Does Medicare Cover a Kidney Transplant?

Health Line

a day ago

Key takeaways
Medicare covers most services related to organ transplantation performed in approved hospitals, including heart, intestine, kidney, liver, and cornea transplants.
Medicare Part A covers inpatient services during hospitalization. Part B covers doctor's services related to the transplant, and Part D helps cover prescription drugs needed for transplantation, including immunosuppressant drugs.
Medicare generally covers almost all costs related to Medicare-approved organ transplants, including pre-transplant services, surgery, follow-up care, immunosuppressant drugs, and medical care for the organ donor.
In this article, we'll discuss when Medicare covers organ transplants, what you need to know about Medicare coverage, and what out-of-pocket costs you can expect for organ transplantation.
Which Medicare part covers a kidney transplant?
Medicare Part A is hospital insurance. It covers any necessary services related to the following transplants:
heart
lung
kidney
pancreas
intestine
liver
In addition, Medicare also covers other transplants that aren't organ transplants. This includes the following transplants:
cornea
stem cell
bone marrow
Under Part A, covered services include most inpatient services during hospitalization, such as laboratory testing, physical exams, room and board, and pre-and post-op care for you and your organ donor.
On the other hand, Medicare Part B is medical insurance, which means it covers any doctor's services related to your transplant.
Services covered under Part B include those related to your diagnosis and recovery, such as doctor's or specialist's visits, laboratory testing, or certain prescription drugs.
Part B will also cover these services for your organ donor when necessary.
Part C
Medicare Part C (Medicare Advantage) covers all the services listed above in Part A and Part B. Some Part C plans also cover prescription drugs and possibly additional health perks, like fitness memberships and meal services.
Medicare Advantage Special Needs Plans (SNPs) are plans that offer coordinated services for people with chronic or disabling conditions.
These plans can be especially beneficial to people who have certain conditions that may require an organ transplant, such as end stage renal disease and chronic heart failure.
Part D
Medicare Part D helps cover prescription drugs needed for organ transplantation.
While Part D coverage varies by plan, all Medicare prescription drug plans must cover immunosuppressant drugs. These medications, which weaken your immune system to make it less likely that your body will reject a new organ, are required for transplantation.
Most prescription drug plans also cover other medications that may be necessary for organ transplant recovery, such as pain relievers, antidepressants, and others.
When does Medicare cover organ transplants?
Once a doctor has determined that a Medicare beneficiary requires a covered organ transplant, the program should cover the procedure.
Medicare doesn't set any criteria for covered organ transplants, but exceptions to this are people undergoing intestine or pancreas transplants must have their transplants at a hospital with a Medicare-approved liver and kidney transplant program, respectively.
In addition, organ transplant programs generally have eligibility requirements. What these requirements are depends on the type of transplant and may involve limitations on age or people living with certain health conditions.
How much does an organ transplant cost with and without Medicare?
According to a 2020 research report on transplant costs in the United States, the average costs for organ transplants include:
Heart transplant: $1,664,800
Lung transplant: $1,295,900 (double lung) or $929,600 (single lung)
Intestine transplant: $1,240,700
Liver transplant: $878,400
Kidney transplant: $442,500
Pancreas transplant: $408,800
Medicare pays for most services and costs associated with Medicare-approved organ transplants. Services include:
pretransplant services, such as testing, lab work, and exams
surgery
follow-up services
immunosuppressant and other necessary prescription drugs, in some cases
Medicare also pays for all costs related to finding a donated organ and all medical care for the organ donor, such as doctor's visits, surgery, and other necessary medical services.
While Medicare covers almost all organ transplantation costs, you'll still owe out-of-pocket costs.
Out-of-pocket costs for organ transplant in 2025
Type of cost Medicare
Part A Medicare
Part B Medicare
Part C Medicare
Part D
Monthly premium $0 to $518,
depending on your work history $185,
depending on your income depends on the plan you choose depends on the plan you choose
Deductible $1,676 per benefit period $257 per year depends on the plan you choose $0 to $590,
depending on the plan you choose
Copay and coinsurance coinsurance of 0% to 100% per day, depending on how many days you stay 20% of the Medicare-approved amount for covered services depends on the plan you choose coinsurance or copays depend on the plan you choose
You may have other costs associated with your organ transplant surgery that Medicare doesn't cover. These out-of-pocket costs may include:
transportation and lodging for the surgery
child care or other expenses at home
potential loss of income
What if you can't afford a kidney transplant?
Your Medicare coverage should significantly lower your out-of-pocket cost for your transplant. In addition, you may be able to lower your remaining out-of-pocket costs by enrolling in a Medicare supplement plan or Medigap.
Medigap helps cover Original Medicare deductibles, copayments, and coinsurance. Some Medigap plans also cover Part B excess charges and foreign travel costs. That said, you cannot use Medigap with Part C.
Your transplant provider may also offer a payment plan so that you can spread the cost over a longer period of time. In addition, if your income falls below a certain threshold, you may also qualify for Medicaid.
In addition, the American Transplant Foundation lists several organizations that offer resources on fundraising for a transplant.
Are liver transplant patients eligible for Medicare?
If you are not eligible for Medicare but anticipate that you require an organ transplant, your eligibility for Medicare depends on either your age or the type of transplant that you need.
Anyone ages 65 and over is automatically eligible for Medicare, and by law, no insurance plan can deny you based on a preexisting condition.
That said, if you are younger than 65 and you need a transplant, you can only qualify for Medicare if you are living with end stage renal disease (ESRD) and are undergoing dialysis. Other types of needed organ transplants do not count for this exception.
Takeaway
An organ transplant can be an expensive surgery, but Medicare generally covers beneficiaries for almost all services under their plan.
Part A covers most hospital-related services, while Part B covers most medical-related services.
Part D can help cover prescription drug costs for immunosuppressants you may need to take before or after the transplant, while Medigap can help tackle some of the out-of-pocket costs associated with each Medicare plan.
Contact your doctor or healthcare team for more information on what Medicare will cover for your organ transplant surgery and what to expect.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.