Does Medicare Cover Dialysis?
Dialysis is a medical process of removing excess water, toxins and other materials from a person’s blood when their kidneys can no longer do it naturally — a condition called end-stage renal disease. Medicare Part B may cover dialysis for ESRD, but you will have to pay 20 percent coinsurance.
When Is Dialysis Needed?
You will likely need dialysis when you develop end-stage renal disease (ESRD), sometimes called end-stage kidney disease or end-stage kidney failure.
ESRD develops when the gradual loss of your kidney function reaches an advanced stage. This is usually around the time you have lost 85 to 90 percent of your kidney function, according to the National Kidney Foundation.
When you get to this point, your kidneys are no longer able to adequately filter impurities and toxins out of your blood on their own and you will need dialysis to do it for them.
Dialysis does the job your kidneys can no longer do, but it will not cure your kidney disease. You will need to have dialysis treatments for the rest of your life unless you have a kidney transplant.
Where Is Dialysis Done and How Does It Work?
Your doctor will help you decide the best place for your dialysis treatments. It can be done in a hospital, an off-site dialysis center or in your home.
The decision will depend on your medical condition and your wishes. You should also consider what Medicare or other insurance will cover.
There are two types of dialysis: Hemodialysis and peritoneal dialysis.
In hemodialysis, a doctor performs minor surgery to create an access point on your arm and leg. This is done by altering blood vessels or implanting a catheter. This allows your blood to flow through an artificial kidney outside your body when you receive your regular dialysis treatments.
In peritoneal dialysis, your blood is cleaned inside your body by exchanging fluids through a bag or through a machine. Again, a doctor will have to make an access point using a catheter.
- Removes salt, extra water and waste from the blood to prevent build-up in the body.
- Keeps chemicals in your blood — potassium, sodium and others — at safe levels.
- Helps control blood pressure.
Dialysis Services Covered by Medicare
If you have ESRD, Medicare Part B (medical insurance) will cover dialysis services and supplies. You must be enrolled in and paying the monthly premium for Medicare Part B.
- Inpatient dialysis treatments
- Outpatient dialysis treatments
- Dialysis treatment in Medicare-approved facilities while traveling in the United States
- Home dialysis equipment and supplies
- Home-dialysis training
- Laboratory tests and other necessary dialysis-related services and supplies
- Most injectable or oral dialysis drugs
- Some home support services (such as trained dialysis worker visits and face-to-face meetings with doctors or other health professionals once a month)
Generally, Medicare does not pay for transportation to and from dialysis treatment except for medically necessary ambulance services.
Medicare Advantage Plans, ESRD and Dialysis Coverage
Generally, you cannot enroll in a Medicare Advantage plan (Part C) if you have already been diagnosed with end-stage renal disease. But there are two prominent exceptions.
- If you have insurance through your job provided by the same company that offers a Medicare Advantage Plan, you can enroll in that company’s Medicare Advantage plan.
- You can enroll in a Medicare Advantage Special Needs Plan if it specifically serves people who have end-stage renal disease.
However, if you enrolled in a Medicare Advantage plan before you developed ESRD, you cannot be kicked off the plan. And if the plan leaves Medicare or leaves your service area, you will have a special enrollment period to sign up for another Medicare Advantage plan where you live.
How Much Does Dialysis Cost with Medicare?
Dialysis is expensive. You will typically have to pay 20 percent of the Medicare-approved price for all dialysis services and supplies, but Medicare will pick up the remaining 80 percent in an approved dialysis center. You may also have to meet your annual deductible before Medicare pays.
If you have a Medicare Advantage plan or a Medigap plan that covers your coinsurance, it may cover part of your 20 percent share.
The specific amount you owe will depend on the type of coverage you have and any additional insurance that may cover part of your costs. If you qualify, your state’s Medicaid programs may also help you with costs.
Does Medicare Cover Kidney Transplants?
Original Medicare — Parts A and B — cover some of the costs for kidney transplants. Your costs may differ if you are enrolled in a Medicare Advantage plan.
Under Medicare Part B, that means you’ll have to pay your deductible ($198 in 2020) and 20 percent of the Medicare-approved amount. Medicare will pick up the other 80 percent.
Your doctor is limited in how much they can charge if they don’t accept Medicare. If your doctor does not take assignment, you are limited to paying 15 percent above the Medicare-approved cost for your services.
Medicare will pay for laboratory tests and will help you pay for blood services necessary for your transplant. You will be responsible for paying for the first three units of blood.
Your deductible and a copayment will apply to the rest. You can replace the blood with blood donations, either your own or from people you know or are related to.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2019, December). Medicare Coverage of Kidney Dialysis & Kidney Transplant Services. Retrieved from https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf
- National Kidney Foundation. (2015). Dialysis. Retrieved from https://www.kidney.org/atoz/content/dialysisinfo
- National Kidney Foundation. (2007). A “New Normal”: Life on Dialysis – The First 90 Days. retrieved from https://www.kidney.org/sites/default/files/docs/11-10-0307_dialysistransitionbk2_oct07_lr_bm.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). I Have End-Stage Renal Disease (ESRD). Retrieved from https://www.medicare.gov/manage-your-health/i-have-end-stage-renal-disease-esrd
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Dialysis Services & Supplies. Retrieved from https://www.medicare.gov/coverage/dialysis-services-supplies