Medicare covers liver transplants, but only under specific conditions

Yes, Medicare covers liver transplants — both the surgery itself and the hospital stay. However, coverage depends on where you have the transplant done and whether your doctor believes you are a suitable candidate. Medicare will pay for the transplant at hospitals that meet federal standards, but you will still have costs of your own, and the approval process requires documentation that the transplant is medically necessary.

The transplant must take place at a Medicare-approved transplant center. Not every hospital that performs transplants is approved by Medicare, so your doctor's choice of facility matters. If you go to a non-approved center, Medicare will not cover the procedure, even if the surgery itself is medically sound.

Key Takeaways

  • Medicare Part A covers the hospital costs of a liver transplant at an approved transplant center, including the surgery, hospital stay, and when ready post-transplant care.
  • Your doctor must document that the transplant is medically necessary and that you are healthy enough to survive the surgery and take immunosuppressant drugs for life.
  • You will owe your Part A deductible, coinsurance during your hospital stay, and all costs for anti-rejection medications after you leave the hospital.
  • The transplant center will evaluate you before surgery to confirm you meet Medicare's medical criteria and can follow the lifelong medication regimen required after transplant.
  • Medications to prevent organ rejection are not covered by Medicare Part A or Part B and can cost hundreds of dollars per month, so you may need Part D or other coverage.

What Medicare Part A covers during the transplant

Medicare Part A covers the hospital stay for the liver transplant surgery itself. This includes the operating room, anesthesia, the surgeon's fee, the organ procurement, and the initial days in the hospital after surgery while you recover. Part A also covers any complications that occur during your hospital stay, such as infection or organ rejection episodes that require treatment before discharge.

The length of your hospital stay varies. Most people stay 7 to 14 days after a liver transplant, though some stay longer if complications arise. Medicare will cover the full cost of your hospital care during this time, minus your Part A deductible and any coinsurance you owe.

Part A does not cover the cost of the organ itself — that is paid through the national organ procurement system and is not billed to you or to Medicare as a separate charge. The transplant center handles organ procurement as part of the surgical procedure.

Your out-of-pocket costs during and after transplant

Even though Medicare covers the hospital stay, you will have costs. In 2024, you owe your Part A deductible before Medicare begins paying. After you meet the deductible, you pay coinsurance (a percentage of the hospital bill) for days 1 through 60 of your stay, and a higher coinsurance amount for days 61 and beyond. The exact amounts change each year.

The largest ongoing cost is immunosuppressant medications — the drugs you must take for the rest of your life to prevent your immune system from rejecting the new liver. These medications are not covered by Part A or Part B. If you have Part D prescription drug coverage, some of the cost may be covered, but you will likely pay a monthly copay. If you do not have Part D or supplemental coverage, these drugs can cost $500 to $2,000 per month or more, depending on which medications you take.

You will also need regular blood tests and doctor visits after you leave the hospital to monitor how well the new liver is working and to adjust your medications. Part B covers these visits and tests, but you will owe your Part B deductible and coinsurance.

How Medicare decides whether to cover your transplant

Before you can have a liver transplant at a Medicare-approved center, the transplant team must determine that you meet Medicare's medical criteria. This is not a financial decision — it is a medical one. The team looks at whether your liver disease is severe enough that transplant is your best option, whether you are healthy enough to survive major surgery, and whether you can reliably take medications for life.

The transplant center will order tests including blood work, imaging of your liver and blood vessels, heart and lung function tests, and often a mental health evaluation. Your doctors will review your medical history to look for conditions that would make transplant too risky — such as active cancer, severe heart disease, or ongoing alcohol or drug use. They will also assess whether you understand the lifelong commitment to taking medications and attending follow-up appointments.

If the transplant team concludes you are not a suitable candidate, Medicare will not cover the transplant. You have the right to ask for a second opinion at another transplant center, and Medicare will cover the evaluation at that center as well.

