Topic: Medicare and Transplants.
Marions asked me to post this under Insurance:
I just found out recently that if a person is over age 65 generally transplants are NOT an option. My brother in law was diagnosed with failing kidneys and they refused to put him on the transplant list because he was over age 65. His wife had a liver transplant when she was 60 (pre Medicare). Even a live donor was out of the question. Apparently if you are over 65 Medicare feels a transplant is a waste of money?
Marions posted that in Texas Medicare would not pay for a transplant. I live in Wisconsin and so does my brother in law. So my reply to Marions was:
Since Medicare is a 'Federal' program I'm pretty certain that what is the norm in one state would be the norm in any other state in the U.S. as we are all under one Federal Government. Right?
In Tom's case (my husband who had CC), my son was willing to be a live donor and so was Tom's son for a liver transplant as they can use only a small section of the liver. As to whether or not a persons medical insurance would cover that type of transplant, it would depend upon the policy. Most medical insurance's do have some type of 'transplant protocol' written into their policies. I know for certain that all Fully Insured policies do, and for ASO (Self Funded) policies, it is up to the individual company that is paying the claims for the ASO plan.
Medicare ? I don't work for Medicare so I don't know what rules they have or what they will or will not cover. I do have a Medicare booklet here as we were just in the process of getting Tom signed up for Medicare when he passed. I'll have to take a look and see what it states regarding transplants! Not right now though as it is 3:32 am (I can't sleep) Imagine that eh?
I do know that when Tom first presented with CC we did discuss the transplant option. Given his other medical conditions, they really played down a transplant, even with a live donor option BECAUSE CC can come back even with a new liver and stats show that a transplant may not change the outcome. Even Mayo clinic Stats show that. I was amazed when I read that one!