Does Medicare Cover Cornea Transplants?

Transplants are procedures that are often performed when more common treatments don’t relieve a medical condition in an organ. One of the most common type of transplants is a cornea transplant.

In this transplant, scarred or diseased corneal tissue is replaced with donor tissue. Cornea transplants tend to have a high rate of success.

If this is a procedure that you or a loved one need, a common question you likely have is “does Medicare cover cornea transplants?”

In this article, we answer that question in clear, plain English. You will also find the average costs of corneal transplant for those who don’t have insurance coverage.

Does Medicare Cover Cornea Transplants?

The short answer is yes; Medicare will cover the cost of corneal transplants. But not 100% of the time.

As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your corneal transplant. Below we look at what these are so you know what to expect.

Original Medicare Coverage

Original Medicare (Medicare Part A and Part B) provides coverage for corneal transplants. For Original Medicare to cover this type of surgery, your corneal transplant has to be considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Medicare Part A Coverage

Coverage for transplant procedures is provided by Medicare Part A if it takes place in an inpatient setting. Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

For days 61 to 90, Part A will still provide coverage. However, you will pay a copayment of each day you are in the hospital during this time. After 90 days, Part A will no longer provide coverage.

However, Part A does provide 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days but, again you will have to pay a copayment each day you are in the hospital.

Medicare Part B Coverage

On the other hand, coverage for cornea transplant procedures often falls under Medicare Part B because it often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of transplant procedures. You will pay for the remaining 20 percent.

Additionally, Original Medicare also provides coverage for other transplant operations as long as it is medically necessary and it is ordered by your healthcare provider. Aside from cornea and stem cell transplant, other transplant procedures must take place in a Medicare-approved transplant center.

Part C and Part D Coverage for Cornea Transplant

Medicare Advantage plans (Medicare Part C) also provide coverage for cornea transplant, as well as other transplant procedures. They have to cover everything Original Medicare covers and will offer coverage for additional treatments, services and equipment as well.

What each plan covers and how much the out-of-pocket costs will be vary depending on the specifics of your plan.

How Much Does A Cornea Transplant Cost?

The average cost of a cornea transplant is between $13,000 and $27,000 for those who don’t have insurance coverage. It is often cheaper when performed in an outpatient setting rather than in a hospital.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.