Is At Home Recovery After a Transplant Covered by Medicare?

Reader Alert: This week, I received a text message from one of Toni Says® Medicare clients that I would like to share with the Toni Says® readers. You may never know when you or one of your family members will experience a life changing medical diagnosis.

The text reads:
Toni: I need to put together a 24/7 home care recovery plan after a liver transplant. The surgery is over a year out, but I would appreciate some tips on Medicare and how to plan for this event. Thanks in advance, a Toni Says client. (name withheld for confidentiality)

To My Readers:
This text made me realize that America is not prepared for a life changing medical need such as a transplant.

Luckily, my client has Original Medicare with a Medicare Supplement allowing him and his team of medical providers together to pick which rehab/ skilled facility and home health agency he will use while recuperating from his liver transplant.

In the Medicare and You handbook, there is a segment in Section 2 that discusses transplants and immunosuppressive drugs. It states that “you must have Part A in place at time of the covered transplant and that you must have Part B at the time you get immunosuppressive drugs. You pay 20% of the Medicare-approved amount for the drugs and the Part B deductible applies”.

It also discusses that “Medicare covers doctor services for heart, lung, kidney, pancreas, intestine and liver transplants under certain conditions, but only in Medicare-certified facilities.”

The handbook also states, “if you’re thinking about joining a Medicare Advantage Plan (like an HMO or PPO) 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.”

“Note: Medicare drug plans (Part D) may cover immunosuppressive drugs if Medicare Part B doesn’t cover them.” In other words, be sure you have a complete Medicare Part D planning consultation before you enroll in a specific Medicare Part D plan to be sure that the Part D plan chosen covers all of your transplant drugs as well as prescriptions you take daily.
If your Part D plan does not cover your transplant prescription drugs, then who will pay…. You will!

Regarding my client’s question about Medicare paying for 24/7 at home care while he is recuperating from his liver transplant, I do not have good news.

Medicare pays absolutely nothing 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 requirements.
Medicare will only pay for rehab or skilled nursing. If you do not meet Medicare’s qualifications for skilled nursing, you will pay 100% of the cost out of your pocket.

I have informed my client to begin speaking with what is called at-home provider services, his church, or friends about getting their help with round-the-clock help at home to help his wife. If he has a long-term care policy, it may pick up some costs.

In today’s financial climate, America has new long-term care options to maximize the 401K capabilities and get more bang for your 401K dollars!

Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at www.tonisays.com. Have a Medicare question? Call 832/519-8664 or email info@tonisays.com.