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Does Medicare Cover Heart Transplants?

 

With older Americans at greater risk of heart disease, learn what Medicare does and does not cover for heart transplants.

David Minaya
February 10, 2022

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Here in the U.S., someone dies of cardiovascular disease every 36 seconds , and about 80% of those who die from coronary heart disease are age 65 or older . Given these staggering statistics, you may wonder, “ Does Medicare cover heart transplants?” These days, they’re not so unheard of: more than 2,000 people  undergo heart transplants each year in the U.S. Medicare does cover services for heart transplants, as well as other organs , including lung, kidney, pancreas, intestine and liver. Below, we’ll answer some of the biggest questions surrounding heart transplant coverage through Medicare.

Medicare Heart Transplant FAQs

What parts of Medicare cover heart transplant services?
If you’re receiving the transplant in a Medicare-certified facility, Medicare Part B covers your doctor services, while Medicare Part A covers services while you’re in the hospital, as well as follow-up care and certain prescriptions. Medicare Part A will also pay for finding the organ you’ll have 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.
As a Medicare beneficiary, what can I expect to pay for a heart transplant?

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:

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Services provided to prepare for the transplant, including finding the organ
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The actual surgery
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Follow-up services to ensure the transplant is successful
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Immunosuppressive drugs and other transplant-related prescriptions, if needed

Costs not covered may include things like:

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Lost income as a result of the transplant
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Transportation and lodging, should you need to travel for the surgery
What immunosuppressive or transplant-related drugs does Medicare cover?

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 your heart transplant was done at a Medicare-approved facility, Medicare Part B does cover your immunosuppressive drugs for as long as you have Medicare if you :

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Had Part A at the time of the transplant AND
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Have Part B when you get the immunosuppressants

If you had any other medical coverage other than Medicare at the time of your transplant but then later became eligible for Medicare, Part D can cover  your immunosuppressant drugs.

While it’s important to know the answers to these questions for your 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.

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