What are the Qualifications for Medicare to Cover a Lung Transplant?

You must have a diagnosis of progressive end-stage cardiopulmonary or pulmonary disease. All other treatment options must be exhausted, and doctors must document the medical necessity. Care must take place at a certified Medicare transplant facility.

How Much Does a Lung Transplant Cost with Medicare?

A bilateral lung transplant can cost up to $1 million. With Original Medicare, you pay the Part A deductible ($1,736 in 2025) for the hospital stay and 20% coinsurance for Part B services. A Medigap plan can significantly reduce your out-of-pocket costs.

Does Medicare Pay for Anti-rejection Drugs?

Yes. Medicare pays for anti-rejection (immunosuppressive) drugs if it covers your transplant. If Medicare doesn't pay for your transplant, a Part D plan may still cover anti-rejection drugs. These drugs prevent the body from rejecting the transplanted organ.

How Much Does Medicare Pay for Lung Cancer Screenings?

If you qualify, Medicare pays 100% for an annual lung cancer screening. Eligible beneficiaries include those ages 55–77 who currently smoke or quit within the last 15 years and have a 30-pack-year smoking history.

How do I Get on the Lung Transplant List?

First, get a referral from your doctor. Then contact a transplant facility (there are more than 200 nationwide) and schedule an evaluation. Once the hospital's transplant team deems you a suitable candidate, they will add you to the national waiting list.

Do Medicare Supplement Plans Cover Lung Transplants?

Yes. When Medicare approves a lung transplant, Medigap covers the remaining deductibles, coinsurance, and copayments. This is critical given the high cost of transplant surgery, which can reach $1 million.

What are the Qualifications for Medicare to Cover a Lung Transplant?

You must have a diagnosis of progressive end-stage cardiopulmonary or pulmonary disease. All other treatment options must be exhausted, and doctors must document the medical necessity. Care must take place at a certified Medicare transplant facility.

How Much Does a Lung Transplant Cost with Medicare?

A bilateral lung transplant can cost up to $1 million. With Original Medicare, you pay the Part A deductible ($1,736 in 2025) for the hospital stay and 20% coinsurance for Part B services. A Medigap plan can significantly reduce your out-of-pocket costs.

Does Medicare Pay for Anti-rejection Drugs?

Yes. Medicare pays for anti-rejection (immunosuppressive) drugs if it covers your transplant. If Medicare doesn't pay for your transplant, a Part D plan may still cover anti-rejection drugs. These drugs prevent the body from rejecting the transplanted organ.

How Much Does Medicare Pay for Lung Cancer Screenings?

If you qualify, Medicare pays 100% for an annual lung cancer screening. Eligible beneficiaries include those ages 55–77 who currently smoke or quit within the last 15 years and have a 30-pack-year smoking history.

How do I Get on the Lung Transplant List?

First, get a referral from your doctor. Then contact a transplant facility (there are more than 200 nationwide) and schedule an evaluation. Once the hospital's transplant team deems you a suitable candidate, they will add you to the national waiting list.

Do Medicare Supplement Plans Cover Lung Transplants?

Yes. When Medicare approves a lung transplant, Medigap covers the remaining deductibles, coinsurance, and copayments. This is critical given the high cost of transplant surgery, which can reach $1 million.

Medicare Coverage for Lung Transplants

Quick Answer

Part A (Hospital): CoveredPart B (Doctors): CoveredAnti-Rejection Drugs: Covered

Medicare partially covers lung transplants when medically necessary. You must have a progressive end-stage cardiopulmonary or pulmonary diagnosis, all other options must be exhausted, and care must take place at a certified Medicare transplant facility. Part A covers hospital services, Part B covers doctors' services, and both may cover immunosuppressive drugs. A lung transplant can cost up to $1 million, making supplemental coverage critical.

Coverage Comparison by Plan Type

Plan Type	Coverage	Notes
Transplant surgery (inpatient)	Covered	Part A covers hospital services, exams, tests, labs, and the transplant procedure
Doctors' services	Covered	Part B covers surgeons and physicians in outpatient settings
Anti-rejection drugs	Covered	Parts A, B, and D may cover immunosuppressive medications
Skilled nursing facility	Covered	Part A covers SNF stays following the hospital visit
Lung cancer screening	Covered	Part B covers annual screening for eligible beneficiaries at 100%
Medicare Advantage (Part C)	Covered	Coverage varies by plan; contact carrier before transplant
Medicare Supplement (Medigap)	Covered	Covers deductibles, coinsurance, and copayments left by Parts A and B

Understanding Your Coverage Options

Original Medicare (Part A)

Covered - Hospital & Transplant Services

Covers hospital services including exams, tests, and labs for the transplant

Covers the transplant surgery and inpatient hospital stay

May cover inpatient stays at a skilled nursing facility after discharge

May cover home health care directly following the hospital visit

Covers blood transfusions and donor organ procurement

Original Medicare (Part B)

Covered - Doctors' Services

Covers doctors' services for the transplant in outpatient settings

May cover immunosuppressive (anti-rejection) drugs in some circumstances

Covers annual lung cancer screenings at 100% for eligible beneficiaries

You pay the Part B deductible ($283 in 2025) then 20% coinsurance

Medicare Advantage (Part C)

Covered - Per Plan Rules

Each Advantage plan has its own rules for lung transplant coverage

Premiums tend to be lower, but you pay copayments for services rendered

You must contact your carrier directly to discuss coverage before the transplant

Must cover at least the same benefits as Original Medicare

Medicare Supplement (Medigap)

Covered - Fills Cost Gaps

Covers deductibles, coinsurance, and copayments left by Original Medicare

Critical for a procedure that can cost up to $1 million

No network restrictions or prior authorization requirements

Provides financial protection for unexpected surgical complications

Lung Transplant Cost Estimates

Item	Estimated Cost
Bilateral lung transplant (total cost)	Up to $1,000,000
Part A deductible (2025)	$1,736 per benefit period
Part B deductible (2025)	$283 annually
Part B coinsurance	20% of Medicare-approved amount
Anti-rejection drugs (Part D)	Varies by formulary tier
With Medigap Plan G	Part B deductible only ($283)

✦ Important Exceptions & Limitations

You Must Have a Progressive...

You must have a progressive end-stage cardiopulmonary or pulmonary diagnosis to qualify

All Other Treatment Options Must...

All other treatment options must be exhausted before Medicare approves the transplant

Care Must Take Place At...

Care must take place at a certified facility participating in Medicare's transplant program

Doctors Must Document the Medical...

Doctors must document the medical necessity of the transplant

Part D Drug Formularies Are...

Part D drug formularies are subject to change - verify your medications are covered

Medicare Advantage Plans May Have...

Medicare Advantage plans may have different rules; contact your carrier before the procedure

✦ Frequently Asked Questions

David Haass

Author

David Haass is a licensed Medicare expert and member of the Forbes Finance Council who has been helping beneficiaries navigate their Medicare options.

Ashlee Zareczny

Reviewer

Ashlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare.