a gift through your will
For Patients & Families: Kidney Transplant Information
kidney
transplants
overview and introduction
learn about kidney transplants
When a patient's kidneys fail, they need medical treatment to help their body perform the work their own kidneys can no longer manage on its own. One of the most effective treatment options for kidney failure is a kidney transplant.
A kidney transplant is a surgical procedure that places a healthy kidney from a live or deceased donor into a person whose kidneys no longer function properly.
It is important to note that a kidney transplant is a treatment for kidney failure; it’s not a cure. Patients who receive transplants will need to take daily medication to ensure their immune systems don't reject the new kidney. Patients will also need to see their health care providers regularly.
A working transplanted kidney does a better job of filtering wastes and keeping you healthy than dialysis. However, a kidney transplant isn’t for everyone. Your doctor may tell you that you’re not healthy enough for transplant surgery.
about kidney transplants
basic facts and information
Use the following list to learn more about kidney transplants and find answers to some common questions related to organ donation.
If you are eligible for Medicare, your EGHP will be your primary insurance (pays first) for 30 months after starting dialysis or having a kidney transplant. This is called a coordination period. After 30 months, your EGHP will become your secondary insurance (pays second) and Medicare will become primary.
When should I apply for Medicare?
You can apply for Medicare when you first start dialysis or wait and apply closer to the end of the 30-month coordination period. Once you apply you will be responsible for the monthly Part B premiums.
If you are planning to have a transplant and want Medicare to help pay for your immunosuppressant medications you will have to apply for Medicare part A and B when you become eligible.
Insurance Choices for Dialysis and Transplant Patients with Private Insurance (Decision Aid)
If you have insurance through the ACA's marketplace, you do not need to sign up for Medicare unless you want to. You should evaluate your costs and coverage with the ACA plan vs Medicare.
To help here is a Kidney Care Insurance Worksheet which is designed to help compare plans offered in the health insurance marketplaces established by the Affordable Care Act, so you can choose the most affordable and comprehensive plan.
It is also important to note that if you apply for Medicare you will lose any subsidies you receive from your ACA Marketplace coverage. If you chose not to enroll in Medicare when your kidneys fail, you will have penalties with higher premiums if you chose to enroll later.
Remember, Medicare only pays 80% of dialysis treatment so you will need a supplemental plan (Medigap) so you should also calculate this cost into your assessment.
To find out what supplemental policies you qualify for, please contact the Illinois Health Insurance Assistance Programs (SHIPs).
Medicare covers 80% of costs for dialysis treatment and 80% of the cost of immunosuppressant medications needed after transplant.
- - - - -
Do I need a supplemental insurance to help cover what Medicare doesn't?
Ideally, yes. There are a few coverage options:
Medigap Plans – you must apply for these plans within 6 months after you first become eligible for Medicare. They are available to anyone over 65 years old. Some states also offer these plans for people under 65. To find out what Medigap plans are available in your state, contact your State Health Insurance Assistance Programs (SHIPs).
Medicaid – need to qualify based on income. Income requirements vary by state.
Thinking about Transplant?
What other options do I have for Medicare plans?
Managed Care Plans – Some states are offering pilot programs enrolling people who are eligible for both Medicare and Medicaid.
Medicare Advantage – is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. People with ESRD are not eligible to apply for these plans, but some may already be enrolled in a Medicare Advantage plan before starting dialysis or needing a transplant.
If you have health insurance through your employer, you will be subjected to the Medicare Coordination of Benefits (COB) period. This means that your employee group health plan will pay for your dialysis treatment for 30 months and then Medicare will automatically become your primary insurance.
If you choose to continue to keep your employee group health plan it would then become secondary to Medicare and could help pay the extra 20% not covered by Medicare part B.
You do not need to apply for Medicare at any time unless you choose to. If you choose to apply for Medicare, and your private insurance plan is through the Affordable Care Act, you will lose your private plan coverage. This is because Affordable Care Act insurance plans are for people who no other insurance options.
