Does Medicare Cover Kidney Transplants?
Chronic kidney disease (CKD) affects 37 million adults in the U.S. — but 9 in 10 people with CKD don’t even know they have it.
CKD is most common among adults ages 65 and older, accounting for 38% of all Americans diagnosed. And of the 786,000 people living with end-stage renal disease (ESRD), only 29% achieve a kidney transplant.
Given these staggering statistics, you may be wondering if you’re covered as a Medicare beneficiary should you ever need a kidney transplant.
What Parts of Medicare Cover Kidney Transplants?
You’ll find varying levels of coverage when it comes to Medicare, kidney transplants and the services surrounding it. For those with Original Medicare (parts A and B), you may be covered for the following:
Medicare Part A (hospital insurance)
Any services while an inpatient at a hospital
Fees for the kidney registry
Tests to evaluate your medical condition, as well as the condition of any potential donors
The cost of finding a kidney, plus care for your kidney donor
Any inpatient care the donor may need post-surgery
Blood, should you need it while in the hospital
Medicare Part B (medical insurance)
Any services your doctor provides before, during and after kidney transplant surgery
Doctor services for the donor while they’re in a hospital
Immunosuppressive drugs post-surgery
Blood, should you need it at any time
What Other Kidney Transplant Services Can Medicare Cover?
Medicare Part D can help cover any drugs not covered by Medicare Part B, and Extra Help could provide further coverage for those with limited income and resources.
Conditions for transplant immunosuppressive drug coverage could vary for those on Medicare with ESRD. In December 2020, Medicare changed its laws to provide lifetime coverage for the immunosuppressive drugs needed by kidney transplant recipients — even if they’re only on Medicare due to their ESRD.
Beginning January 1, 2023, Medicare offers a new benefit to help pay for your immunosuppressive drugs beyond 36 months. If you don't have other health coverage, Medicare covers this new benefit when you sign up starting October 1, 2022. Coverage starts January 1, 2023, for beneficiaries who sign up for Medicare by December 31, 2022,
To qualify for indefinite coverage under Medicare Part B, you must:
Have gotten the transplant from a Medicare-approved facility
Have been eligible for Medicare at the time of your transplant and applied for Medicare before the transplant surgery
Not have Medicaid
Not have any other health insurance with immunosuppressive benefits
The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) are developing an enrollment program for this new coverage, which will take effect as of Jan. 1, 2023.
For more details on kidney transplant coverage through Medicare, call Senior Healthcare Direct to speak to a licensed agent at 1-833-463-3262, TTY 711.
LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.