If your doctor has recommended a kidney transplant and you are enrolled in Medicare, the federal government’s health care agency will cover some of your costs. You’re eligible as long as you have Original Medicare (either Part A, Part B, or both).
Medicare Part A, often referred to as hospital insurance. It covers inpatient services at a Medicare-certified hospital. Part A also covers your kidney registration fee as well as lab tests that may be needed to determine both your condition and the condition of potential kidney donors. If there are no kidney donors, Part A covers the costs of finding a proper kidney. If you do find a donor, Part A covers the full cost of care before the surgery, the surgery itself, and aftercare expenses for the donor. If the surgery involves complications that necessitate additional inpatient hospital care for the donor, Part A covers that as well. Finally, Part A covers the necessary blood including units of packed red blood cells, blood components, and any processing or administration costs associated with giving you blood.
Medicare Part B covers doctors’ services. This includes pre-surgery care, the surgery itself, and post-surgery care. Part B also covers doctors’ services for your kidney donor. Transplant drugs, also known as immunosuppressive drugs, are covered by Part B for a limited time following your discharge from the hospital after a transplant procedure. Part B also covers blood much like Part A, with packed red blood cells, blood components, and processing and administration costs falling under the coverage umbrella.
The patient must pay 20% of the Medicare-approved amount for doctors’ services. Transplant procedures typically involve facility charges, which are also the patient’s responsibility. Original Medicare patients pay nothing for living kidney donors or Medicare-approved lab tests. Specific costs relating to facility charges and doctors’ fees may be obtained from your doctor or healthcare provider. The amount you owe will depend on your existing insurance, how much your doctor charges, and the location where you receive your tests or procedures. Occasionally your doctor may recommend services more often than what Medicare covers as listed above. You may also require transplant-related services that Medicare does not cover at all.
Be sure to consult with your doctor in detail to determine exactly what services you need and exactly how much they will cost. You can also call Medicare directly at 1-800-633-4227 if you have additional questions.
Medicare also covers kidney transplants for children, using most of the same criteria listed above. If your child receives Medicare due to permanent kidney failure and doesn’t qualify for Medicare for another reason, Medicare coverage will end 12 months after the last month of dialysis treatments or 36 months after the month of a kidney transplant. Your child’s Medicare coverage may resume if he or she:
- starts dialysis again or gets a kidney transplant 12 months after the month they stopped receiving dialysis treatments
- start dialysis or receives another kidney transplant 36 months after their original kidney transplant