How to Pay For an Organ Transplant Surgery
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How to Pay For an Organ Transplant
Updated July 31, 2014.
Organ transplant surgery is very expensive. The initial testing that is required in order for a patient to be placed on the waiting list for a transplant can cost tens of thousands of dollars, even if the patient is not hospitalized.
It is not uncommon for the cost of the transplant surgery and following hospitalization to result in a bill that exceeds $500,000. Unfortunately, the expenses do not end with surgery; the cost of medications in the year after surgery typically exceeds $30,000 a year.
Ideally, a patient will have primary insurance to pay the majority of the transplant expenses and a secondary form of insurance to pay the remaining expenses. Even with excellent insurance coverage that pays 80% of the total bill, the remaining 20% can exceed $100,000 from the surgery alone. With secondary or supplemental insurance coverage, the remaining 20% may be paid by the insurance company rather than the patient.
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The Costs of Organ Transplantation
Updated July 31, 2014.
Pre-transplant hospitalizations, lab tests and general testing in preparation for surgery all contribute to the high cost of a transplant. Some additional costs that you may not anticipate include:
- Hospitalization required before surgery
- Treatment costs prior to surgery, such as dialysis and insulin pumps
- Transplant surgery and hospitalization
- Anti-rejection medications
- Ongoing visits with the transplant surgeon
- Any additional treatment required
- Insurance deductibles, co-pays and premiums
- Non-medical expenses, including child care, travel, and lodging
- Lost wages
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Paying For an Organ Transplant With Private Insurance
Updated July 31, 2014.
Private insurance is coverage that is not sponsored by the government; the patient or a spouse typically obtains a private insurance policy from his or her employer. In some cases, particularly for people who are self-employed, private insurance can be obtained outside of the workplace. In that case, the patient pays the insurance premium.
Depending on the plan, private insurance may assume a good bulk of the cost of an organ transplant.
However, most insurance plans have a “cap” or a maximum that the insurance company will pay for the care of a patient. This cap may be met or exceeded with standard care during the course of an organ transplant.
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Secondary Insurance Can Help Defray Costs of an Organ Transplant
Updated July 31, 2014.
Secondary insurance is a policy that is obtained in addition to insurance obtained through an employer, the government or privately. It is recommended that potential transplant patients who do not have a secondary insurance policy obtain a secondary policy to help pay the costs that are not covered by a primary insurance policy.
COBRA is an example of private insurance that is obtained outside of the workplace; the patient pays the insurance premium.
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Using Medicare and Medicaid to Pay for an Organ Transplant
Updated July 31, 2014.
Medicare
This type of government-funded insurance pays for transplants, but not everyone qualifies for coverage.
Patients over the age of 65, the disabled, and those who have been diagnosed with end stage renal disease (ESRD) qualify for Medicare. Additionally, patients may qualify if they or their spouse have paid into the Medicare system. The Medicare website www.medicare.govprovides detailed information about qualifying for coverage, and what coverage is available in each state.
Medicaid
Medicaid is government-sponsored insurance for low income patients that is administered by individual states. The coverage, as well as qualifications for coverage, can vary between states. The income limit to qualify varies based on the size of the family and income level, but a low income does not necessarily mean a patient will qualify for coverage.
If a patient does not qualify for Medicaid due to income level, he or she still may qualify for “spend down” Medicaid, which takes into account the amount of money being paid for health care. The financial planner at the transplant center should be able to help patients navigate dealing with the social security office that administers Medicaid.
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Using Veteran's Benefits to Pay for an Organ Transplant
Updated July 31, 2014.
Veterans who are currently serving in the military or who have retired from the military may qualify for supplemental insurance through the government, known as Tricare. This veteran's benefit will contribute to the expenses of an organ transplant.
More information is available at the Tricare website.
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Paying For an Organ Transplant With Personal Funds
Updated July 31, 2014.
Many patients cannot afford to pay for the full cost of organ transplant surgery, or even a small insurance deductible amount, using their personal funds. Most people waiting for an organ transplant have financial difficulties, especially if their illness has caused them to be placed on disability.
This is not uncommon, and many patients explore other options to help them fund their procedure.
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Fundraising to Pay For a Transplant
Updated July 31, 2014.
Some transplant patients approach public service organizations to help pay for the costs of transplantation. Civil service organizations are often willing to donate to help a patient get a life-saving surgery. Other patients opt to hold fundraising events, such as walk-a-thons, or appeal to their friends, family and fellow community members to help raise the money they need.
The financial coordinators at transplant centers may be able to provide help with locating organizations that can contribute to your fundraising efforts.
Some patients have great success with online fundraising, using websites likeGiveForward.com to share their story and urgent need.
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