Interesting News Article

[Mandelin]

Was just reading this article. Is it true Medicare will only cover 3 years of anti-rejection pills? abcnews.go.com/Health/organ...

[Hidden]

The information below is taken directly from the Medicare.gov website under Kidney Transplants (the typos are also theirs, not mine). If you are not interested in reading the entire post the short answer is, "Yes, it's true." If you aren't happy with the answer you might check into what you can advocate for by contacting local organizations or write your U.S. (Congress) Representative and/or your U.S. Senator.

Kidney transplants

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) cover different items and services related to kidney transplants.

Part A covers transplant services and pays part of the costs for these:

Inpatient services in a Medicare-certified hospital

Kidney registry fee

Laboratory and other tests needed to evaluate your medical condition and the medical condition of potential kidney donors

Finding the proper kidney for your transplant surgery (if there's no kidney donor)

The full cost of care for your kidney donor (including care before surgery, the actual surgery, and care after surgery)

Any additional inpatient hospital care for your donor in case of problems due to the surgery

Blood (whole units of packed red blood cells, blood components, and the cost of processing and giving you blood)

Part B covers transplant services and pays part of the costs for these:

Doctors' services for kidney transplant surgery (including care before surgery, the actual surgery, and care after surgery)

Doctors' services for your kidney donor during their hospital stay

Transplant drugs, also called immunosuppressive drugs (for a limited time after you leave the hospital following a transplant)

Blood

Medicare will only pay for your transplant drug therapy for 36 months after the month of the kidney transplant if both of these apply:

You're entitled to Medicare only because of permanent kidney failure.

You have the pancreas transplant after the kidney transplant.

This is because your Medicare coverage will end 36 months after a successful kidney transplant if you only have Medicare due to permanent kidney failure.

Medicare will continue to pay for your transplant drugs (also called immunosuppressive drugs) with no time limit if either of these apply:

You were already entitled to Medicare because of age or disability before you got End-Stage Renal Disease (ESRD) .

You became eligible for Medicare because of age or disability after getting a transplant.

Your costs in Original Medicare

You pay:

20% of the Medicare-approved amount .

Various amounts for transplant facility charges.

Nothing for a living donor for a kidney transplant.

Nothing for Medicare-approved laboratory tests.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

Other insurance you may have

How much your doctor charges

Whether your doctor accepts assignment

The type of facility

Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Things to know

These services are covered if they’re done by the Medicare-certified hospital where you’ll get your transplant or another hospital that participates in Medicare.

Note

If you have a problem with the care that you’re getting for your transplant or with getting a referral for a transplant work-up, you have the right to file a complaint (grievance).

Related resources

Find hospitals

Find dialysis facilities

National Kidney Foundation External Link icon

Medicare & You: End-Stage Renal Disease (ESRD)/kidney transplant eligibility & enrollment (video)

[orangecity41 NKF Ambassador in reply to Hidden]

So, if already on Medicare or placed on Medicare due to disability, (SSI) then it does cover it for longer than 3 years.

[Hidden in reply to orangecity41]

Yes, at least as I understand it. However, it's written in typical government English which will require a legal reading to untangle or a phone call to Medicare.

[orangecity41 NKF Ambassador in reply to Hidden]

so true

[Mandelin in reply to Hidden]

Thanks Mr. Kidney. That makes a little more sense from what I thought. The DaVita person I had at the class I took was telling me about a 90 year old who was still on dialysis and she said it was their choice, now I wonder if it was because they couldn’t afford the alternative. Sad.

[aben]

It all depends on your age and Medicare eligibility status. If you're only eligible for Medicare because of ESRD then that eligibility only extends for 36 months at which point they consider the transplant successful.

[WYOAnne NKF Ambassador]

If you are under 65, when you are in end-stage ckd, you can get 3 years of Medicare. When the 3 years are up, you have to go back on your regular insurance. Prior to my transplant, when I started dialysis I started my 3 years of Medicare. When time was up, I went back on my husband's insurance. I had no problem with receiving my transplant meds.

When you are over 65 you can sign up for Medicare, but you have to pay for Part D which pays for medications.

[Mandelin in reply to WYOAnne]

Thanks everyone. I thought it did, just wasn’t sure what this article was talking about, now I do.

[Bobbiereed]

If you are under 65--Yes. Medicare ceases to exist after 36 months post transplant. My son, now age 28 is in this situation. He lost his medical through Medicare and also all prescription benefits on November 30, 2018. I am a big advocate for changing this. He fought so hard to live and went through dialysis for two years before a non-related living donor stepped up and gave him one of his kidneys. We just gotta keep his new kidney functioning and discontinuing medication coverage certainly isn't the way to do it.

[Hidden]

One thing was suggested to me is that in the next election look to support whatever candidate, of either party, that supports Medicare for All. That would make it the choice for all enrolled and allow unlimited coverage for those with chronic conditions. It would be the quickest way to see change. Between now and that time sadly there are no other options available at the moment. Open enrollment has ended (midnight on December 7th). Of course, if you can pick up another plan it may still be an option.