Curated by Claudia Shannon / Research Scientist / ishonest

When does Medicare cover organ transplants?

Medicare covers medically necessary services related to the prevention, diagnosis, and treatment of health conditions.

While Medicare doesn’t set any criteria for covered organ transplants, organ transplant programs generally do have eligibility requirements.

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Once a doctor has determined that a Medicare beneficiary requires an organ transplant, Medicare will cover the following transplants:

• cornea
• heart
• intestine
• kidney
• liver
lung
• pancreas
• stem cell

Medicare covers only transplants performed through Medicare-approved transplant programs. These approved organ transplant programs must exist within hospitals that are contracted to provide services under Medicare.

The only exception to this rule is that cornea and stem cell transplants don’t need to be performed in a Medicare-approved transplant center.

How much does Medicare pay for organ transplants?

Between doctor’s visits, laboratory testing, surgery, and more, organ transplantation is quite expensive.

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According to a 2020 research report of transplant costs in the United States, the average costs for organ transplants include:

• $1,664,800 for a heart transplant
• $1,295,900 for a double lung transplant or $929,600 for a single lung transplant
• $1,240,700 for an intestine transplant
• $878,400 for a liver transplant
• $442,500 for a kidney transplant
• $408,800 for a pancreas transplant

Medicare pays for most services and costs associated with Medicare-approved organ transplants. Services include:

• pretransplant services
• surgery
• follow-up services
• immunosuppressant and other necessary prescription drugs, in some cases

Medicare also pays for all costs related to finding a donated organ and all medical care for the organ donor, such as doctor’s visits, surgery, and other necessary medical services.

While Medicare covers almost all organ transplantation costs, you’ll still owe out-of-pocket costs for your services.

Possible out-of-pocket costs for organ transplant

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Other costs may also be associated with your organ transplant surgery that Medicare doesn’t cover. These out-of-pocket costs may include:

• transportation and lodging for the surgery
• child care or other expenses at home
• potential loss of income

Which Medicare plans may be best for you if you know you need an organ transplant?

If you need an organ transplant in 2020, here’s what services each Medicare part will cover for your diagnosis, procedure, and aftercare.

Part A

Medicare Part A is hospital insurance. It covers any necessary services related to the following transplants:

• heart
• intestine
• kidney
• liver
lung
• pancreas
• stem cell

Covered services under Part A include most inpatient services during hospitalization, such as laboratory testing, physical exams, room and board, and pre- and post-op care in the hospital.

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Part A will cover these services for your organ donor, as well.

Part B

Medicare Part B is medical insurance. Part B covers any doctor’s services related to the following transplants:

• cornea
• heart
• intestine
• kidney
• liver
lung
• pancreas

Services covered under Part B include those related to your diagnosis and recovery, such as doctor’s or specialist’s visits, laboratory testing, or certain prescription drugs.

Part B will also cover these same services for your organ donor, when necessary.

Part C

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Medicare Part C (Medicare Advantage) covers all Part A and Part B services listed above. Some Part C plans also cover prescription drugs and possibly even additional health perks, like fitness memberships and meal services.

Medicare Advantage Special Needs Plans (SNPs) are a type of plan that offers coordinated services for people with chronic or disabling conditions.

These plans can be especially beneficial to people who have certain conditions, such as end-stage renal disease and chronic heart failure, that may require an organ transplant.

Part D

Medicare Part D helps cover prescription drugs needed for organ transplantation.

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While Part D coverage varies by plan, all Medicare prescription drug plans must cover immunosuppressant drugs. These medications, which weaken your immune system to make it less likely that your body will reject a new organ, are required for transplantation.

Most prescription drug plans also cover other medications that may be necessary for organ transplant recovery, such as pain relievers, antidepressants, and more.

Medigap

Medigap helps cover out-of-pocket costs associated with your Medicare- covered organ transplant. These costs may include deductibles, copayments, and coinsurance.

Some Medigap plans also offer coverage for Part B excess charges and foreign travel costs.

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