Original Medicare (Part A and Part B) does cover heart transplants and certain other organ transplants if considered medically necessary by a doctor.
Medicare Advantage (Part C) plans also cover heart transplants, and they also include an annual out-of-pocket spending limit. This can potentially save you money in Medicare costs for your heat transplant.
Original Medicare does not include an out-of-pocket spending cap.
Hospital costs related to your heart transplant are typically covered by Medicare Part A.
Doctor services related to your transplant are typically covered by Medicare Part B.
Even if Medicare covers your heart transplant, you are generally responsible for a portion of the costs. Some of these costs include:
Lifetime reserve days are 60 additional days of coverage that can be used over the course of your life. For each lifetime reserve day, Medicare pays all covered costs except for the daily coinsurance. Once you use these 60 days, they cannot be renewed.
If you have a Medicare Advantage plan, your coinsurance and deductible costs could vary. Some Medicare Advantage plans may include $0 deductibles. All Medicare Advantage plans include an annual out-of-pocket spending limit.
Depending on the type of Medicare Advantage plan you have, you may be required to get your heart transplant from a doctor or hospital in your plan network.
For specific pricing information regarding your heart transplant, we recommend speaking with your doctor directly.
Medicare covers immunosuppressive transplant drugs if Medicare also helped pay for your heart transplant.
Medicare Advantage (Medicare Part C) plans are sold by private insurers as an alternative to Original Medicare.
Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, which means if your heart transplant is covered by Original Medicare, it should also be covered by Medicare Advantage.
In addition to the basic benefits every Medicare Advantage plan must provide, many Medicare Advantage plans offer additional benefits that aren’t offered by Original Medicare.
Examples of some of these additional benefits include:
To learn more about Medicare Advantage, or to find Medicare Advantage plans in your area, speak with a licensed insurance agent.
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