Are organ donors and transplants covered by Medicare?

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If you are a living organ donor or awaiting a transplant, you will need proper healthcare during the processes of before and after having surgery. Regardless if you are the donor or recipient, the procedures can be expensive. By being enrolled in Medicare, you have the opportunity to have some of the costs covered.

Medicare coverage for living organ donors

As a live donor, you have the option to donate a variety of organs if you choose to someone who may be in dire need of one. These donations can include, but are not limited to, a kidney, a lung or part of a lung, pancreas, blood, skin, or even bone marrow. Depending on what you are donating, you can be subjected to different tests to make sure you are a perfect match with the recipient and other necessary exams to ensure your health. If you are granted the “go-ahead” for the donation, you’ll then need to receive healthcare during the surgery, and of course, after the surgery. This is where things can become expensive.

However, if you are enrolled in Original Medicare, there will be no medical costs to you when you donate a kidney, part of your liver, pancreas, or intestines. Having a Medicare Advantage plan will also give you the same coverage as Original Medicare, and possibly with more benefits depending on which plan you choose.

Fortunately, you also won’t be expected to pay any deductibles, coinsurance, or copayments for the transplant.

Medicare coverage for the recipient

In order to receive coverage from Medicare for an organ transplant, you need to have the transplant surgery in a Medicare-approved hospital. Medicare will then partially cover any transplants regarding the heart, lung, kidney, pancreas, liver, bone marrow, intestines, and cornea. Medicare Part A will kick in and cover the costs for the transplant itself, but you’ll be expected to pay the deductible for Part A. Medicare Part B will cover any immunosuppressive medications you’ll need for the transplant, but you will be expected to pay the Part B deductible, coinsurance, and copayments. Medicare Advantage plans do offer the same benefits as Medicare Parts A and B, but depending on which plan you use, there can be different additional benefits.

When you enroll in Original Medicare, you have the option to also enroll for Medicare Supplement plans. The Medicare Supplement plans will help cover any costs that Original Medicare Parts A and B did not cover. However, unless you are already enrolled in Medicare Supplement Plan C or F, you won’t receive any coverage for Medicare Part B’s deductible. If you are currently not enrolled in Plans C or F, but were eligible for Medicare before January 1, 2020, you do have the opportunity to enroll for those plans, but be aware that some insurance companies have moved away from offering them.

What if I don’t qualify for a transplant and need dialysis?

Medicare will also help cover medical costs for dialysis. Medicare Part A will cover the cost for dialysis treatments when in the hospital. Medicare Part B, on the other hand, will cover a variety of services related to dialysis, except for transportation. These services include:

  • Dialysis treatments for outpatients, but only in Medicare-approved facilities
  • Self-dialysis training
  • Specific home support services
  • Inpatient and outpatient doctor services
  • Most medications that are injectable, along with their oral forms, but only for outpatient and home dialysis
  • Other services or supplies related to treatment
  • Dialysis treatment within a Medicare-approved facility when traveling in the U.S.

Other solutions to covering costs

If the Medicare plan you are enrolled with or are considering does not seem like it will give you the coverage you need, there are other options that will work with Medicare to cover the costs. As mentioned before, Medicare Supplement plans can fill in the gaps of what Medicare does not cover. There are 10 different supplement options available which will cover most, if not all, of the remaining medical costs.

You can also apply for Medicaid, which offers nearly the same amount of coverage as Medicare does. Medicaid will serve as a secondary payer compared to Medicare, who will pay first for those services.

If you receive healthcare coverage from your previous employer, they sometimes will require you to enroll in Medicare Parts A and B to help with any healthcare coverage. If this is the case, Medicare will most likely be the primary source of coverage, and then the employer will pay afterwards.

Questions about your coverage?

Here at Bobby Brock Insurance, we are focused on making sure you receive the answers you need, especially about Medicare coverage. Our agents work for you, not the insurance company, so give us a call today at 662-844-3300.

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Justin Brock

President & CEO of Bobby Brock Insurance