Does Medicare Cover Transplants?

Learn if Medicare covers transplants for medically necessary organs

by Ray Wilson+ on Aug 07, 2015 | 14 Comments

Transplants are necessary if you have certain type of failures. If you qualify to receive an organ, and are in a lucky position to have made one available to help save your life, will Medicare cover it? That is a fear of many Medicare-eligible person because will it cost you an arm and a leg to get a heart?

Does Medicare cover Transplants?

Medicare does partially cover heart, lung, kidney, pancreas, intestine, liver transplant, bone marrow, and cornea transplants if you are qualified. The actual transplant is covered by Original Medicare Part A, and you would still owe Part A deductible $1,340 and possible coinsurance, and transplant immunosuppressive drugs are covered by Part B, you will owe Part B deductible ($183), copays, and coinsurance.

One of the major benefits of being enrolled in Original Medicare is you utilize any facility or transplant doctor in the nation that accepts assignment.

Does Medigap Cover Transplants?

Most Medigap plans will pay part or all of your Transplant costs, Part A deductible $1,340 (Medigap Plan A does not), and all Medigap cover all or part of your Part B copays and coinsurance to cover your transplant immunosuppressive drugs, however only Medigap C and F will also cover your Part B deductible ($183).

One of the major benefits of Medigap is it works with Original Medicare’s nationwide network.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Transplants?

Medicare Advantage does cover some of the costs transplants. However, there are a few things to note, since most Medicare Advantage plans are HMO need to contact their plan to see how their Medicare Advantage provider requires prior authorization (as it can be different from Original Medicare) and how the plan covers your costs.

One of the drawbacks of Medicare Advantage is they are generally HMO networks. This could mean that you have limited amount of doctors and hospitals to choose from to perform your transplant.

Learn More about Medicare AdvantageGet a MA Quote

For further questions call a Senior65 agent at 800-930-7956.

Print Friendly Version

Reader Comments and Questions

(Click here to leave a comment)

By dan on July 19, 2018

A friend of mine has Medicare Parts A & B. He is about to purchase Medigap Plan F. There is a very good possibility that he will need a liver transplant in the near future. After Parts A & B services are satisfied will Medigap Plan F pick up all other costs throughout the process & is there ever a ceiling in coverage costs ? Thanks Dan,
There is never a "ceiling" in the dollar amount a Medigap plan F would pay for expenses. There are a few areas, such as skilled nursing, where they will cap their coverage based on usage days (100 in the case of skilled nursing). You can learn more about plan F caps here.
When you friend is ready, please have him/her call Senior65 so we can help with enrollment. There is never a charge to work with Senior65 and we offer Medigap plans at the guaranteed lowest price.

-Chris at Senior65.com


By Gabriella on May 03, 2018

How do you qualify for a lung transplant on Medicare with Medicap supplementalI am 69.....have. COPD, Able to walk so not terribly incapacitated and not on O2 so would like to know if I could get one ahead of getting much worse.

Gabriella
Talk to your doctor and they can walk you through the approval process and confirm if you are a candidate.
-Eric from Senior65.com


By lynne on November 11, 2017

i have been approved for a liver tranplsnt. wll medicare part a&b paid fir the drugs vangancidovir,tacrolimus,and mycoplendale mofatil

Lynne,
Senior65 gives an overview of how Medicare works so you will know if you want to by additional coverage using our services. If you have an upcoming operation, please contact the Center for Medicare Services for your exact benefit reimbursements.
Jacima from senior65.com


By Kelly on May 22, 2017

I have very bad COPD and I'm in need of a possible single or double lung transplant. I have Medicare A and B and mutual of Omaha supplemental plan F. Will these coverages pay fully for my operation.

Kelly,
Lung transplants are covered by Medicare in certain circumstances. If you qualify, Medigap Plan F will fill in the gaps of coverage, and you should have no out of pocket costs with your above coverage.
-Amy from https://www.senior65.com/


By vicki on March 26, 2017

My 57 year old brother has been diagnosed with Pulmonary Fibrosis. He has medical coverage for 'critical care' only. This does not include the oxygen he uses at home nor any rehab facility or medication. Is there a state or federally funded medical coverage that he would be able to access with this preexisting condition? He is not able to work outside or even from home. His Dr. is also recommending that he register for a double lung transplant. Thanks.

