Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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For the most part, all costs that are related to your or your loved one’s heart transplant will be covered by health insurance. For example, 97% of all of the plans offered by Blue Cross/Blue Shield cover the costs of heart transplants.

To get several insurance quotes to compare simply type your zip code into the free quote tool above!

The majority of commercial and insurers offer this kind of coverage period. The Medicaid programs of the majority of states also offer some type of heart transplant coverage, if the transplant happens at one of their approved locations.

What is the cost of a heart transplant?

Not all states or insurance companies offer health transplant coverage, or even the same kind of coverage. Heart transplants add up to, on average, a total of over $650,000 in 2007 (which included the cost of getting the heart, evaluation fees, doctor’s fees, general hospital costs, and post-op care) and that price has only gone up each year.

Several centers in California in 2009 said that the total cost was closer than $1 million. It will be your responsibility to find out what exactly coverage your company or potential company may offer, as you do not want to be the one that ends up being responsible for such huge costs.

Once you determine that your insurance company does include a transplant as a benefit, you will want to ask some questions. For example, is there a maximum amount that the company will cover for transplant—a lifetime maximum? You will want to know what it is, of course.

  • How do prescriptions work?
  • Are they covered?
  • Is there a lifetime maximum for prescriptions?

Just 3 years ago, the average cost of medications for a transplant was nearly $30K.

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What are the eligibility guidelines for a heart transplant?

Then, if you can get a heart transplant covered, you need to be aware of some of the most common guidelines about who is eligible for a heart transplant to begin with. The screening process is long and careful, evaluating you on several points.

For one, some transplant centers says that you have to be at younger than 69 years old when you’re put on the waiting list. You can’t have any other illnesses at the time of transplant such as infections, cancers, any disease or illness that affects the circulation to either your brain or your legs. Also, you must be found psychologically and physically fit. You cannot have smoked or drank any alcohol for three months prior to be putting on the waiting list, and you cannot smoke or drink afterward, either.

You will have to be answer “yes” to a few questions:

  • Have you tried and/or excluded other treatments?
  • Will you likely die if you do not receive the heart?
  • Other than the immediate health issue, is the rest of your health generally good?
  • Will you be able to follow all the post-procedure rules, including lifestyle changes, examinations, and medication treatments?

If you answer “no” to even one of those questions, doctors may not consider a transplant as an option for you.

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Do I have to have health insurance to get a heart transplant?

The truth is, also, that many transplant centers require that you have health insurance that will cover the transplant before they can put you on the list or give you a donor heart because the process is so expensive. If you do not have insurance, you may have to place a deposit of more than $100K. This can be devastating to most individuals and their families.

And, as started earlier, sometimes even when you do have insurance, you may still not get the transplant you need. The Medicaid program of Nevada, for example, is one of the Medicaid programs that is rather strict; while they cover heart transplants, they cover them only up to age 20.

Everything pertaining to health care is going to change drastically because of the 2010 health care reform bill that was recently passed. For now, however, we all have the health care that we have and no other.

If you are worried if procedures such as heart or kidney transplants will be covered by your insurance, or by a potential insurance company, please check with your specific insurance provider. There are too many variations of the possible coverage that simply make it too risky to not know the ins and outs of your health insurance plan.

If you are looking for health care coverage in general, using the online health insurance quotes tool on this page is a good way to get started. It can quickly give you rates from several companies who can provide what you are looking for.

Enter your zip code to receive free insurance quotes instantly!