Does Medicare Cover Heart Transplants?

Heart transplants patients are getting older: 1 in 50 people who receive a heart transplant are aged 70 or older. And while heart transplants sound scary, recent studies show that survival rates continue to improve despite an increase in older and higher-risk heart transplant recipients. In fact, approximately 85 to 90% of heart transplant patients are still alive one year after their surgery, with an annual death rate of approximately 4% thereafter, and a three-year survival rate of almost 75%. This is all good news, but if you have to undergo a heart transplant, you are probably concerned about many things, including the cost of the surgery and whether Medicare will cover it.

Why Heart Transplants Become More Necessary With Ageolder woman grabbing her chest

Heart failure develops when your heart can no longer pump enough blood to provide your body with oxygen and nutrients. This can be caused by chronic conditions that you might have; if you reach heart failure, you could come to a point where medication cannot help, and the only option is to receive a heart transplant. 

Medicare Coverage

One of the great things about Medicare is that it covers a wide variety of medical services, since there are different parts that cover different things. Part B covers general medical services that you would get from your doctor, and Part A covers services you receive while you’re in the hospital, as well as follow-up care and prescriptions. When it comes to receiving a transplant, Medicare Part A will pay for the surgery, as well as for finding the organ that you will receive during the surgery.

If it is not possible to receive a heart from a donor in time, you can consider receiving an artificial heart, but you should know that Medicare does not cover artificial hearts, whether permanent or temporary. 

How Much Will You Pay?

Although Medicare does cover a lot of medical services and treatments, it does not cover everything 100%. Once Medicare approves the surgery, they will cover:

  • Services provided to prepare for the transplant, including finding the organ
  • The actual surgery
  • Follow-up services to ensure the transplant is successful
  • Any immunosuppressive drugs and other transplant-related prescriptions, if needed

All of the above will be covered at 100%, but you will have out-of-pocket costs, including your:

illustration of a bill and calculator

  • Medicare Part A deductible
  • Medicare Part B deductible, which must be fully paid if you receive any services following the surgery, such as rehabilitation. 
  • Medicare Part B coinsurance- Medicare will only cover 80% of any necessary outpatient treatment and therapy sessions you receive, leaving you to pay 20% out-of-pocket

Extra Coverage

As we pointed out above, Medicare Part B will only cover the cost of services or treatment received at 80%, leaving you to pay for the other 20% out-of-pocket. If you have to have major surgery, like a heart transplant, this can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.