Does Medicare Cover Kidney Transplant Drugs? 

The first successful kidney transplant was carried out in 1954, and since then, kidney transplants have become the most commonly performed transplant procedure in the United States. Although any type of transplant operation carries risks, modern medicine has nearly perfected the art of renal transplantation. Seniors who undergo kidney transplants have high five-year survival rates.

Considerations for kidney transplantation

Despite transplant operations being performed more safely than ever, there are still considerations for both seniors and doctors before a kidney transplant takes place. Your overall health and any confounding medical factors need to be considered along with lifestyle concerns.

Additionally, organ transplant recipients typically need to take immunosuppressive medications for life to prevent rejection of the new organ. These medications are often expensive, meaning seniors should consider insurance options like Medicare coverage before undergoing a kidney transplant.

Does Medicare cover kidney transplant drugs?

Thankfully, seniors who receive Medicare benefits can rely on the program to help cover the cost of kidney transplant drugs. Medicare actually has a separate set of regulations for treating Medicare recipients who undergo care for end-stage renal disease (ESRD). These regulations include considerations for kidney transplants and the associated immunosuppressive drugs they require.

How Medicare Part B covers kidney transplant drugs

In most cases, Medicare Part D, the prescription drug benefit, provides coverage for prescription medications under Medicare. For patients who undergo a kidney transplant that is covered by Medicare insurance, Medicare Part B actually supplies coverage for immunosuppressive prescription medications.

Medicare Part B-ID for ESRD medication coverage

This special part of Medicare insurance is known as Part B-ID. It does not cover anything aside from immunosuppressive drugs, but it can be used in conjunction with other parts of Medicare. Typically, Medicare benefits are reserved for Americans over the age of 65. If you are diagnosed with ESRD at any age, you may gain special access to Medicare benefits for a limited time.

If you receive temporary Medicare benefits due to ESRD, your coverage automatically ends 36 months after a kidney transplant. Medicare Part B-ID is designed to allow people in this situation to continue receiving coverage for immunosuppressive drugs, even if they no longer qualify for Original Medicare through age or medical condition.

Your costs and obligations under Medicare Part B-ID

Like with Original Medicare Part B benefits for outpatient care, people who receive Medicare Part B-ID are required to pay 20% of the cost of immunosuppressive drugs. This differs from the prescription drug benefit of Medicare Part D which requires Medicare recipients to pay a copay for certain drugs when purchasing them from pharmacies. Additionally, you cannot have other coverage for immunosuppressive drugs and still receive Medicare Part B-ID.

Medicare coverage for kidney transplants and associated care

It’s also worth noting that Medicare benefits will pay for kidney transplant operations and associated care. Medicare Part B covers costs associated with doctor visits and diagnostic testing preceding a kidney transplant. Medicare Part B also covers the actual transplant surgery itself.

If you are hospitalized following a kidney transplant, which is practically impossible to avoid, Medicare benefits under Part A supply inpatient coverage. You can utilize up to 60 days of hospital inpatient coverage per benefit period or 20 days of inpatient coverage in a skilled nursing facility (SNF) per benefit period.

Medicare Part D covers prescription drugs that you take at home following a kidney transplant, including pain medications and antibiotics. This coverage does not include the immunosuppressive drugs discussed above that are covered by Medicare Part B-ID.