Protect medication coverage
Understand ordinary Part B immunosuppressive drug coverage and the separate Part B-ID benefit.
New to Medicare terms?Open the plain-language glossary.
Was Medicare Part A in effect when the kidney transplant occurred? For ordinary Part B coverage of eligible anti-rejection medicines, Part B must also be active when prescriptions are filled.
For someone who has Medicare only because of ESRD, Part B generally covers immunosuppressive (anti-rejection) medicines after a qualifying kidney transplant if Part A was in effect at the time of transplant, the transplant took place at a Medicare-certified facility, and Part B is active when the prescription is filled. Part B does not pay retroactively for medicines filled before Part B begins.
Alex had Part A when the transplant took place at a Medicare-certified hospital. Alex later added Part B. Once Part B became active, it could help pay for eligible anti-rejection prescriptions. If Alex later qualifies for full Medicare because of age or disability, Part B coverage of those medicines can continue while the coverage requirements are met.
Sam did not have Part A at the transplant and cannot establish Part A coverage for that date. Adding Part B later does not make these transplant medicines eligible for ordinary Part B coverage. Sam should ask about other drug coverage, such as Part D or another health plan, before any coverage changes.
If ESRD-only Medicare ends 36 months after a successful transplant, a separate Part B Immunosuppressive Drug benefit (Part B-ID) may be available to people who meet its requirements and do not have disqualifying other health coverage. It covers eligible anti-rejection medicines only, not other medical care. Read Medicare's transplant drug guide and Part B-ID eligibility rules.
Part D or another health plan may cover medicines that do not meet Part B requirements. Before coverage changes, ask the drug plan, transplant team, and Social Security to confirm what will pay.
The calculator estimates when ESRD-only Medicare may end; this page explains why medication coverage needs separate review.
