For kidney transplant recipients, immunosuppressive drugs are imperative to protect your new kidney and keep you healthy. Patients previously with Medicare Part B would lose coverage for these expensive medications after 36 months. 

In December 2020, Congress passed legislation to provide ongoing Medicare coverage for immunosuppressive drugs. This benefit, which finally became available in October 2022, is called Medicare Part B Immunosuppressive Drug (Part B-ID). Keep reading for answers to common questions about Part B-ID.* 

Am I eligible to enroll? 

To be eligible for Part B-ID, you must meet the following criteria:

• Currently or previously had Medicare because of end-stage kidney disease (ESKD) that ends 36 months after a kidney transplant
• Attest that you are not currently enrolled in other health coverage and don’t expect to enroll in coverage that would make you ineligible for Part B-ID. 

Other health coverages that would make you ineligible include:

• Group or individual health plans (including Marketplace plans) or National Health Plans
• TRICARE
• Medicaid or Children’s Health Insurance Program (CHIP) coverage that includes immunosuppressive drug coverage
• Department of Veteran Affairs (VA) coverage, or eligibility to get immunosuppressive drugs from the VA

When can an eligible patient enroll?

Starting on October 1, 2022, eligible patients can apply for the Part B-ID benefit. They can also disenroll at any time without penalty. 

When will coverage start? 

If a patient signs up by December 31, 2022, eligible patients will start receiving coverage on January 1, 2023. After 2022, coverage will start the month following the month in which the patient applied. 

What is covered? 

The Part B-ID benefit will cover continuous immunosuppressive drugs, which are needed to prevent the rejection of a transplanted organ. 

It will not cover the following:

• Part A, Part B, or Part D services, supplies, or medications
• Drugs that treat conditions that result from immunosuppressive drug regimens, such as antibiotics and vitamins

How does it work with other insurance?

A patient cannot have coverage for immunosuppressive drugs with any other insurance. If you enroll in Part B-ID but later get other coverage, you will need to notify Social Security within 60 days to disenroll. If you lose your other coverage, you can apply for Part B-ID. 

What are the out-of-pocket costs?

The annual Part B deductible and 20% coinsurance will apply for patients with Part B-ID.

Where can I learn more?

To learn more about eligibility for Part B-ID, you can view Medicare’s Checking Medicare Eligibility. If you think you or a loved one meet the criteria, call Social Security at 1-877-465-0355 to enroll. If a teletype (TTY) machine is needed, please call 1-800-325-0788.  

*Medicare Part B Immunosuppressive Drug Benefit. (2022, November 2). Centers for Medicare and Medicaid Services (CMS). https://www.cms.gov/partbid-provider