When medications and treatments have not improved a diseased or failing lung, some people have to face the prospect of a lung transplant. Aside from the risks of this major surgery, you may be concerned about the costs of pre- and post-operative care, as well as the surgery and hospital stay. Medicare can help cover your medical expenses and let you focus on what’s important – your health.
Lung transplants can cost between $200,000 and $1,000,000, depending on the extent of the surgery, any complications, hospitalization, or recovery time. If you are eligible for Medicare and your physician determines that a lung transplant is medically necessary, Medicare will help cover the costs as you prepare for surgery, receive services during your hospital stay, and recover from the transplant.
How can Medicare help you pay for a lung transplant?
Medicare Part A (Hospital Insurance) helps cover the costs of a lung transplant that takes place in a Medicare-approved hospital. Part B (Medical Insurance) covers doctors’ services necessary in relation to the transplant, including office visits. Lung transplant coverage also includes necessary laboratory tests and exams, follow-up care, procurement of organs, and immunosuppressive drugs under certain conditions.
If you receive your benefits through Original Medicare, you will pay 20% of the Medicare-approved amount, and will be responsible for the Part B deductible. Transplant facility charges may vary. Although Part B will cover some of the costs of drugs associated with the transplant, such as immunosuppressive drugs to prevent organ rejection, you may want to consider enrolling in a stand-alone Prescription Drug Plan (PDP) to help pay for other medications prescribed before or after your surgery. Although Original Medicare does cover many costs, supplementary insurance, also known as Medigap, may help cover some of the out-of-pocket expenses, such as coinsurance, copayments, and deductibles.
If you are enrolled in a Medicare Advantage plan, it must provide at least the same coverage as Part A and Part B, but you may have additional benefits, including prescription drug insurance. You generally still pay your Part B deductible, but Medicare Advantage plans usually have an annual out-of-pocket maximum that may help protect you if you are facing overwhelming medical expenses. Compare your options and find the Medicare insurance plan that will meet your specific needs.