also covers immunosuppressive drugs (transplant drugs) in certain circumstances.
Your costs in Original Medicare
For the transplant and related services, you pay:
- 20% of the Medicare-approved amount for Part B services, after you meet the Part B deductible.
- Nothing for Medicare-approved laboratory tests.
- Nothing for the services provided to the donor for a kidney transplant.
Important: There’s a limit on the amount your doctor can charge you, even if your doctor doesn’t accept assignment .
If you’re in a Medicare Advantage Plan (Part C) , what you pay may be different. Learn more about Medicare Advantage Plans if you have ESRD.
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 rules for prior authorization.