Jane Dotson
Kidney transplants are a common procedure, but they are also an expensive one. The good news is that health insurance does cover kidney transplants, and there are different types of policies that can cover expenses to a specified limit. However, it's important to note that not all costs associated with kidney donation are covered by insurance. For example, while the recipient's insurance will cover the donor's general expenses, such as evaluation, surgery, and limited follow-up tests, it may not cover all follow-up services or additional expenses like transportation, lodging, and lost wages. Donors should also be aware that donating a kidney can affect their ability to get or afford disability or life insurance in the future. Understanding the financial implications of kidney donation is crucial before making any decisions.
| Characteristics | Values |
|---|---|
| Donor's insurance coverage | Medical costs related to donation are covered by the recipient's health insurance. |
| Recipient's insurance coverage | The recipient's insurance covers the donor's general expenses, such as evaluation, surgery, and limited follow-up tests and medical appointments. |
| Additional expenses | The donor may need to cover additional expenses such as transportation, lodging, long-distance phone calls, childcare, or lost wages. |
| Financial assistance | The National Living Donor Assistance Center (NLDAC) offers programs to help cover lost wages or travel expenses for qualifying donors. |
| Medicare | Medicare may provide coverage for donors who experience donation-related complications. |
| State laws | Some states, like California, require employers with 15 or more employees to provide up to 30 days of paid leave for organ donation. |
| Tax deductions | Many states offer tax deductions or credits to living kidney donors. |
| Disability insurance | The donor may need to consider the potential impact on their ability to obtain or afford disability or life insurance after donating. |
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What You'll Learn
Recipient's insurance covers donor's general expenses
The financial implications of kidney donation are a concern for many potential donors. The good news is that the transplant recipient's insurance will cover the donor's general expenses, such as the evaluation, surgery, and limited follow-up tests and medical appointments. This is true whether the donor is a directed donor (knows the recipient) or a non-directed donor (doesn't know the recipient).
However, it's important to note that the recipient's insurance may not cover all expenses. For example, it may not include transportation, lodging, long-distance phone calls, childcare, or lost wages. These additional expenses can be significant, and donors should be aware of them before deciding to donate. There are, however, financial resources available to help donors with these costs. For instance, the National Living Donor Assistance Center (NLDAC) may be able to provide financial assistance for travel, lodging, meals, and other non-medical expenses. Some transplant hospitals also offer free or low-cost hospitality houses for donors and their families.
Additionally, donors may be able to receive reimbursement for lost wages through NLDAC, NKR, or other programs. Some states have also passed laws to protect living donors' rights and make it easier for more people to donate. For example, California state law requires employers with 15 or more employees to provide up to 30 days of paid leave for organ donation and allow employees to return to the same or equivalent positions.
It's worth noting that Medicare or the kidney recipient's private insurance will cover the direct costs of kidney donation, such as medical testing, surgery, and some medicines for the recipient. However, there may be indirect costs, such as travel or lost wages, that are not covered by Medicare or private insurance. Donors should carefully consider the potential financial implications and seek information from their transplant center or social worker to understand the full range of expenses covered and any additional costs they may incur.
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Donor's lost wages and travel expenses
While the recipient's insurance will cover the donor's general medical expenses, it may not cover the donor's lost wages, travel, lodging, long-distance phone calls, or childcare. The donor's own insurance may also not cover these expenses.
Donors must participate in an NKR donation or donate at a Donor Shield Direct center to receive living donor assistance. Donor Shield is the only comprehensive program in the United States that protects living kidney donors and offers lost wage reimbursement. It is backed by the National Kidney Registry, which is the largest paired exchange program in the world. Donors covered by Donor Shield are eligible for living donor financial assistance for lost wages, up to a maximum of $2,000 per week for up to 12 weeks. Lost wage reimbursement beyond three weeks requires additional clearance from the transplant center.
Some states have enacted tax deductions or credits for living donors' unreimbursed expenses, including lost wages. There is also pending federal legislation that would provide a federal tax credit of up to $5,000 for unreimbursed expenses, including lost wages, for living donors of kidneys, livers, lungs, pancreas, intestine, or bone marrow.
In California, state law requires employers with 15 or more employees to provide up to 30 days of paid leave for organ donation and allow employees to return to the same or equivalent positions. Some donors may be eligible for sick leave, state disability, or the Family and Medical Leave Act (FMLA). The FMLA allows employees to return to the same or an equal position and stay on the employer's health insurance plan without paying higher costs. However, FMLA only covers government or public employees or employees of private employers with more than 50 employees who have worked there for at least one year.
