Close close icon

Medicare Coverage for Lung Transplants


Lung transplants aren’t simple procedures. Also, they can sometimes be costly – at times, up to $1 million to replace both lungs. Luckily, Medicare provides coverage for lung transplants if they’re medically necessary. We’re here to help explain what this coverage entails and answer other questions you may have about lung transplants while on Medicare.

Does Medicare Cover Lung Transplants

Under certain conditions, Medicare partially covers lung transplants. But, you must have a progressive end-stage cardiopulmonary or pulmonary diagnosis to qualify. Doctors must document the medical necessity of the transplant. Also, all other options must have been considered before you’re eligible. Care must take place at a certified location participating in Medicare’s transplant program.

What Does a Lung Transplant Cost with Medicare

The preparation for surgery, services during a hospital stay, and the transplant recovery may all have coverage. Your hospital insurance, Part A, covers the necessary exams, tests, and labs, as well as hospital services for your transplant. Part A may also cover inpatient stays at a skilled nursing facility or other home health care directly following the hospital visit. Part B covers doctors’ services for your transplant in outpatient settings. In some circumstances, both parts may also cover immunosuppressive (anti-rejection) drugs. For lung transplants, Medicare may also cover blood transfusions and donor organ procurement.

Do Medicare Supplements Cover Lung Transplants

When Medicare approves a service, Medigap provides coverage. Parts A and B only pay for so much. There’s still deductibles, coinsurance, and copayments you must pay. Those additional costs have coverage through a Medigap policy.

Do Medicare Advantage Plans Cover Lung Transplants

Medicare Advantage plans require you to contact the company that handles your claims. Premiums tend to be lower, and you pay copayments for services rendered. Each Advantage plan has its own rules for lung transplant coverage. You must call the company directly to discuss coverage options before getting a lung transplant.

How Can Part D Coverage With Lung Transplants

Part D mostly provides coverage for the drugs that Part B doesn’t. However, each Part D plan has a 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 managed by private insurance companies and help provide coverage for prescriptions such as anti-rejection drugs.

Is Medicare Going to Cover a Lung Cancer Screening

The good news is, coverage is available for cancer treatments. Recipients of 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. Also eligible are smokers averaging a pack a day for a minimum of 30 years who show no signs or symptoms of lung cancer. When approval happens, there’s 100% coverage for lung cancer screening.

How to Get on the Lung Transplant List

The first step to get on the lung transplant list is to contact your doctor for a referral. Then, you must contact a transplant facility, of which there are more than 200. Be sure to do research, so you find the transplant facility that’s right for you. After finding the facility of your choice, schedule an appointment for an evaluation. Once the hospital’s transplant team deems you a suitable candidate, they’ll add you to the national waiting list.

FAQs

What are the qualifications for Medicare to cover a lung transplant?
The recipient generally must have a diagnosis of progressive end-stage cardiopulmonary or pulmonary disease. Also, they need to exhaust all other options for the procedure to be medically necessary.
How much does Medicare pay for lung cancer screenings?
If you qualify, Medicare pays in full for an annual lung cancer screening.
Does Medicare pay for anti-rejection drugs?
Medicare pays for your anti-rejection drugs if it provides coverage for your transplant. If Medicare doesn’t pay for your transplant, a Part D plan may cover anti-rejection drugs. Also known as immunosuppressive drugs, anti-rejection drugs keep the body from rejecting a transplanted organ.

How to Find Medicare Coverage for a Lung Transplant

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.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

Comment

Your email address will not be published. Required fields are marked *