Is at-home recovery after a transplant covered by Medicare?
The Medicare handbook also states, “Medicare covers doctor services for heart, lung, kidney, pancreas, intestine and liver transplants under certain conditions, but only in Medicare-certified facilities.”
The handbook continues, “If you’re thinking about joining a Medicare Advantage Plan and are on a transplant waiting list or believe you need a transplant, check with the Medicare Advantage plan before you join to make sure your doctors, other health care providers, and hospitals are in the plan’s network. Also, check the plan’s coverage rules for prior authorization and coverage for your living donors.”
Regarding the Toni Says client’s question about Medicare paying for at-home care while he is recuperating from his liver transplant, I did not have good news for him.
Original Medicare pays zero for at-home care while recuperating from a transplant or any illness. Medicare will pay for home health visits if there is a doctor’s order and it meets Medicare’s medical requirements.
Medicare will only pay for skilled nursing or rehab facility care. If you do not meet Medicare’s qualifications for skilled nursing, you will pay 100% of the cost for it out of your pocket.
I have informed the Toni Says client to begin speaking with at-home provider services, friends, and family about receiving their help with round-the-clock care at home to aid him and his wife. If he has a long-term care policy, it may pick up costs not paid by Medicare.
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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question or want to discuss long-term care options, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition is available at www.tonisays.com.
Copyright 2024 Toni King, Distributed by Counterpoint Media
