Given these staggering statistics, your Medicare clients may wonder about their options if they ever find themselves in need of a heart transplant. These days, they’re not so unheard of: more than 2,000 people undergo heart transplants each year in the U.S.
Medicare covers services for heart transplants, as well as other organs, including lung, kidney, pancreas, intestine and liver. Below, we’ll answer some of your clients’ biggest questions surrounding heart transplant coverage through Medicare.
Medicare Heart Transplant FAQs
Q: What parts of Medicare cover heart transplant services?
A: If you’re receiving the transplant in a Medicare-certified facility, Medicare Part B covers doctor services, while Medicare Part A covers services while in the hospital, as well as follow-up care and certain prescriptions. Medicare Part A will also pay for finding the organ to be transplanted.
However, Medicare does not cover artificial hearts, whether permanent or temporary until a viable human heart is found.
Medicare Part D drug coverage can help cover the cost of prescriptions not fully covered under Part B.
Q: As a Medicare beneficiary, what can I expect to pay for a heart transplant?
A: Reports show a heart transplant in the U.S. costs an average of $1.66 million before Medicare. If approved by Medicare, most costs will be covered, including:
- Services provided to prepare for the transplant, including finding the organ
- The actual surgery
- Follow-up services to ensure the transplant is successful
- Immunosuppressive drugs and other transplant-related prescriptions, if needed
Costs not covered may include things like:
- The premium, deductible, coinsurance or copay
- Lost income as a result of the transplant
- Transportation and lodging, should the patient need to travel for surgery
Q: What immunosuppressive or transplant-related drugs does Medicare cover?
A: Transplants require certain drugs — before and after surgery — to ensure success, and Medicare Part D can cover some drugs that Part B does not.
If the heart transplant was done at a Medicare-approved facility, Medicare Part B will cover immunosuppressive drugs for as long as you have Medicare if you:
- Had Part A at the time of the transplant AND
- Have Part B when you get the immunosuppressants
If you had any other medical coverage other than Medicare at the time of the transplant but then later became eligible for Medicare, Part D can cover immunosuppressant drugs.
While it’s important to know the answers to these questions for your clients’ own peace of mind, if you have the gift of health, consider paying it forward. You could save up to eight lives through organ and tissue donation. Become an organ donor today to help save lives.
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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.