Vicki,
Since this is a very specific case, we can't directly answer your question. You'll need to make a few calls to Medicaid, Medicare, and the Exchange (because each may possibly cover him). This way you can find out what is available to him, and if he qualifies early for Medicare. After that, you can contact your state's department of insurance. We wish you the best!
-Amy from https://www.senior65.com/


By Matt on February 26, 2017

will medicare pay for a complete (PKP) cornea transplant

Matt,
Medicare covers cornea transplants under some circumstances. You will need to contact Medicare directly to find out if you qualify.
-Michelle from https://www.senior65.com/


By Evelyn bell on January 30, 2017

my husband need a bone morrow transplant he will be using a live donor, he goes to Vanderbilt Cancer for his treatment. we were told this is not covered .He turned 65 10/18/1951 has medicare a and b and also medcare supplement plan G

Evelyn,
You will want to contact Medicare directly to confirm coverage.
-Amy from https://www.senior65.com/


By Michelle Stelly on December 19, 2016

My husband has medicare A & B and needs a lung transplant, not sure if its single are double can you tell me if Medicare will pay and how much?

Michelle,
For specific coverage, you will want to contact CMS directly. If your husband is interested in looking into a health plan to help cover the costs, please have him call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Lisa on August 26, 2016

I have health insurance through my spouses work and I have Medicare part A. I am in need of a liver transplant and will be trying to use a living donor. Does Medicare cover any of the medical expenses of the living donor?

Lisa,
Medicare covers liver transplants if you meet certain criteria, however, they do not specifically detail if they cover living liver transplants. With that said, they do cover living kidney and pancreas transplants, so, it is likely that they do. You will want to contact CMS directly to find out if you are covered.

If you plan on leaving your spouse's health coverage and are interested in enrolling in a Medigap or Medicare Advantage plan call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Larry Buhrman on August 11, 2016

I had a liver transplant done almost 12 years ago. I had Medicare parts A and B. I have been receiving free immunosuppressant medication up until today when I tried to refill my prescription. I was told that my part B Medicare coverage had run out and I no longer had it. I don't know if the representative is correct or not, but she says I no longer have the part B coverage. I'm 70 years old and have never missed a payment on my insurance. Do you know what has happened with this? Does coverage run out after 12 years? I also have AARP plan F. Thanks for your help. Larry Buhrman

Larry,
This is a very strange case, indeed. We have never heard of your Part B terminating for no reason. So there are a few suggestions we have for you: If this a drug that is administered by a doctor or at a facility, you'll want to contact Medicare directly to find out why you are no longer covered by Part B. If it is a drug purchased at a pharmacy, you'll want to contact your Part D (prescription drug insurance plan) provider to find out if there was a cap on coverage.

If it is your Part D coverage that is the culprit, please contact one of our licensed independent insurance agents (800-930-7956) during Open Enrollment (Oct 15 - Dec 7), and we can help you find another Part D drug plan.
--Amy from https://www.senior65.com/


By DOYLE E. BURKETT on May 04, 2016

I HAVE COPD ; SHORT OF BREATH, TREATMEMT: V.A.MEDICAL CRNTER HIGH 6 WEST IOWA CITY , IOWA 52246-2208 http://WWW.IOWA-CITY.MED.VA.GOV

Doyle,
We'd be happy to help you find a health plan that meets your needs. Please speak to one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By Jean Lasuer on December 03, 2015

Will Medicare, part A , B and or Supplemental plan F cover the cost of a cornea transplant needed to to Fuch's Dysrophy

Jean
Medicare Part B will cover cornea transplants, if you meet certain conditions determined by your doctor and Medicare. If you are approved for a cornea transplant through Medicare, Medicare Supplement Plan F will cover your deductible, copays, and coinsurance.
-Chris from https://www.senior65.com/


By Reba on August 19, 2015

Does Medicare cover any other transplants, besides the ones you listed?

Reba,
The list we have provided is directly from Medicare, but there may be other transplants available. We suggest contacting Medicare directly to make sure your transplant is covered by them.
-Michelle from https://www.senior65.com/


By Hugo Gonzales on August 11, 2015

My wife is turning 65 in November, on the list for a heart transplant, and we want to go with Medigap, but will Medigap not cover her transplant since it's a preexisting condition?

Hugo,
If your wife had creditable coverage (qualifying health insurance, either individual/job-based/other form) leading up to joining a Medigap plan, then there should not be a waiting period for any services, including transplants. Hope this helps.
-Amy from https://www.senior65.com/



Leave a Question or Comment Below

We are a small but energetic team! If you are already working with an insurance agent, please direct your question to him or her.

If you do not have an agent (or our unsatisfied with your agent's knowledge or service), shoot us your question below and consider enrolling in a plan through Senior65! For more check out "Why work with Senior65?"










We will not publish your last name or email if you submit this form.



It's 100% FREE to work with Senior65

Call our licensed agent today at 800-930-7956. Click here to learn 5 great reasons to work with Senior65.com