Does Medicare Cover Liver Transplant? 2026 Costs and Drug Coverage

Medicare does cover a liver transplant when the surgery is medically necessary and performed at a Medicare-approved transplant program. Part A pays for the hospital stay and the cost of acquiring the donor organ; Part B pays for the surgeon, specialists, and outpatient follow-up. You still owe the standard deductibles and the 20% Part B coinsurance unless supplemental coverage picks those up.¹

What Part A and Part B Each Pay For

Part A covers the inpatient side: the transplant surgery itself, the hospital stay, the tests and labs performed during admission, and the cost of procuring the donor liver.¹ Organ acquisition is handled as a “pass-through” cost, meaning approved facilities are reimbursed on a reasonable-cost basis separate from the standard payment for the transplant admission.²

Part B covers the physician side: surgeon fees, specialist consultations, outpatient visits before and after the transplant, and certain immunosuppressive medications. Lab tests done at Medicare-certified laboratories are covered at no cost to you.¹

Which Diagnoses Are Covered

Medicare’s coverage rules for liver transplantation live in two national coverage determinations. NCD 260.1 covers adult transplantation for end-stage liver disease and hepatocellular carcinoma. NCD 260.2 covers pediatric liver transplantation.³

For hepatocellular carcinoma, the clinical benchmark is the Milan criteria: a single tumor no larger than 5 cm, or up to three tumors with none exceeding 3 cm, with no vascular invasion or metastasis. Patients who meet those criteria can receive MELD exception points from UNOS, which raises their position on the waiting list.⁴

Some diagnoses sit outside the NCDs and are left to the local Medicare contractor. Extrahepatic cholangiocarcinoma, neuroendocrine tumor metastases to the liver, and hemangioendothelioma fall in that gray zone. Anything considered investigational or experimental is excluded.³

The Approved-Facility Requirement

The transplant must happen at a facility CMS has certified as an approved transplant program. This applies whether you have Original Medicare or a Medicare Advantage plan. A transplant at a non-approved facility is not covered.¹

CMS certifies programs based on compliance with federal Conditions of Participation covering data submission, clinical experience, and patient outcomes. You can look up certified programs by state and organ type through the CMS Quality, Certification and Oversight Reports site at qcor.cms.gov.⁵

What You’ll Pay Out of Pocket in 2026

Even with Medicare covering the bulk of the bill, you’re responsible for standard cost-sharing. For 2026, the Part A deductible is $1,736 per benefit period, which applies to the transplant admission. After the deductible, there is no additional coinsurance for the first 60 days of the hospital stay.⁶

For Part B services, including the surgeon and specialists, you pay the annual Part B deductible of $283 and then 20% of the Medicare-approved amount for each covered service.⁶ A liver transplant is expensive enough that 20% of the physician charges alone can run to tens of thousands of dollars.

One coverage gap catches a lot of patients off guard. Medicare does not pay for transportation to the transplant facility.¹ Because approved liver transplant programs cluster at major medical centers, travel and lodging can be significant, and those costs fall on you or your supplemental coverage.

How Medigap Changes the Math

A Medicare Supplement (Medigap) policy covers the deductibles and coinsurance that Original Medicare leaves behind.⁷ For a procedure this expensive, the difference between having any Medigap plan and having none is far larger than the differences among plan letters.

Plan G is the strongest option for people who became Medicare-eligible on or after January 1, 2020. It covers 100% of Part A coinsurance, 100% of Part B coinsurance, the full Part A deductible, and Part B excess charges. The only standard cost it doesn’t cover is the annual Part B deductible. Plan F, which also covers the Part B deductible, is available only to those who qualified for Medicare before January 1, 2020.⁸ Plan N carries lower premiums, covers the Part A deductible and Part B coinsurance, but does not cover Part B excess charges and requires small copayments for some office and emergency room visits.⁹

Medicare Advantage Rules

Medicare Advantage (Part C) plans must cover everything Original Medicare covers, including medically necessary liver transplants. Every Medicare Advantage plan also caps your annual out-of-pocket spending, which can matter enormously during a transplant year.⁶

The tradeoff is process. Advantage plans can require a pre-service coverage determination, and members or their providers may need to submit documentation of the diagnosis and the intended transplant center before surgery.³ The facility still has to be Medicare-approved. If the plan directs you to a distant transplant center, federal rules require it to provide reasonable transportation and accommodations for you and a companion.¹⁰ Some carriers offer more generous travel benefits. Certain Humana Medicare plans, for example, provide up to $10,000 in travel and lodging assistance per transplant when the center is at least 100 miles away.¹¹

Immunosuppressive Drugs After Surgery

Liver transplant recipients take immunosuppressive medications for life. Which part of Medicare pays for them depends on your coverage at the time of the transplant.

