Planning for Medical Expenses

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Organ Transplant

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Medicare is a medical insurance with benefits determined by the federal government. If you have permanent kidney failure (end-stage renal disease), you are eligible for Medicare benefits if you meet criteria for U.S. residency and work history. It doesn’t matter how old you are or what income you have. However, you can only purchase Medicare under the renal-disease rules if you have had a transplant or are on dialysis. Medicare benefits can help pay the costs of your kidney transplant at a Medicare-approved facility.

Medicare has two parts, Part A and Part B, and they offer different levels of benefits. You must be enrolled in Medicare at the time of the transplant in order to receive transplant-related benefits. For more information, contact the financial counselor at the Swedish Organ Transplant Program. You also may contact your local Social Security office and ask for the booklet titled “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services," or you may go to the Medicare site.

Employer or Individual Medical Insurance

In many cases, an insurance policy that is provided through an employer or purchased on an individual basis may be responsible for transplant costs. The vast majority of insurance plans pay for a transplant, as it is a standard (not experimental) medical treatment. At the time of your evaluation, our financial coordinator will discuss your insurance situation with you and go over the coverage your plan provides.

Your Costs

In most cases, Medicare and private insurance will not pay for a transplant completely. You should check into your own insurance benefits to determine hospital co-pays and prescription drug costs. As the number of medications that you will take after the transplant will be significant, it is especially important that you maintain a secondary insurance with prescription drug benefits.