Once you have Medicare, you are considered to have other coverage and would no longer qualify for coverage through the Affordable Care Act.
The effective date of Medicare based on ESRD is dependent upon the type of treatment you choose:
For hemodialysis patients Medicare is effective the 4th month of treatment. For example:
If hemodialysis is begun in May, Medicare becomes effective August 1
For home dialysis patients Medicare is effective the first month of treatment
For transplant recipients Medicare is effective:
The month you're admitted to the hospital for a kidney transplant or for health care needed prior to a transplant if the transplant takes place that same month or within the following two months
OR
Two months prior to transplant if the transplant is delayed more than two months after you are admitted to the hospital in anticipation of transplant or related health services
No, the Affordable Care Act Marketplace only provides primary insurance to people without any health insurance coverage. You may want to see if you are eligible for Medicaid, or contact the Illinois State Health Insurance Assistance Programs (SHIPs) to see if there are supplemental insurance policies available for you.
If you would like personal help understanding Medicare A, B, D, and Medigap supplement plans, plus how to enroll in a suitable plan, contact your state's SHIP. These trained volunteers are experts in Medicare resources, and provide unbiased insurance counseling.
You earn 1 work credit for earning a specific amount of money ($1,300 in 2017) from work in a 3-month quarter. The chart below gives a general guide to number of work credits needed to qualify for Medicare at a particular age.
To find out how many work credits you have, call Social Security at 1-800-772-1213.
Here are defentions to some widely-used inurance language:
ACA Marketplace: The Affordable Care Act Health Insurance Marketplace, helps people without health coverage find and enroll in an insurance plan that fits your budget and meets your needs.
Balanced Billing - when a healthcare provider bills you for the difference between what your health insurance pays and what your provider charges.
Copayment (copay): Amount you may have to pay for healthcare or medications. A copay is often a fixed amount (for example $25).
Deductible: Amount you must pay for healthcare or medications before your insurance will pay.
Employer group health plan (EGHP): Coverage sponsored by an employer or union. If you either you, your spouse, or your parent (for children up to age 26) are working you may be eligible for insurance through your (their) employer. Employers with 50 full-time employees or more must offer insurance to their employees.
In-Network: Healthcare providers, practices, hospitals, etc. that are covered by your insurance plan. Choosing in-network providers is cheaper than out-of-network providers. To find a list of in-network providers contact your health insurance plan.
Medicaid: helps pay medical costs for people with low income and little savings. Medicaid can pay your Medicare premiums, deductibles, coinsurance and some costs Medicare doesn't cover.
Out of Network: Healthcare providers, practices, hospitals, etc. that are not as well covered by your insurance plan. It is cheaper to choose in-network providers instead of out-of-network providers. To find a list of in-network providers contact your health insurance plan.
Out of pocket maximum: The most you’ll have to pay during a period (usually a year). Once you reach the out of pocket maximum your plan pay 100% of covered services.
Premium: Amount to be paid monthly or quarterly to keep the health insurance plan active.
getting a transplant
how it works
Learn what to expect when receiving a kidney transplant - find facts about surgery, recovery, and how to plan for life with a new kidney.
If you are eligible for Medicare, your EGHP will be your primary insurance (pays first) for 30 months after starting dialysis or having a kidney transplant. This is called a coordination period. After 30 months, your EGHP will become your secondary insurance (pays second) and Medicare will become primary.
When should I apply for Medicare?
You can apply for Medicare when you first start dialysis or wait and apply closer to the end of the 30-month coordination period. Once you apply you will be responsible for the monthly Part B premiums.
If you are planning to have a transplant and want Medicare to help pay for your immunosuppressant medications you will have to apply for Medicare part A and B when you become eligible.
Insurance Choices for Dialysis and Transplant Patients with Private Insurance (Decision Aid)
If you have insurance through the ACA's marketplace, you do not need to sign up for Medicare unless you want to. You should evaluate your costs and coverage with the ACA plan vs Medicare.