Finding a Medicare-approved transplant center

Not all hospitals that perform liver transplants are approved by Medicare. You can find a list of approved centers on the Centers for Medicare & Medicaid Services (CMS) website, or ask your hepatologist (liver specialist) which centers near you are Medicare-approved.

If your doctor recommends a transplant center that is not Medicare-approved, you have two choices: you can pay out of pocket for the transplant at that center, or you can ask your doctor to refer you to an approved center instead. Many people travel to approved centers even if they are far from home, because Medicare coverage makes the cost manageable.

The transplant center will handle the referral process with Medicare. You do not need to contact Medicare yourself to get pre-approval for the transplant — the center's team will submit the medical documentation and work with Medicare to confirm coverage before your surgery date.

What happens if you are waitlisted for a liver

If you are approved for transplant, you will be placed on the national waiting list. While you wait, Medicare covers the costs of monitoring your liver disease — blood tests, ultrasounds, doctor visits, and any treatments to manage complications of liver disease. These are covered under your regular Part B benefits.

The wait for a liver can be weeks to months, depending on your blood type, the severity of your disease, and the availability of donor organs in your region. During this time, your transplant center will stay in touch and may adjust your medications or treatment plan based on how your liver is functioning.

If you receive a call that a donor liver is available, you will go to the hospital when ready. The transplant center will do final tests to make sure you are still healthy enough for surgery, and then the transplant will proceed. All of these pre-transplant tests and the surgery itself are covered by Medicare Part A.

Planning for the cost of anti-rejection drugs

The biggest financial challenge after transplant is paying for immunosuppressant medications. These are essential — missing doses or stopping them can cause your body to reject the new liver, which can be fatal. Because these drugs are so important, you need a plan to pay for them before your transplant surgery.

If you have Part D prescription drug coverage, review your formulary (the list of covered drugs) before transplant to see which immunosuppressants are covered and what your copays will be. Some Part D plans cover these drugs better than others. You can switch plans during the annual enrollment period (October 15 to December 7 each year) if your current plan does not cover your medications well.

If you do not have Part D, you can enroll during a special enrollment period after your transplant. However, it is better to enroll before surgery if possible, so your medications are covered from day one.

Some transplant centers have financial counselors who can help you find programs that reduce the cost of immunosuppressants, including manufacturer information programs or nonprofit organizations that help transplant recipients pay for drugs. Ask your transplant team about these resources.

Frequently Asked Questions

Does Medicare cover the liver from a living donor?

Yes. If you receive a liver from a living donor (usually a family member), Medicare covers the transplant surgery and hospital stay at an approved center in the same way it covers a deceased-donor transplant. The living donor's surgery and hospital stay are also covered by Medicare if the donor is a Medicare beneficiary, or by the donor's own insurance if they are not yet on Medicare.

What if I need a second transplant because my first one failed?

Medicare covers a second liver transplant under the same rules as the first. You will need to be re-evaluated by the transplant team to confirm you are still a suitable candidate, but if you are approved, Medicare will cover the surgery and hospital stay at an approved center.

Are there any liver diseases Medicare will not cover transplants for?

Medicare does not have a blanket exclusion for any specific liver disease. However, the transplant center may determine that transplant is not medically appropriate for your particular condition — for example, if your cancer has spread beyond the liver, or if your heart is too weak to survive surgery. The decision is based on your individual medical situation, not on the name of your disease.

Can I use Medicare Advantage instead of Original Medicare for my transplant?

Most Medicare Advantage plans cover liver transplants at in-network transplant centers, but coverage rules vary by plan. Before you need a transplant, contact your Medicare Advantage plan to confirm that transplants are covered and to find out which centers are in your network. If your plan does not cover transplants, you can switch to Original Medicare during the annual enrollment period.

What if the transplant center bills me for something Medicare should have covered?

Contact Medicare directly at 1-800-MEDICARE to report the bill. You can also file a complaint with your state's insurance commissioner if you believe the center is billing you incorrectly. Keep copies of all bills and correspondence with the transplant center and Medicare.