Does Medicare cover liver transplants?

Does Medicare cover liver transplants? The short answer is “yes,” with some caveats. If you’re an adult aged 65 or over and enrolled in Original Medicare Part A or Part B, then you will likely receive some financial assistance with your liver transplant from the United States federal government’s health care program. Part A typically covers inpatient hospital stays, skilled nursing facility care, hospice care, and some other basic health care services. Part B typically covers doctors’ services, outpatient care, medical supplies, and preventive services.

So, what is a liver transplant and why is it important? It is a surgical operation that makes use of a liver from a recently deceased donor in order to help a patient whose original liver has failed due to drug or alcohol abuse, infection, or disease. Some partial liver transplants can use tissue from a living donor, since the liver will typically grow back to a normal size. The liver is a vital organ because it eliminates toxic substances from the body, it produces immune factors that help the body resist infections, and it makes new proteins.

Medicare Part A generally covers the hospital-related expenses for liver, heart, lung, kidney, pancreas, and intestine transplants. Medicare Part B usually covers doctors’ services for these organ transplants. Medicare’s organ transplant coverage includes

  • necessary lab tests
  • pre-surgery exams
  • transplant drugs (sometimes referred to as immunosuppressive drugs)
  • follow-up care
  • the procurement of organs

You will need to pay your Original Medicare Part B deductible. The deductible is the up front cost that you must pay for access to health care before Medicare or any other insurance begins to pay. You will then usually pay 20% of the Medicare-approved amount for your doctor’s services during a transplant procedure. The Medicare-approved amount is the amount that a doctor or supplier that accepts a Medicare assignment can be paid. It may be less than the amount that a doctor usually charges, which is why it is important to confirm it with your doctor prior to scheduling a procedure. If you do not, you may end up having to pay higher out of pocket costs than anticipated.

Organ transplants typically feature associated facility costs, which may vary depending on when and where you schedule your transplant surgery. Check with your doctor or health care provider to determine these costs. The specific amounts will depend on any existing insurance that you may have as well as your location, your doctor’s usual fees, whether or not he or she accepts the assignment under Medicare supervision, the type of facility at which your surgery is performed, and a number of other factors.

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