How Much Does a Heart Transplant Cost?
We all know how vital the heart is for the human body. It pumps blood and provides the needed oxygen and nutrients for us to breathe and function. But if your heart isn’t working correctly, doctors may suggest a heart transplant. In this article, we’ll look at the cost of a heart transplant, how to pay for this cost, and the surrounding care needed. First, let’s talk about the heart transplant procedure.
What is heart transplant surgery?
Heart transplant surgery is a type of organ transplant in which a failing or malfunctioning heart (also known as end-stage heart failure) is replaced with a healthier heart. The healthy, new heart comes from a deceased donor. Because of its severity, a cardiac transplant is often considered after trying other methods of treatment, such as medications or other surgical procedures. According to Yale Medicine, approximately 3,700 heart transplant surgeries are performed annually in the United States.
A heart transplant may be needed due to many different reasons, including:
- Cardiomyopathy (the weakening of the heart muscle)
- Coronary artery or coronary heart disease
- Ventricular arrhythmias (irregular heartbeats)
- Congenital heart defects (heart problems you’re born with)
- Heart valve disease
- Other severe heart conditions
While many successful heart transplants happen every year in the United States, many patients are on a transplant program waiting list. During this time, they have evaluations that confirm their procedure eligibility. These tests could include overall health assessments, cardiac function, lung (pulmonary) function, blood pressure, and psychological well-being tests.
Matching with a donor heart is also tedious, as many criteria must be met, from blood type to tissue compatibility to body size. These criteria help minimize the rejection risk and maximize a successful outcome. While the heart transplant process can be stressful, potential recipients and their families must understand the financial implications of such a surgery. Let’s take a look at the costs of heart transplant surgery.
Understanding the costs of a heart transplant
The cost of a heart transplant is not just the procedure’s cost. Many different factors can affect the total cost. According to a 2020 report, healthcare consulting company Milliman estimated that the average total billed cost per heart transplant patient was $1,664,800.
Here are some of the critical factors that can determine the total cost of heart transplant procedures and care, as well as the estimated expenses in that 2020 finding:
- Pre-transplant care: Before the procedure, you may be required to complete a comprehensive evaluation process. This process could include tests, consultations with heart specialists, prescription costs, and other related healthcare services. Costs for this care can vary based on where you receive care and your specific condition. However, general estimates put this cost at $49,800.
- Organ procurement: Locating and transporting the donor heart can also be costly, estimated at $131,500.
- Surgical procedure and hospital stay: The cost of the surgical procedure and resulting hospital stay can exceed $1 million. Because heart transplant recipients require a prolonged hospital stay, these costs include inpatient care, nursing, and intensive monitoring.
- Physician and surgeon fees: You must also pay the doctor or team of medical professionals performing the surgery. These costs can exceed $111,000.
- Post-transplant care: A procedure like a heart transplant requires continuous and focused follow-up medical care, sometimes including dedicated caregivers. For the six months after surgery, these care costs can be up to $270,000.
- Lifelong Medications: You may be required to take immunosuppressant medication and other medications to help your body get used to the new organ. Over your lifetime, you may need constant medication, and these medication costs can add up. The estimated cost for these medications is $39,500.
- Hidden costs: There are also a variety of hidden costs that can add up, such as travel expenses to visit a particular medical center or transplant center, doctor visits, consultations and follow-up care, and home modification and lifestyle changes due to surgery. Therefore, keep these hidden costs in mind as you explore getting a heart transplant.
- Insurance coverage: Your insurance can pay for some or all of the surgery’s costs, but the insurance you have can affect the total out-of-pocket expenses you can expect. As you navigate your insurance coverage, you must understand the deductibles, copayments, or coinsurance costs you may be responsible for.
These costs can be a barrier to the hope of a heart transplant. However, there are a few ways to cover the costs associated with heart transplant surgery.
Crowdfunding for heart transplants
A powerful way to get help for your heart transplant is crowdfunding. Even with insurance, the procedure and care can be costly. It can be even more difficult if you’re paying for the entire transplant process out of your own pocket. No matter your situation, starting a GoFundMe can help you get closer to the support you need. Get help for yourself, a loved one, or a friend in just a few minutes by starting a fundraiser.
