Does Medicaid Cover Liver Transplants? Medicaid’s Role In Liver Transplant Financing

While liver transplant surgery comes with a substantial cost, individuals eligible for the procedure can find financial relief through insurance coverage, which often covers a significant portion of the expenses.

Additionally, various organizations offer financial support to those in need.

Liver transplant surgery is a crucial intervention for individuals in the advanced stages of liver failure, necessitating the procedure when other treatments fail to restore liver function or reverse damage.

As reported by the American Liver Foundation, approximately 6,000 liver transplants are performed annually in the United States, with over 17,000 Americans waiting for a donor.

This article presents an overview of the expenses associated with liver transplants, addressing the variable costs influenced by factors such as location, medical charges, healthcare facility, insurance provisions, and more.

In 2020, data indicates that the average cost of a liver transplant amounts to $878,400.

This comprehensive figure covers expenses incurred from 30 days before the transplant procedure to 6 months after the surgery.

This breakdown encompasses:

Procurement:
Definition: Procurement encompasses all services involved in retrieving liver tissue from a donor, covering retrieval, preservation, and transportation costs.
Estimated Cost: $104,200

30-Days Pretransplantation:
Explanation: Incurred 30 days before hospital admission for a liver transplant, it includes comprehensive physical, psychological, and laboratory testing costs.

This covers crossmatching for donor compatibility, blood screening, and X-rays.
Estimated Cost: $46,200

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Hospital Transplant Admission:
Details: This fee incorporates admission and facility charges, encompassing room and board, inpatient care, and other facility-related expenses.
Estimated Cost: $490,600

Physician Services:
Description

Charges for a doctor’s professional services during a liver transplant admission, covering every surgical procedure according to Healthcare Common Procedure Coding System (HCPCS) guidelines.
Estimated Cost: $59,200

Post-Transplant Discharge:
Inclusion

Encompassing all hospital readmissions, lab testings, outpatient visits, and postsurgical complications occurring 180 days after a liver transplant. It includes both transplant-related and nontransplant-related expenses.
Estimated Cost: $140,200

Outpatient Medications:
Coverage: This accounts for the cost of all prescription medications, including immunosuppressants, from discharge to 180 days after the transplant.
Estimated Cost: $38,000

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Liver Transplants and Health Insurance

The extent of coverage for liver transplants is determined by an individual’s insurance plan, with most plans having a cap on the amount they can pay. Here’s how different insurance options address liver transplant costs:

Medicare

Eligibility

Individuals in the end-stage of liver disease may qualify for Medicare.

Coverage

Medicare Parts A and B cover necessary services related to liver transplants, including laboratory tests, physical exams, procurement of the liver, follow-up care, and immunosuppressive drugs.

Additional Coverage

Medicare Advantage (Part C) can help with out-of-pocket costs and may include emergency services, mental health counseling, and therapy.

Medigap

Description

A private insurance plan to supplement Original Medicare, covering costs left over by Medicare, such as deductibles, copayments, and coinsurance following a liver transplant.

Payment

Medigap pays after Medicare and the individual have completed their payments for medical services.

Secondary Insurance

If an individual has secondary insurance, a Medigap plan may not be necessary, as the secondary policy can cover additional expenses.

Does Medicaid Cover Liver Transplants?

Eligibility:

Individuals eligible for a liver transplant and requiring free or low-cost care based on income and family size may qualify for Medicaid.

Coverage:

Medicaid covers various liver transplant costs, including hospital care, physician services, laboratory tests, prescription drugs, personal care services, and home-health services.

Limitations:

Medicaid programs typically cover liver transplants within the state unless no local transplant centers are available.

Financial Aid Programs

Assistance:

Several financial aid programs provide support for liver transplant costs.

They include the American Transplant Foundation, Help Hope Live, Liver Health Connection, National Foundation for Transplants, and Transplants Patients Trust in the United Kingdom.