Ways to Pay for an Organ Transplant Surgery

Surgery can be extremely expensive, and organ transplant surgeries are more expensive than most. A heart transplant in the United States can result in billed charges (before insurance coverage) of more than $1.3 million.

For transplant patients—or anyone who anticipates a very expensive surgery—the following tips may help with the financial burden and prevent unnecessary expenses.

1

How to Pay For an Organ Transplant

Surgery can be very expensive and organ transplant surgery is among the most costly procedures. For people facing an expensive procedure, whether or not it's a transplant, you may need to raise funds in advance for treatment. 

The initial testing required for a patient to be placed on a waiting list for a transplant or to be cleared for surgery can alone cost tens of thousands of dollars, even if the patient is not hospitalized during the process.

It is not uncommon for the cost of major surgery and subsequent extended hospitalization to result in a bill that exceeds $500,000. Unfortunately, the expenses do not end with surgery; the cost of medications in the year after surgery can be thousands of dollars a month.

Ideally, a patient will have primary insurance to pay the majority of the expenses and a secondary form of insurance to pay the remaining expenses.

Even with excellent insurance coverage that pays 80% of the total bill, the remaining 20% can exceed $100,000 from the surgery alone. With secondary or supplemental insurance coverage, the remaining 20% may be paid by the insurance company rather than the patient.

2

The Costs of Organ Transplantation and Other Expensive Surgeries

Pre-surgery hospitalizations, lab tests, and general testing in preparation for surgery all contribute to the high cost of a transplant. Some additional costs that you may not anticipate include:

  • Hospitalization required before surgery
  • Treatment costs prior to surgery, such as dialysis and insulin pumps
  • Transplant surgery and hospitalization
  • Anti-rejection medications
  • Ongoing visits with the transplant surgeon
  • Any additional treatment required
  • Insurance deductibles, co-pays, and premiums
  • Non-medical expenses, including childcare, travel, and lodging
  • Lost wages
3

Paying For an Expensive Surgery with Private Insurance

Private insurance is coverage that is not sponsored by the government; the patient or a spouse typically obtains a private insurance policy from his or her employer. In some cases, particularly for people who are self-employed, private insurance can be obtained outside of the workplace. In that case, the patient pays the insurance premium.

Depending on your plan, private insurance may assume a good portion of the total cost of an organ transplant. However, most insurance plans have a maximum or "cap" on the amount that the company will pay. This cap may be met or exceeded in the standard care provided during the course of an organ transplant.

4

Secondary Insurance Can Help Defray Costs of Surgery

Secondary insurance is an addition to primary insurance; you can obtain it through an employer, the government, or a private company. It is recommended that potential transplant patients who do not have a secondary insurance policy obtain a secondary policy to help pay the costs that are not covered by a primary insurance policy.

COBRA is an example of private insurance that is obtained outside of the workplace; the patient pays the insurance premium.

5

Using Medicare and Medicaid to Pay for Expensive Surgery

Medicare

This type of government-funded insurance pays for transplants, but not everyone qualifies for coverage. It also pays for many other types of surgery, if the procedure is deemed necessary.

Patients age 65 and older, patients younger than 65 with certain disabilities, and those who have been diagnosed with end-stage renal disease qualify for Medicare. Additionally, patients may qualify if they or their spouse have paid into the Medicare system. The Medicare website www.medicare.gov provides detailed information about qualifying for coverage, and what coverage is available in each state.

Medicaid

Medicaid is government-sponsored insurance for low-income patients that is administered by individual states within federal guidelines. Medicaid coverage qualifications vary from state to state. The income limit to qualify is based on the size of the family and income level, but a patient with a low income does not necessarily qualify automatically for coverage.

If a patient does not qualify for Medicaid due to income level, he or she still may qualify for “spend down” Medicaid, which takes into account the amount of money being paid for health care.

A financial planner at your transplant center should be able to help you navigate the process of dealing with Medicaid.

6

Using Veteran's Benefits to Pay for an Organ Transplant

Veterans currently serving in the military or who have retired from the military may qualify for Tricare—supplemental insurance through the government. This veteran's benefit will contribute to the expenses of an organ transplant.

The TRICARE website is an excellent resource for patients and families who have questions about coverage.

7

Paying for an Organ Transplant with Personal Funds

Many patients cannot afford to pay for the full cost of organ transplant surgery—or even an insurance deductible—using personal funds. Most people waiting for an organ transplant have financial difficulties, especially if their illness has caused them to be placed on disability.

This is not uncommon, and many patients explore other options to help them fund their procedure.

8

Fundraising to Pay for a Transplant

Some transplant patients approach public service organizations for help in paying the costs of transplantation. Civil service organizations may be willing to donate to help a patient get a life-saving surgery. Other patients hold fundraising events, such as walkathons, or appeal to their friends, family, and fellow community members to help raise the money they need. Before launching a fundraising campaign, it's best to check with your city or county governments, a legal advisor, or your transplant team about legal and financial laws and guidelines.

The financial coordinators at transplant centers may be able to provide help with locating organizations that can contribute to your fundraising efforts.

Some patients have great success with online fundraising, using websites such as GiveForward.com to share their story.

Don't Let the Cost Stop You

It may be challenging, but finding a way to pay for an expensive surgery may be far easier than you think. Don't let the potential expense stop you from working with a surgeon and a healthcare team. You may be pleasantly surprised at the programs available to help you with the costs of even the most expensive procedures.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bentley TS, Phillips SJ. 2017 U.S. organ and tissue transplant cost estimates and discussion. Milliman, Inc, August 3, 2017.

  2. Houston J. Why organ transplants are so expensive in the US. Business Insider. Published September 12, 2019.

  3. United Network for Organ Sharing. What every patient needs to know. Published 2019.

  4. Center on Budget and Policy Priorities. Policy basics: introduction to Medicaid. Updated August 16, 2016.

  5. Tricare. Covered services: transplants. Updated October 3, 2018.

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