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Donor's medical costs for routine care
Ideally, donating a kidney should cost the donor nothing. The recipient's health insurance will cover the donor's medical costs related to the donation, including the donor's evaluation at the transplant centre (lab work, imaging like X-ray, CT scans, etc.), surgery, and limited follow-up tests and medical appointments. However, the recipient's insurance may not cover follow-up services for the donor if medical problems occur from the donation.
Routine healthcare appointments such as yearly visits to the dentist and OBGYN visits for female donors are not covered by the recipient's health insurance because these appointments are not related to the donation process. Donors are expected to keep up with routine healthcare appointments regardless of their decision to donate.
Donors may incur other costs that are not covered by insurance or other sources, such as lost wages for time off work, travel expenses, lodging, and childcare. Financial assistance programs are available to cover these additional kidney donation costs. The two main programs that reimburse kidney donation costs are the National Living Donor Assistance Center (NLDAC) and the National Kidney Registry's Donor Shield program. NLDAC, administered by a division of the United States Health and Human Services, offers reimbursement for lost wages (up to three days for evaluations and six weeks for surgery, recovery, and follow-ups), travel expenses, and other out-of-pocket expenses. Donor Shield, offered through the National Kidney Registry, reimburses eligible kidney donors for donation-related expenses, including lost wages (up to a maximum of $2,000 per week for up to 12 weeks, $24,000 total), travel, lodging, meals (for the donor and a travel companion), and dependent care (up to a combined maximum of $6,000 for travel and dependent care). The maximum reimbursement for all donation-related costs under Donor Shield is $30,000.
It is important to discuss the financial implications of donation with the transplant centre and medical team, as many transplant centres have social workers or financial coordinators who can help donors navigate the financial aspects and provide information on available resources and support.
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Donor's unreimbursed expenses
While the recipient's health insurance will cover the medical costs related to your donation, there are additional expenses that aren't usually covered. These unreimbursed expenses are specific to the legislation your state has passed, and they must be directly related to the organ donation process and considered medically necessary.
Unreimbursed expenses can include lost wages during the donor's recovery period, which can be a big expense. Living donors are typically responsible for any time lost from work, unless their employer provides paid leave or allows the donor to use short-term disability. Some donors may use a combination of vacation time, sick leave, and/or short-term disability during their recovery period. To avoid financial hardship, donors can discuss these issues with their transplant center's financial counsellor or social worker, who can advise on potential sources of financial assistance.
Other unreimbursed expenses may include travel and lodging expenses, phone calls, and childcare. Some transplant hospitals offer free or low-cost hospitality houses for donors and their families, and there are also financial programs available to help pay for costs related to donating that aren't covered by the recipient's insurance. The National Living Donor Assistance Center (NLDAC) is one such program that can provide financial assistance for travel and subsistence expenses associated with living organ donation.
Additionally, many states have enacted tax deductions or credits for living donors to address unreimbursed expenses associated with donation. There is also pending federal legislation that would provide a federal tax credit of up to $5,000 for unreimbursed expenses, including lost wages, for living donors of kidneys, livers, lungs, pancreases, intestines, or bone marrow. Donors should keep thorough records of all expenses related to organ donation, including receipts, invoices, and any documentation that verifies the expenses being claimed.
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Insurance coverage limits
The financial implications of kidney donation can be a concern for donors, and it is important to understand the costs of kidney donations and transplants for both the kidney recipient and the living kidney donor. The good news is that the transplant recipient's insurance will cover the donor's general expenses, such as the evaluation, surgery, and limited follow-up tests and medical appointments. However, there are limits to this coverage, and it is important to understand what is and isn't covered.
The recipient's insurance will not cover follow-up services for the donor if medical problems occur from the donation. It also does not cover transportation, lodging, long-distance phone calls, childcare, or lost wages. These additional expenses can add up, especially if there are complications or the donor needs time off work to recover.
Some resources are available to help with these additional costs. The National Living Donor Assistance Center (NLDAC) provides financial assistance for travel, lodging, meals, and other non-medical expenses connected with the evaluation, surgery, and follow-up services (within 90 days of the donation). The NLDAC also offers programs to help cover the cost of lost wages for qualifying donors. Additionally, many states offer tax deductions or credits to living kidney donors, so it is worth contacting the relevant state department to find out more.
Some transplant candidates have Medicare, which may provide coverage for donors who experience donation-related complications. It is worth noting that Medicare Part B will cover the recipient's medicines for the life of the transplant, regardless of their age. Finally, some transplant centers may provide medical and disability insurance that covers problems that may occur from the donation, either free of charge or for purchase.
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