Kidney Transplants And Health Insurance: What’s Covered, What’s Not

In general, most comprehensive health insurance policies cover kidney transplants after the waiting period has ended. “Coverage generally includes hospitalization expenses related to the transplant surgery, which can include surgeon fees, intensive care unit (ICU) charges, the cost of a hospital room, diagnostic tests, and medications that are administered during the patient's hospitalization,” says Arun Ramamurthy, co-founder, Staywell.Health.

What Is Not Covered

Expenses like donor screening, travel, post-discharge care, or complications are often excluded. Also, long-term immunosuppressant medicines, which are lifelong after a transplant, are usually not covered or are capped under Outpatient Department (OPD) benefits, if at all. So yes, there is coverage, but it might not be as comprehensive as people assume,” says Sarita Joshi, head of health and life insurance, Probus.

How Much Cover Do You Need 

A Rs 5 to Rs 10 lakh cover sounds decent on paper, but for a kidney transplant today, it’s usually not enough. A transplant in a good hospital can easily cost anywhere between Rs 8 and Rs 12 lakh just for the surgery and immediate care, and that’s before you factor in donor expenses and post-transplant treatment.

“From what we see on the ground, a base cover of at least Rs 20 to Rs 25 lakh makes more sense, especially in metro cities. If possible, combining a base policy with a super top-up is a smarter, more affordable way to reach that level of protection without paying very high premiums,” says Joshi.

Factor In Out-of-Pocket Expenses 

Out-of-pocket expenses mostly happen in three areas. First, donor-related costs, many of which fall outside policy limits or exclusions. Second, long-term medicines like immunosuppressants are essential but not fully covered by most insurers. “And third, non-medical or indirect costs such as repeated follow-ups, diagnostic tests, travel, or choosing hospitals and doctors beyond policy sub-limits,” says Joshi.

“While coverage gaps are largely a result of the fact that most health insurance plans at this time were created primarily for short-term hospital stays and did not consider the complexity of long-term multi-phased treatment involved with organ transplantation, many insurers are now attempting to expand their offerings into more comprehensive plans,” says Ramamurthy.