If you had Medicare Part A when the transplant was performed at an approved facility, Part B covers your immunosuppressants for as long as you remain Medicare-eligible.¹² Unlike kidney transplant patients, liver recipients do not get a special Medicare entitlement based on the diagnosis, so continued coverage depends on qualifying through age or disability.¹³

If you had private insurance or Medicaid when the transplant happened and later became Medicare-eligible, Part D covers your immunosuppressants rather than Part B.¹² This applies to most liver transplant recipients: roughly 69.6% hold non-Medicare insurance at the time of surgery. Part D plans must include nearly all immunosuppressants on their formularies, but off-label uses can still be denied, and about 16.5% of liver transplant regimens involve off-label or off-compendia prescriptions.¹⁴

One boundary worth flagging: the Medicare Part B Immunosuppressive Drug benefit (Part B-ID) that took effect in January 2023 applies only to kidney transplant recipients who originally qualified for Medicare through end-stage renal disease and whose standard coverage has ended. Liver transplant recipients are not eligible for it.¹⁵

Living-Donor Transplants

Medicare covers living-donor liver transplants at approved facilities. Under the recipient’s Medicare coverage, Part A pays for the donor’s evaluation, surgery, and follow-up in addition to the recipient’s costs. The donor does not pay for the surgery or the medical evaluation.¹⁶

Donors can still face non-medical costs Medicare won’t touch: travel, lodging, meals, lost wages. The federal Living Organ Donation Reimbursement Program, run by HRSA, helps with those. It provides assistance with travel, lodging, meals, and up to four weeks of lost wages for donors whose combined household income with the recipient falls at or below 350% of the federal poverty guidelines, with a financial hardship exception for those above the threshold.¹⁷

Alcohol-Related Liver Disease and the Six-Month Rule

Medicare itself does not require a period of sobriety before covering a liver transplant. The often-cited “six-month rule” for alcohol abstinence is a practice adopted by individual transplant centers and professional bodies, not a federal Medicare condition of payment.¹⁸

UNOS uses the six-month standard as a general guideline while allowing exceptional cases to be reviewed by regional boards, and American Association for the Study of Liver Disease guidelines advise six months of abstinence but do not treat it as an absolute bar.¹⁸ Each transplant program sets its own policy, and some state Medicaid programs add restrictions, but Medicare’s national coverage policy does not condition payment on a specific abstinence period.¹⁹

1
Medicare.gov. Organ Transplants
2
CMS.gov. Transmittal 13698, Change Request 14262
3
Bynder. Medicare Advantage Policy Manual, Liver Transplants
4
National Center for Biotechnology Information. Clinical Criteria for Liver Transplantation in Hepatocellular Carcinoma
5
CMS.gov. Organ Transplant Program Certification
6
MedicareAdvantage.com. Does Medicare Cover Liver Transplants
7
Medigap.com. Medicare Coverage for Organ Transplants
8
Medicare.gov. Compare Medigap Plan Benefits
9
U.S. News & World Report. Medicare Supplement Plan F vs Plan G
10
Blue Cross Blue Shield of Kansas. MA Transplant Travel Benefits Policy
11
Humana. Transplant Services Questions
12
American Society of Transplantation. Immunosuppressant Drug Coverage Under Medicare Part D
13
National Academies. Immunosuppressive Therapy and Organ Transplantation
14
American Journal of Transplantation. Immunosuppressant Drug Coverage Vulnerabilities
15
CMS.gov. Part B-ID Provider Information
16
Medical News Today. How Much Does a Liver Cost
17
Federal Register. Reimbursement of Travel and Subsistence Expenses Toward Living Organ Donation
18
National Center for Biotechnology Information. Alcohol Abstinence and Liver Transplantation
19
National Center for Biotechnology Information. Medicaid Policies and Liver Transplantation for Alcohol-Associated Liver Disease