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Transplant Essentials

HOME  //  RESOURCES  //  TRANSPLANT ESSENTIALS

Kidney Transplantation - Insurance

Can I go to any hospital for my kidney transplantation?

No. Only certain hospitals are approved to perform kidney transplantation. To be covered by Medicare, your transplant center has to be a Medicare certified facility.

What should I know about insurance for my kidney transplantation?

  • Patients should have appropriate insurance for kidney transplantation.

  • Insurance should include transplant evaluation cost, transplant surgery, hospitalization, outpatient follow-up including labs, medications including immunosuppressive medications, medications to prevent viral infections and routine medications for blood pressure, diabetes and cholesterol. In addition, your insurance should cover cost incurred for evaluating living donor, donor surgery, pre and post surgery donor management. Similarly insurance should cover cost incurred for obtaining a kidney from a deceased donor.

  • Inadequate coverage or large copayment for surgery, hospitalization, medications, labs and follow-up visits can become very expensive.

  • Centers may not list patients if they don’t have adequate insurance coverage for transplantation. Hence, discuss with your transplant center and obtain additional insurance before transplantation.

  • Appropriate insurance coverage for rehabilitation or nursing home, nursing home recovery and home visiting nurse may be necessary.

  • Insurance should remain active when you are on the list for kidney transplantation.

  • Strongly recommend that you discuss with a financial expert at the transplant center and take advise before listing for transplantation.

What is Medicare -Part A, Part B and Part D?

  • Medicare Part A covers inpatient services in an approved hospital, tests (blood and others) to evaluate medical condition, kidney registration fee for transplantation, tests required to evaluate a potential donor, donor management including pre surgery, surgery and post surgery care and cost incurred to find a proper deceased donor.

  • Medicare Part B typically covers 80% of approved changes related to doctor's services in hospital for kidney donor and kidney transplant surgery and care in hospital after surgery as well as immunosuppressive medications for a definite period.

  • Medicare part B does not cover medications for other conditions such as high blood pressure, cholesterol or diabetes. Medicare offers prescription coverage for other medical conditions other than what is covered by Medicare part B (Immunosuppressive medications).

  • Medicare Part D is for drugs other than immunosuppressive medications. Medicare prescriptions drug coverage (Part D) is offered by private insurance companies that are approved by Medicare. This could either be Medicare Prescription drug plans that added to your existing Medicare or Medicare Advantage plan (HMO plan).

Will my private insurance cover transplantation?

  • Private insurance should cover transplantation and most costs associated with living donor transplantation.

  • First and foremost your private insurance has to approve you as a candidate for transplant evaluation and then for transplantation at a given center.

  • Your private insurance will cover for transplantation as long as you remain eligible for private insurance.

  • Please discuss with the private insurance or request transplant centers financial expert to discuss with you about coverage and benefits detail.

When do I qualify for Medicare insurance?

  • You will be qualified for Medicare either based on your age (65 years or greater) or based on permanent disability (example - blindness) or permanent kidney failure requiring long-term dialysis treatment or from the time of kidney transplantation.

  • Medicare benefits typically start on the fourth month after you have started dialysis. As soon as you begin dialyze, speak to your dialysis unit social worker who can asset you with coverage for dialysis as well as for transplantation.

Will my Medicare cover kidney transplantation forever?

  • No. Medicare will expire 3 years after kidney transplantation unless you are above 65 years or you have permanant disability due to other reasons (example blindness).

  • Strongly recommend that you discuss with a financial expert at the transplant center and take advise for various options.

Should I maintain my insurance while on list for kidney and long-term after transplantation?

Yes. Patient should discuss with the transplant financial expert or a social worker for more details.

Will my insurance or Medicare cover surgery, hospitalization, medications, outpatient care, rehabilitation, nursing home after transplantation?

Yes. Please see the section on Medciare Part A, B and D. You should discuss with the transplant financial expert or a social worker for more details.

What are the resources available for Medicare?

You can contact 1-800-MEDICARE (1-800-633-4227) or www.medicare.gov