A lung transplant is a serious procedure that is performed by a transplant surgeon, along with a team of medical personnel, social workers and others who assist before, during and after the surgery.
Lung transplants are done on patients whose lungs are dangerously damaged. Most have a life expectancy of no more than 24 months.
Some of the illnesses that result in the need for a lung transplant (either one or both lungs) include:
- Severe cystic fibrosis (CF)
- Bronchopulmonary dysplasia or chronic obstructive pulmonary disease (COPD)
- Pulmonary hypertension
- Heart disease
- Pulmonary fibrosis
Medicare Coverage for Lung Transplants
Part A, which includes hospital coverage, pays for hospital stays, skilled nursing care in qualified facilities, some of the post-hospital and in-facility care upon returning home, blood transfusions and hospice care.
For transplant patients, Part A covers the sourcing of transplant organs from donors and the surgical procedure and all that it involves.
Medicare Part B pays for all outpatient medical needs, including visits to the doctor’s office, x-rays, MRIs, CAT scans, preventive care, and implementation, home, and mobility equipment, ambulance service, emergency room visits, post-surgery supplies, chemotherapy, and other health care need
Medicare Part D, the prescription drug coverage, will cover medications.
Original Medicare Coverage for Lung Transplants
Your Original Medicare Part A covers the surgery itself, then Medicare Part B covers your doctors care. Keep in mind, Medicare only covers 80%, you’re responsible for the remaining 20%.
Both parts combined will cover:
- Organ procurement
- Labs, exams, and tests
- Transplant surgery
Medicare Part D Coverage for Lung Transplants
Medicare Part D is an essential part of the picture for transplant patients. There are anti-rejection and immune system suppression drugs that must be taken before, during and after. In most cases for the rest of your life.
While each Medicare Part D Plan has its own list of approved drugs, all of these plans must cover immune-suppressants.
For Medicare Advantage recipients, the costs are generally the same, but patients should carefully investigate what is and is not covered by their HMOs and PPOs.
Medicare Supplement Plans Help Cover the Costs of a Lung Transplant
As state above, Medicare only pays 80% of your medical costs. This leaves you responsible for the remaining 20%, as well as other out of pocket costs that can quickly add up. A Medicare Supplement Plan will cover the remaining 20%, as well as other out of pocket costs, depending on the letter plan you choose.
If you’re concerned about the out of pocket expenses your Original Medicare doesn’t cover, you’re not alone. There’s 10 different Medicare Supplement Plans to choose from, all have a different range of benefits. Learning the differences can be overwhelming, let us help you.
We help Medicare beneficiaries become educated on their healthcare benefits. Our services are free, and we’re licensed in your state. Whether you’re just looking for information on what your current plan covers, or looking to add additional coverage, give us a call. Our agents are standing by ready to help you through the Medicare maze.
You can also compare Medicare rates online using our online rate form here.
Lung Transplant Approval Process
Because a lung transplant is an expensive procedure, in some cases costing over one million dollars (for a double lung transplant), detailed documentation and history must be presented for the surgery to be covered by Medicare.
All other options must be exhausted before a transplant is approved. Doctors, psychiatrists, social workers, and other experts must believe that a positive outcome is likely.
Lung Transplants Can Be Lifesaving
Medicare recipients who receive a lung transplant and recover successfully will find their lives greatly improved by the ability to breathe easily and function normally. With Medicare coverage and a Medigap plan, patients can also breathe a sigh of relief at having most of the costs of this expensive and complicated surgical procedure covered.
Lung Cancer Screening with Medicare
The Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides for Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). The coverage is effective immediately.
“This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States,” said Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality for CMS.
Medicare will now cover lung cancer screening with LDCT once per year for Medicare beneficiaries who meet all of the following criteria:
- they are age 55-77, and are either current smokers or have quit smoking within the last 15 years;
- they have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years); and
- they receive a written order from a physician or qualified non-physician practitioner that meets certain requirements.
Medicare coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening.
The NCD also includes required data collection and specific coverage eligibility criteria for radiologists and radiology imaging centers, consistent with the National Lung Screening Trial protocol, U.S. Preventive Services Task Force recommendation, and multi-society multi-disciplinary stakeholder evidence-based guidelines.
“We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program,” Conway said.