Does Medicare cover heart transplants?

Heart transplants, also known as cardiac transplants, are a form of surgical procedure designed to help patients with severe coronary artery disease and end-stage heart failure. Hearts are taken from recently deceased donors and implanted into the patient. Post-procedure survival periods average 15 years as of 2016. Nearly 3,500 heart transplant procedures are performed worldwide on an annual basis, with half of those occurring in the United States.

Medicare does provide some assistance with transplant procedures. This is welcome news if you’re facing a heart transplant and aware of the fact that it can cost upwards of $1.2 million barring any complications. All individuals who are enrolled in Original Medicare Part A or Part B are eligible for transplant coverage benefits.

Medicare Part A, which is also referred to as hospital insurance, may cover heart transplants under certain conditions at a Medicare-certified hospital facility. It also covers lung, kidney, pancreas, intestine, and liver transplants. This transplant coverage includes the procurement of a donor heart, any necessary lab tests or pre-surgery exams, transplant drugs (sometimes called immunosuppressive drugs), and any necessary follow-up care.

Medicare Part B, which is also referred to as medical insurance, may cover your doctor’s services for a heart transplant procedure. You will need to pay your Medicare Part B deductible before the coverage kicks in. When it does, the government will pay for 80% of the Medicare-approved amount for your doctor’s services. That leaves you responsible for the remaining 20%. The Medicare-approved amount is the amount that your doctor will be paid by Medicare. This amount may be less than what your doctor usually charges for his or her services, so be sure to consult with your doctor to determine exactly what you will have to pay.

Additional coverage needs

What if you doctor recommends services more often than those provided by Medicare coverage? What if services that Medicare doesn’t cover are recommended? If you have third-party insurance in addition to Medicare, it might be able to help absorb the significant costs. This could help with the heart transplant surgery as well as ancillary costs like transplant facility charges, test fees, and the like. It is important to note that transplant surgery coverage is not guaranteed. Because of the costs of the procedure and the risks involved, transplant surgery coverage could be denied even though Medicare lists transplant surgeries as covered on its official website. Eligibility is typically made on a case-by-case basis. It’s made in consultation with your doctor and based on a number of factors unique to your personal situation.

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