Medicare does cover liver transplants and other organ transplants that are considered medically necessary. The surgery itself is covered by Medicare Part A (hospital insurance), and doctors services related to your transplant are covered by Medicare Part B (medical insurance).
Medicare Advantage (Medicare Part C) plans also cover liver transplants when they are medically necessary. Medicare Advantage plans also include an annual out-of-pocket spending limit, which Original Medicare (Part A and Part B) does not cover.
This spending limit could save you from potentially paying thousands of dollars in out-of-pocket Medicare costs.
Does Medicare Advantage cover transplant drugs?
Medicare Advantage plans provide the same hospital and medical benefits as Original Medicare. Most Medicare Advantage plans also offer additional benefits that Original Medicare doesn’t cover.
These extra benefits can include, but aren’t limited to:
- Prescription drug coverage (which can include transplant drugs that Part B doesn’t cover)
- Routine vision and dental coverage
- Hearing care coverage
- Wellness programs such as SilverSneakers
Some Medicare Advantage plans have monthly premiums as low as $0.
How much do liver transplants cost with Medicare?
You must get your organ transplant in a Medicare-certified facility for it to be covered by Medicare.
- Once you pay your Part A deductible ($1,408 per benefit period in 2020), Medicare Part A will cover some of the hospital costs related to your liver transplant and you will pay your Medicare Part A coinsurance.
- Your Part A coinsurance amount is based on how long you are in the hospital. A typical hospital stay for a liver transplant is about 12 days.1 For days 1-60 spent in the hospital, the Part A coinsurance is $0.
- Once you meet your Medicare Part B deductible ($198 per year in 2020), Medicare generally pays 80 percent of the Medicare-approved amount for the doctor’s services related to your liver transplant, and you pay the remaining 20 percent.
In addition to the charges above, you may have to pay various transplant facility charges. Medicare covers all Medicare-certified lab tests.
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