To help here is a Kidney Care Insurance Worksheet which is designed to help compare plans offered in the health insurance marketplaces established by the Affordable Care Act, so you can choose the most affordable and comprehensive plan.
It is also important to note that if you apply for Medicare you will lose any subsidies you receive from your ACA Marketplace coverage. If you chose not to enroll in Medicare when your kidneys fail, you will have penalties with higher premiums if you chose to enroll later.
Remember, Medicare only pays 80% of dialysis treatment so you will need a supplemental plan (Medigap) so you should also calculate this cost into your assessment.
To find out what supplemental policies you qualify for, please contact the Illinois Health Insurance Assistance Programs (SHIPs).
Medicare covers 80% of costs for dialysis treatment and 80% of the cost of immunosuppressant medications needed after transplant.
- - - - -
Do I need a supplemental insurance to help cover what Medicare doesn't?
Ideally, yes. There are a few coverage options:
Medigap Plans – you must apply for these plans within 6 months after you first become eligible for Medicare. They are available to anyone over 65 years old. Some states also offer these plans for people under 65. To find out what Medigap plans are available in your state, contact your State Health Insurance Assistance Programs (SHIPs).
Medicaid – need to qualify based on income. Income requirements vary by state.
Thinking about Transplant?
What other options do I have for Medicare plans?
Managed Care Plans – Some states are offering pilot programs enrolling people who are eligible for both Medicare and Medicaid.
Medicare Advantage – is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. People with ESRD are not eligible to apply for these plans, but some may already be enrolled in a Medicare Advantage plan before starting dialysis or needing a transplant.
If you have health insurance through your employer, you will be subjected to the Medicare Coordination of Benefits (COB) period. This means that your employee group health plan will pay for your dialysis treatment for 30 months and then Medicare will automatically become your primary insurance.
If you choose to continue to keep your employee group health plan it would then become secondary to Medicare and could help pay the extra 20% not covered by Medicare part B.
You do not need to apply for Medicare at any time unless you choose to. If you choose to apply for Medicare, and your private insurance plan is through the Affordable Care Act, you will lose your private plan coverage. This is because Affordable Care Act insurance plans are for people who no other insurance options.
Once you have Medicare, you are considered to have other coverage and would no longer qualify for coverage through the Affordable Care Act.
The effective date of Medicare based on ESRD is dependent upon the type of treatment you choose:
For hemodialysis patients Medicare is effective the 4th month of treatment. For example:
If hemodialysis is begun in May, Medicare becomes effective August 1
For home dialysis patients Medicare is effective the first month of treatment
For transplant recipients Medicare is effective:
The month you're admitted to the hospital for a kidney transplant or for health care needed prior to a transplant if the transplant takes place that same month or within the following two months
OR
Two months prior to transplant if the transplant is delayed more than two months after you are admitted to the hospital in anticipation of transplant or related health services
No, the Affordable Care Act Marketplace only provides primary insurance to people without any health insurance coverage. You may want to see if you are eligible for Medicaid, or contact the Illinois State Health Insurance Assistance Programs (SHIPs) to see if there are supplemental insurance policies available for you.
If you would like personal help understanding Medicare A, B, D, and Medigap supplement plans, plus how to enroll in a suitable plan, contact your state's SHIP. These trained volunteers are experts in Medicare resources, and provide unbiased insurance counseling.
You earn 1 work credit for earning a specific amount of money ($1,300 in 2017) from work in a 3-month quarter. The chart below gives a general guide to number of work credits needed to qualify for Medicare at a particular age.
To find out how many work credits you have, call Social Security at 1-800-772-1213.
Here are defentions to some widely-used inurance language:
ACA Marketplace: The Affordable Care Act Health Insurance Marketplace, helps people without health coverage find and enroll in an insurance plan that fits your budget and meets your needs.
Balanced Billing - when a healthcare provider bills you for the difference between what your health insurance pays and what your provider charges.
