Immunosuppressive Drug Coverage for Medicare Patients is Here

The Department of Health and Human Services (HHS) and Social Security Administration (SSA) have taken steps toward implementing indefinite Medicare Part B coverage of immunosuppressive drugs for kidney transplant recipients. This legislative victory from late 2020 directly resulted from advocacy by NKF patients, caregivers, and health professionals.

The new benefit (Medicare Part B-ID) provides continued Medicare coverage of immunosuppressive drugs for kidney transplant recipients whose Medicare eligibility ends 36 months after receiving their transplant if they do not have other public or private health insurance coverage.

Eligibility and coverage

Enrollment began on October 1, 2022, for kidney recipients whose coverage has or will expire before January 1, 2023. Their coverage will resume on January 1, 2023. The new law removes the 36-month limitation only for immunosuppressive drugs. It does not cover any other services or benefits, including additional transplant needs such as lab tests and transplant drugs other than immunosuppressives. 

What you need to know: 

1. If you have access to more comprehensive health insurance coverage such as Medicaid, employer group health insurance, an Affordable Care Act plan, or other types of insurance, you should maintain or apply for it to help meet a broader range of health needs. 
2. If you have other insurance but lose it in the future, you may re-enroll in Medicare without a late enrollment penalty.  
3. If you are age 65 or above or have Medicare coverage due to another disability, your regular Medicare coverage will continue, including for immunosuppressant medications

Social Security and Medicare will notify kidney recipients of their potential eligibility for Part B-ID. You can contact Social Security at 1-877-465-0355 to determine and attest your eligibility or get answers to frequently asked questions about this new Medicare benefit here. 

The Part B-ID monthly premium will be 15% of the combined beneficiary and government Part B premium for total Medicare beneficiaries, or $97.10 monthly in 2023. Part B-ID beneficiaries must also meet the $226 deductible for 2023, and the standard 20% co-pay for each prescription applies.

Watch our webinar, Medicare Immunosuppressant Drug Benefit using this passcode: 7f#uN24e

Join our community of advocates

More big victories like this one are possible with your voice. Your story helps make changes happen in the government and across the nation. We’ll show you how. Take action today. 

NKF Cares

Have more questions about the new immunosuppressant drug coverage? Get answers from a trained professional at our Patient Information Help Line at 1-855-653-2273 or nkfcares@kidney.org