Medicare provides coverage for lung transplants; this includes the sourcing of the operation from the donor, the surgical procedure, and many other necessary services.
Lung transplants are not simple procedures, and they can be costly. Sometimes these surgeries may cost more than $1 million.
Many may need to undergo lung transplant surgery. A lung transplant can replace a failing or diseased lung with a healthy lung from a donor.
Does Medicare Cover Lung Transplants
Under certain conditions, Medicare partially covers lung transplants. Although, beneficiaries must have a progressive end-stage cardiopulmonary or pulmonary diagnosis.
Doctors must document the medical necessity of this procedure; all other options must have been considered or tried before coverage begins.
More so, doctors must include in the medical notes that surgery is likely to be successful. Also, care must happen at a certified location participating in Medicare’s transplant program.
Medicare Lung Cancer Screening
The good news is, Medicare provides coverage for cancer treatments. Beneficiaries ages 55-77, that smoke or quit within 15 years have Part B coverage for annual lung cancer screenings, and Low-Dose Computed Tomography chest scans.
Other eligibility requirements are smokers averaged at a pack a day for a minimum of 30 years and show no signs or symptoms of lung cancer. When approval happens, Medicare pays 100% of the costs of lung cancer screening.
Does Medicare Pay for Anti-Rejection Drugs
Part D covers drugs that Part B doesn’t, for the most part. However, each Part D plan has its’ own drug formulary.
The formulary is a list of drugs that the plan covers. Beneficiaries must understand that this list is subject to change.
Part D plans are sold by private insurance companies to help provide coverage for things like anti-rejection drugs.
Lung Transplant Costs with Medicare
Medicare may cover lung transplant costs. The preparation for surgery, services during a hospital stay, and the transplant recovery may all have coverage under Medicare.
Since Part B is medical insurance, it covers lab work and tests a patient may need before the surgery. Part B also covers outpatient follow-up care.
Any inpatient stays at SNF or some home health care directly following a hospital visit may have coverage by Part A.
Hospice care is always Part A; in lung transplant coverage, Medicare may cover blood transfusions, procurement of donor organs, and the surgery procedure.
How Dangerous is a Lung Transplant
One of the most significant risk factors of lung transplants is the possibility of rejection. Which is why many must continue taking anti-rejection medication after this type of surgery. These medications are necessary for life.
In more recent years, this surgical procedure has had an increase in survival rate afterward. As stated by the National Heart, Lung, and Blood Institute (NHLBI) of lung transplants, it is up to 80% for one-year post-surgery.
However, the rate drops to 50% for survival after five years. Although, years ago, many wouldn’t even survive that long. The survival rate varies among facilities; it’s essential to research before you consider having surgery.
Best Hospitals for Lung Transplants
The best hospitals in the country for lung transplants are:
- St. Joseph’s Hospital and Medical Center. The location is in Phoenix, AZ, and they had the highest survival rate after one-year from a patients’ transplant.
- Next is the UT Southwestern Medical Center/William P. Clements Jr. University Hospital in Dallas, Tx.
- The 3rd best in the nation is in Baltimore, MD – John Hopkins Hospital.
However, from Arizona to Maryland, the number of adults surviving is quite different. They are ranging from over 100 to as little as 27.
Beneficiaries must always research their facility before having this procedure.
How to get on the Lung Transplant List
The first way to get on the lung transplant list is to contact your doctor to get a referral. Then, patients must contact a transplant facility (hospital).
Educate yourself as there are more than 200 facilities. After finding the facility of choice, schedule an appointment to have an evaluation.
Once the hospital’s transplant team deems a patient is the right candidate, they will add you to the national waiting list.
Medicare Supplement Coverage for Lung Transplants
Medigap covers when Medicare approves a service. Before Mary found out she needed a lung transplant, she called her Medicare agent to discuss her coverage options.
Her agent was helpful and set Mary up with a Supplement plan she could afford. The supplement helps her cover the gaps in costs of the lung transplant procedure she was going to have.
Parts A and B only pay for so much. There’s still deductibles, coinsurance, and copayments the beneficiary must pay. Mary had a lung transplant last year.
Those additional expenses of her procedure were paid for by her Supplement coverage.
Medicare Advantage Coverage for Lung Transplants
Medicare Advantage requires you to contact the company that handles your claims. Premiums tend to be lower, and copayments you pay as you go.
Each Advantage plan has its own rules for coverage for lung transplants if you have coverage through an Advantage plan.
You must call his company directly to discuss his coverage options before getting a lung transplant.
Part D Coverage for Lung Transplants
You want to contact the Part D plan to find out which drugs have coverage post-operation. Part D can help pay for the medicines you need after a lung transplant.
Part D coverage is optional. You may purchase a Part D plan to help cover some of the expensive costs of necessary drugs.
Give us a call at the number above or fill out an online rate form. Our agents can quickly help you find your best coverage options.
A serious health condition like pulmonary disease can happen at any time. It’s best to ensure proper coverage before a problem occurs.
Contact one of our agents today. We can help compare rates in your area, and ensure you get the best coverage for your individual health needs. All at an affordable price!