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| Dialysis | Kidney disease | Transplant
Breaking Down New Extended Medicare Coverage for Immunosuppressive Drugs
January 12, 2023, 9:20am EST
Transplant centers require people to have a certain amount of money or savings to ensure they can pay for immunosuppressive drugs—medications crucial to maintaining the kidney transplant. Unfortunately, these can cost thousands of dollars a year for those without insurance, making financial stability one of the most significant barriers to receiving a kidney transplant. A new Medicare benefit has taken effect to help change that, also called Medicare Part B-ID.
"Many patients have to juggle bills and struggle to pay their rent, food, or utilities because of medications that can cost hundreds of dollars a month," said Troy Zimmerman, a special projects director for NKF and Voices for Kidney Health Advocate. "Immunosuppressive drugs are not the only financial issue after a transplant that a patient might face, but this new benefit will encourage more people to seek a transplant."
What does the new Medicare Part B-ID coverage cover?
Before December 2022, transplant recipients lost their Medicare eligibility 36 months after the transplant if they did not qualify for Social Security disability status or were younger than 65. The new extended Medicare benefit (Medicare Part B-ID) covers all FDA-approved transplant immunosuppressive drugs indefinitely, no matter your age or disability status.
Up to 36 months after transplant, Medicare Part B will cover:
- FDA-approved transplant immunosuppressive drugs
- Other transplant medications
- Home health care services
- Medical equipment like wheelchairs
- Preventative services like wellness checks
Beyond 36 months after transplant, Medicare Part B-ID will cover:
- FDA-approved transplant immunosuppressive drugs
Get more answers to frequently asked questions regarding this new coverage.
Who is eligible?
People who received a kidney transplant from a Medicare-approved facility and received Medicare at the time of their transplant are eligible for the new coverage.
The following are not eligible:
- People with public health insurance like Medicaid, Department of Veterans Affairs coverage, or TRICARE.
- People with private health insurance like employer-based plans, the Affordable Care Act, or individual health insurance plans.
If you lose public or private insurance, you can re-enroll in Medicare Part B-ID for immunosuppressive coverage. Once you reach age 65 or qualify based on a different disability, you will also be eligible for complete Medicare Part A and Part B coverage.
How much does the new coverage cost?
The monthly premium will be 15% of the full monthly Medicare Part B rate for beneficiaries aged 65 and higher as determined by the U.S. Department of Health and Human Services (HHS) each September.
For 2023, the immunosuppressive benefit (Medicare Part B-ID) is $97.10 a month.
The standard Medicare Part B deductible ($226 in 2023) and 20% co-pay will continue to apply for the prescribed immunosuppressive drugs, similar to other services under Part B for total Medicare beneficiaries.
How do I enroll for Medicare Part B-ID coverage?
Enrollment began on October 1, 2022, for kidney transplant recipients whose Medicare has ended. Kidney transplant recipients whose Medicare entitlement ends on or after January 1, 2023, can enroll for immunosuppressive coverage anytime.
Contact the Social Security Administration at 1-877-465-0355 (TTY users can call 1-800-325-0778) to enroll.
Have questions? Our Patient Helpline, NKF Cares, is here to help! Call toll-free at 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org to get answers.
More victories are possible with your voice
Expanding Medicare coverage for immunosuppressant drugs would not have been possible without the help of kidney advocates across the United States. We want to ensure that all people with kidney disease have affordable access to new therapies to help preserve kidney function, prevent kidney failure, and reduce the risk of kidney-related complications.
You can help! Join us in calling for improved health equity–Ask your Members of Congress to pass the Health Equity and Accountability Act (HEAA) to help ensure everyone has access to life-saving therapies. Our kidney health depends on it.
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