Copayment (copay): Amount you may have to pay for healthcare or medications. A copay is often a fixed amount (for example $25).
Deductible: Amount you must pay for healthcare or medications before your insurance will pay.
Employer group health plan (EGHP): Coverage sponsored by an employer or union. If you either you, your spouse, or your parent (for children up to age 26) are working you may be eligible for insurance through your (their) employer. Employers with 50 full-time employees or more must offer insurance to their employees.
In-Network: Healthcare providers, practices, hospitals, etc. that are covered by your insurance plan. Choosing in-network providers is cheaper than out-of-network providers. To find a list of in-network providers contact your health insurance plan.
Medicaid: helps pay medical costs for people with low income and little savings. Medicaid can pay your Medicare premiums, deductibles, coinsurance and some costs Medicare doesn't cover.
Out of Network: Healthcare providers, practices, hospitals, etc. that are not as well covered by your insurance plan. It is cheaper to choose in-network providers instead of out-of-network providers. To find a list of in-network providers contact your health insurance plan.
Out of pocket maximum: The most you’ll have to pay during a period (usually a year). Once you reach the out of pocket maximum your plan pay 100% of covered services.
Premium: Amount to be paid monthly or quarterly to keep the health insurance plan active.
finding a kidney
introduction to the donor process
There are two ways to receive a kidney transplant: through a living donor, or through a deceased donor. To learn more about how both processes work, please consult the list below.
If you are eligible for Medicare, your EGHP will be your primary insurance (pays first) for 30 months after starting dialysis or having a kidney transplant. This is called a coordination period. After 30 months, your EGHP will become your secondary insurance (pays second) and Medicare will become primary.
When should I apply for Medicare?
You can apply for Medicare when you first start dialysis or wait and apply closer to the end of the 30-month coordination period. Once you apply you will be responsible for the monthly Part B premiums.
If you are planning to have a transplant and want Medicare to help pay for your immunosuppressant medications you will have to apply for Medicare part A and B when you become eligible.
Insurance Choices for Dialysis and Transplant Patients with Private Insurance (Decision Aid)
If you have insurance through the ACA's marketplace, you do not need to sign up for Medicare unless you want to. You should evaluate your costs and coverage with the ACA plan vs Medicare.
To help here is a Kidney Care Insurance Worksheet which is designed to help compare plans offered in the health insurance marketplaces established by the Affordable Care Act, so you can choose the most affordable and comprehensive plan.
It is also important to note that if you apply for Medicare you will lose any subsidies you receive from your ACA Marketplace coverage. If you chose not to enroll in Medicare when your kidneys fail, you will have penalties with higher premiums if you chose to enroll later.
Remember, Medicare only pays 80% of dialysis treatment so you will need a supplemental plan (Medigap) so you should also calculate this cost into your assessment.
To find out what supplemental policies you qualify for, please contact the Illinois Health Insurance Assistance Programs (SHIPs).
Medicare covers 80% of costs for dialysis treatment and 80% of the cost of immunosuppressant medications needed after transplant.
- - - - -
Do I need a supplemental insurance to help cover what Medicare doesn't?
Ideally, yes. There are a few coverage options:
Medigap Plans – you must apply for these plans within 6 months after you first become eligible for Medicare. They are available to anyone over 65 years old. Some states also offer these plans for people under 65. To find out what Medigap plans are available in your state, contact your State Health Insurance Assistance Programs (SHIPs).
Medicaid – need to qualify based on income. Income requirements vary by state.
Thinking about Transplant?
What other options do I have for Medicare plans?
Managed Care Plans – Some states are offering pilot programs enrolling people who are eligible for both Medicare and Medicaid.
Medicare Advantage – is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. People with ESRD are not eligible to apply for these plans, but some may already be enrolled in a Medicare Advantage plan before starting dialysis or needing a transplant.
If you have health insurance through your employer, you will be subjected to the Medicare Coordination of Benefits (COB) period. This means that your employee group health plan will pay for your dialysis treatment for 30 months and then Medicare will automatically become your primary insurance.
