Does Medicare Cover Organ Transplants?

Original Medicare — Medicare Part A and Part B — covers most costs associated with a transplant under certain conditions and only if it’s performed in a Medicare-approved transplant center.

Medicare Part A covers most of the hospital-related costs of a transplant and Medicare Part B covers most of the medical-related costs.

Medicare plans sold by private insurers may also help you pay for a transplant. These include Medicare Advantage, Medicare Part D prescription drug and Medigap plans.

While Medicare Part A and Part B both cover certain immunosuppressive drugs needed for transplants, a Medicare Part D plan can also help you pay for these medications.

Medigap — or Medicare Supplement plans — may also cover some of your out-of-pocket expenses.

Medicare Advantage plans are required to cover everything Original Medicare covers. But your plan may offer other benefits. If you are on a transplant waiting list and considering a Medicare Advantage plan, check first to make sure your doctors and hospitals are part of the plan’s network.

You may also need prior authorization from your Medicare Advantage plan’s administrator before you can go through with a transplant.

You are responsible for certain costs — coinsurance, deductibles and certain facility fees — associated with your transplant in addition to what Medicare covers.

You pay nothing out-of-pocket to the living donor for a kidney transplant and nothing for any Medicare-certified laboratory tests.

While most transplants have to be performed in a Medicare-approved transplant facility to be covered by Medicare, stem cell and corneal transplants can be performed in nontransplant facilities.

Transplants are complex surgical procedures and can be expensive. Their costs can vary based on the type of transplant, where you live and the facility that performs the procedure.

International consulting and actuarial firm Milliman, based in Seattle, estimated that the average billed costs of transplants in 2020 ranged from $32,000 for a corneal transplant to more than $1.6 million for a heart transplant.

Medicare covers most of these costs for your transplant. And you may have options to cover your out-of-pocket expenses.

Medigap policies can cover copayments, coinsurance and deductibles. Check first to see exactly what your plan covers.

Some transplant centers offer payment plans that let you pay out-of-pocket costs in installments.

If you have limited income and financial resources, you may be eligible for Medicaid through your state Medicaid program.

Hospital transplant programs have to meet certain standards to become a Medicare-approved transplant center.

For approval, a transplant program has to be located in a hospital that accepts Medicare. It also has to meet what are called Conditions of Participation (CoP) for transplanting a particular type of organ — heart, lung, liver, kidney, pancreas or intestine.

Transplant programs have to submit specific data on its operations, its clinical experience and record of patient outcomes.

To gain Medicare approval as a transplant center, the transplant program must show its ability to perform successful transplants while delivering quality patient care. The level of patient care is measured by patient outcomes and the soundness of the program’s policies and procedures.

The standards are set by federal regulations published in the Federal Registry.