Original Medicare (Parts A & B): Transplants and Immunosuppressive Drugs
Provider services for a number of transplants and associated therapies are covered under certain conditions.
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Details on how to apply
When a provider determines that a transplant is required, and a donor is available, they will write a corresponding plan and all associated orders, as well as help with arrangements to commence with the transplant. There are several steps involved in the transplant process that the provider will explain and give guidance.
For more information on Medicare benefits and coverage, call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare Benefits Website. TTY users, call 1-877-486-2048.
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Medicare covers provider services for heart, lung, kidney, pancreas, intestine, liver, bone marrow, and cornea transplants under certain conditions. (Note that Medicare may cover transplant surgery as a hospital inpatient service under Part A.)
Medicare also covers immunosuppressive drugs if Medicare paid for the transplant. Your loved one must have Part A at the time of the covered transplant and must have Part B at the time they receive immunosuppressive drugs. (Also keep in mind that Medicare Part D drug coverage pays for immunosuppressive drugs if Part B doesn't cover them.)
Medicare pays the full cost of care for the kidney donor. Your loved one and their donor will not have to pay a deductible, coinsurance, or any other costs for the donor's hospital stay.
Immunosuppressive drug benefit
If your loved one only has Medicare because of end-stage renal disease (ESRD), their Medicare coverage (Including immunosuppressive drug coverage) ends 36 months (3 years) after a successful kidney transplant, though Medicare will help continue to pay for immunosuppressive drugs beyond that 36 months if your loved one doesn't have certain types of other health coverage (like a group health plan, TRICARE, or Medicaid that covers immunosuppressive drugs).
This benefit is not a substitute for full health coverage. It only covers immunosuppressive drugs - no other items or services. Your loved one can sign up for this benefit any time after their Medicare Part A coverage ends, as long as they had Medicare because of ESRD at the time of their kidney transplant.
Note that your loved one will be charged a monthly premium of $97.10 (or higher based on income) and a $226 deductible for this benefit. Once the deductible is met, they will pay 20% of the Medicare-approved amount for immunosuppressive drugs. If they have limited income and resources, they may be able to get help from their state to pay for this benefit.
Go to Medicare End Stage Renal Disease to learn more.
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