If you choose to continue to keep your employee group health plan it would then become secondary to Medicare and could help pay the extra 20% not covered by Medicare part B.
You do not need to apply for Medicare at any time unless you choose to. If you choose to apply for Medicare, and your private insurance plan is through the Affordable Care Act, you will lose your private plan coverage. This is because Affordable Care Act insurance plans are for people who no other insurance options.
Once you have Medicare, you are considered to have other coverage and would no longer qualify for coverage through the Affordable Care Act.
The effective date of Medicare based on ESRD is dependent upon the type of treatment you choose:
For hemodialysis patients Medicare is effective the 4th month of treatment. For example:
If hemodialysis is begun in May, Medicare becomes effective August 1
For home dialysis patients Medicare is effective the first month of treatment
For transplant recipients Medicare is effective:
The month you're admitted to the hospital for a kidney transplant or for health care needed prior to a transplant if the transplant takes place that same month or within the following two months
OR
Two months prior to transplant if the transplant is delayed more than two months after you are admitted to the hospital in anticipation of transplant or related health services
No, the Affordable Care Act Marketplace only provides primary insurance to people without any health insurance coverage. You may want to see if you are eligible for Medicaid, or contact the Illinois State Health Insurance Assistance Programs (SHIPs) to see if there are supplemental insurance policies available for you.
If you would like personal help understanding Medicare A, B, D, and Medigap supplement plans, plus how to enroll in a suitable plan, contact your state's SHIP. These trained volunteers are experts in Medicare resources, and provide unbiased insurance counseling.
You earn 1 work credit for earning a specific amount of money ($1,300 in 2017) from work in a 3-month quarter. The chart below gives a general guide to number of work credits needed to qualify for Medicare at a particular age.
To find out how many work credits you have, call Social Security at 1-800-772-1213.
Here are defentions to some widely-used inurance language:
ACA Marketplace: The Affordable Care Act Health Insurance Marketplace, helps people without health coverage find and enroll in an insurance plan that fits your budget and meets your needs.
Balanced Billing - when a healthcare provider bills you for the difference between what your health insurance pays and what your provider charges.
Copayment (copay): Amount you may have to pay for healthcare or medications. A copay is often a fixed amount (for example $25).
Deductible: Amount you must pay for healthcare or medications before your insurance will pay.
Employer group health plan (EGHP): Coverage sponsored by an employer or union. If you either you, your spouse, or your parent (for children up to age 26) are working you may be eligible for insurance through your (their) employer. Employers with 50 full-time employees or more must offer insurance to their employees.
In-Network: Healthcare providers, practices, hospitals, etc. that are covered by your insurance plan. Choosing in-network providers is cheaper than out-of-network providers. To find a list of in-network providers contact your health insurance plan.
Medicaid: helps pay medical costs for people with low income and little savings. Medicaid can pay your Medicare premiums, deductibles, coinsurance and some costs Medicare doesn't cover.
Out of Network: Healthcare providers, practices, hospitals, etc. that are not as well covered by your insurance plan. It is cheaper to choose in-network providers instead of out-of-network providers. To find a list of in-network providers contact your health insurance plan.
Out of pocket maximum: The most you’ll have to pay during a period (usually a year). Once you reach the out of pocket maximum your plan pay 100% of covered services.
Premium: Amount to be paid monthly or quarterly to keep the health insurance plan active.
transplant / donor resources
further reading
read more about topics related to kidney transplants
To learn more about topics related to kidney transplantation please visit our national office's Kidney A - Z Health Guide by clicking the links below.
LEARN ABOUT LIVING WITH KIDNEY DISEASE
NKFI kidney health resources
The information shared on this website has been reviewed by staff at the New York City headquarters of the National Kidney Foundation. Please note: material contained here are intended solely for reference. This material does not constitute medical advice; it is intended for informational purposes only. If you feel you need professional medical care, please consult a physician for specific treatment recommendations.