Does Medicare cover lung transplants?

Lung transplants cost between $200,000 to $1 million, depending on on whether one or two lungs are being transplanted. The cost also depends on a number of other factors, including complications, multiple hospitalizations, multiple surgeries, extended recovery times, or critical care needs.

Medicare does occasionally cover lung transplants, as cited on its official website. That said, due to the cost and risks associated with both the procedure and the prospects for long-term patient recovery, your Medicare membership does not guarantee you access to a lung transplant. Medicare usually requires that your doctor document a procedure (in this case, the lung transplant) as medically necessary. This term is somewhat vague and open to interpretation by Medicare, which is precisely the point.

Part A coverage

In order to maximize your chances of receiving Medicare aid with your lung transplant costs, you must of course be enrolled in Original Medicare Part A or Part B. Some Medicare Part C (also called Medicare Advantage) plans may assist you as well. Contact your plan provider to learn more. Medicare Part A usually pays for hospital-related expenses. This can cover organ transplants at Medicare-certified facilities. Medicare’s website lists heart, lung, kidney, pancreas, intestine, and liver transplants as potential covered services. Part A’s organ transplant coverage includes pre-surgery exams, tests, and labs necessary to prep for the procedure. It also may include transplant or immunosuppresive drugs in certain circumstances. Part A may also help you with the costs of follow-up care as well as with the procurement of new lungs from either a living or a deceased donor.

Part B coverage

Medicare Part B covers your doctor’s services for the procedure itself, as well as office visits, consultations, and the like. It is important to note that you will need to pay all of your Part B deductible before Medicare will begin assisting you with coverage. Once you’ve paid the deductible, Medicare will pay 80% of the Medicare-approved costs for your doctor’s services. Keep in mind that the Medicare-approved costs may be lower than your doctor’s usual fee. If this is the case, you will be responsible for the difference, as well as the 20% that Medicare does not cover up front.

It is important that you discuss a potential lung transplant thoroughly with your doctor. Complex surgical procedures with the potential for complications and extensive post-operation care have many ancillary costs. These costs may or may not be covered under your Medicare plan. You also need to confirm that both your doctor and the facility at which you will undergo your lung transplant are Medicare-certified. If they are not, you will be responsible for the full cost of the procedure and any related tests, consultations, or equipment.

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