Insurance coverage for heart transplant surgery
One of the best ways to lower the cost of a heart transplant is to use insurance coverage. There are two main types of insurance coverage: through private insurance companies or government health plans.
Private health care coverage
For those who are still working, you are most familiar with this type of insurance plan. In this type of coverage, an insurance company provides coverage to an entire group or organization. Some employers may pay partial costs of this coverage for employees, while others do not. This type of coverage can also be purchased directly from the insurance provider or through the Health Care Marketplace.
Private healthcare companies tend to have multiple plans, each with specific language that describes care coverage. Often, medically necessary services such as a heart transplant are at least partially covered. Because there are so many different providers and coverages, it’s vital that you review your plan documents to ensure you understand the coverage you have. Contact your provider for more information regarding your specific plan.
Government health insurance plans
The second main insurance type is a government health plan. These plans include Medicare and Medicaid.
Medicare
Medicare provides government health insurance to people 65 and older, people with disabilities, or those with certain diseases. These insurance plans run through private companies that contract with Medicare to offer plans. Medicare plans include hospital insurance (Part A) and medical insurance (Part B). They can also include Medicare Advantage Plans (Part C), Medicare Cost Plans, and the Program of All-inclusive Care for the Elderly (PACE). Prescription drug coverage (Medicare Part D) is also available.
Medicare may cover many of the costs associated with a medically necessary heart transplant surgery if you receive the procedure through a Medicare-approved facility.
Medicaid
Medicaid is a state and federal program that helps cover medical costs for those with limited income and resources. Each state runs its own Medicaid program, following the general rules set forth by the federal government. Because each state is different, they may have other coverage requirements for heart transplant surgeries. Contact your state to learn more about Medicaid eligibility and your coverage options.
If you don’t have insurance coverage, you could shoulder the entire surgery cost. However, some financial assistance programs can provide some relief for financially stressed people.
Heart surgery financial assistance options
If you need help affording the cost of your heart transplant, there are a few nonprofits that might be able to help:
- The HealthWell Foundation: A leading nonprofit organization helping people afford healthcare costs. This foundation may assist with copays, premiums, deductibles, and out-of-pocket expenses.
- Patient Action Network (PAN) Foundation: A nonprofit organization that helps underinsured people with their out-of-pocket expenses. They may be able to help with the cost of heart transplantation.
- The Assistance Fund: A nonprofit organization that helps people pay for treatment and medications for specific diseases. They recently announced support for heart failure patients.
Managing heart transplant costs
For many, heart transplant surgery represents hope. However, the thought of a financial burden can cause more stress for patients and their families. To prepare for the costs of surgery and care, here are a few things you can do to make sure you’re ready:
- Understand the complete financial picture: Before surgery, you should understand the total surgery cost and care. These costs can include your co-payment, deductible, and co-insurance costs. Those utilizing insurance should call ahead and get pre-authorization for the surgery. Verifying you’re using in-network providers is essential, as out-of-network providers can amplify the costs. For those who need financial assistance, the quicker you can secure this assistance, the better. So, be diligent in reaching out to nonprofit organizations early. The United Network for Organ Sharing (UNOS), a private, non-profit organization that handles organ donation in the United States through the government, outlines a list of questions to ask before the procedure.
- Utilize Prescription Assistance Programs: Heart transplant patients will need medications, and lowering your medication cost can significantly reduce your spending. Almost every major pharmaceutical company offers a prescription assistance program. Reach out to them directly to see how you can save.
- Ask about a payment plan: With the hefty surgery cost, a payment plan is a great way to reduce costs by paying in monthly installments. Talk to your patient care coordinator to determine if the medical center or healthcare provider offers a no-interest payment plan. Often, providers offer these no-interest payment plans, allowing you to pay off the debt without incurring interest. In contrast, medical loans or high-interest credit cards can cost you thousands in interest charges. You may also contact your network to see how their support can help you stay out of debt.
For those who are considering a heart transplant, finances can be the last thing on your mind. However, cost is a crucial component of any medical procedure. If costs are a barrier, GoFundMe can help. GoFundMe is a leading crowdfunding site, with thousands of people creating their own fundraisers each day. Our platform is an excellent way to reach a broader audience and get help. So, if you’re ready to get one step closer to the financial help you need for your heart transplant, get started with GoFundMe.