Does Medicare Cover a Heart Transplant?

A transplant is the last resort for an individual suffering from a failing, diseased heart. A heart transplant is only a consideration after medications, treatments, and surgery have not sufficiently improved a heart’s condition. Once someone has reached end-stage heart failure and all other options have been exhausted, a cardiologist and cardiac surgeon will assess if a patient is eligible for a transplant. While you are going through this process, you may be understandably concerned about the medical bills you may be incurring. Find out how Medicare can help you manage your health and help cover the costs associated with a heart transplant.

A heart transplant can help someone with congenital heart failure live a normal life with a healthy heart, but it’s a complicated procedure with substantial risks. Understanding the procedure may help you prepare.

What is a heart transplant? According to the American Heart Association, a heart transplant involves the removal of a diseased heart by transecting the aorta and dividing the left atrium. The cardiac surgeon connects the donor heart by sewing together the recipient and donor vena cavae, aorta, pulmonary artery, and left atrium.  A donor heart is chosen by blood type and body size, but the recipient will have to take immunosuppressive medication to prevent the body from rejecting the new heart. There are risks to consider throughout the process, including the side effects of these medications.

Risks of Heart Transplant

There are risks to consider as you prepare for a heart transplant, but those risks need to be weighed against the danger of your current condition.  The medications taken to prepare your body for the transplant can increase the risk of diabetes, infection, kidney disease, cancer or high blood pressure.

The surgery takes approximately four hours, and will be followed by a one or two-week hospital stay, barring any complications. Post-op care will include follow up tests order by your physicians based on need, such as an electrocardiogram, echocardiogram, Holter monitoring, an endomyocardial biopsy, and blood work. Your doctors will continue to monitor your health during regular check-ups.

Medicare Can Help Cover the Costs of a Heart Transplant

Medicare Part A, also known as Hospital Insurance, covers inpatient organ transplants in Medicare-certified facilities. Medicare Part B will provide coverage for medically necessary tests, lab work, and exams ordered by your physicians prior to surgery. Part B will also cover the cost of immunosuppressive drugs if Medicare paid for your transplant or if your employer
or union group health plan was required to pay before Medicare paid for the transplant. You must have Part A at the time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs. Medicare Part D, prescription drug coverage, may help cover the cost of prescriptions that Part B does not. Medicare also covers comprehensive cardiac rehabilitation programs for recipients of heart transplants, that can include exercise, education, and counseling.

If you are thinking about joining a Medicare Advantage plan, such as a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), and are on a transplant waiting list or believe you need a transplant, check with your plan before you join to make sure your doctors, other health care providers, and hospitals are in the plan’s network. You should also check the plan’s coverage rules for prior authorization.