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. Medicare Part B may cover dialysis, but you will have to pay 20% of the cost.
How Much Does Dialysis Cost with Medicare?
Medicare will cover 80% in an approved dialysis center, but you will typically have to pay 20% of the Medicare-approved price for all dialysis services and supplies. 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% 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.
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.
Dialysis Services Covered by Medicare
Medicare Part B (medical insurance) will cover dialysis services and supplies if they are medically necessary or if you have end-stage renal disease. You must be enrolled in Medicare Part B and paying the monthly premium to qualify.
- Inpatient dialysis treatments
- Outpatient dialysis treatments
- Dialysis treatment in Medicare-approved facilities while traveling in the U.S.
- 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)
Does Medicare Cover Transportation to Dialysis?
Medicare typically does not cover transportation to a dialysis facility. The only caveat to this rule would be if you qualified for ambulance services and were transported to a facility in an ambulance.
Ambulance services are covered when you need to get to a hospital or other facility and transportation in a normal vehicle could be life threatening. Some Medicare Advantage plans offer expanded coverage for transportation to facilities.
How Long Does Medicare Pay for Dialysis
Medicare should continue to cover your dialysis treatments as they are needed. But if there is a change in your situation, then the length of coverage depends on your eligibility.
For example, if you are only eligible for Medicare because you have end-stage renal disease, then your coverage will expire 12 months after the month you stop receiving dialysis treatments. If you received a kidney transplant, then your coverage will end 36 months after the month of your transplant.
If you were receiving dialysis treatment but had Medicare through the typical eligibility requirements of being 65, then there should be no change to your coverage regardless of your health situation.
What Is the Best Medicare Plan for Dialysis Patients?
Original Medicare covers dialysis treatments. This applies either if you meet regular eligibility requirements or if you don’t but have end-stage renal disease.
Original Medicare is provided through the federal government and comes with a monthly premium for Part B, which covers dialysis.
Another potential option is Medigap, which can help cover some of the out-of-pocket costs from Original Medicare. Dialysis can be very costly, meaning that you can be left with major expenses even after Medicare covers 80% of the cost.
One thing to note is that there are insurance companies that will not sell Medigap to beneficiaries who don’t have Medicare through the typical set of requirements. So, beneficiaries who need dialysis but got Medicare before they turned 65 may not be eligible for a plan.
Medicare Advantage Plans and Dialysis Coverage
Medicare Advantage plans may not be the best option to receive dialysis coverage if you already have end-stage renal disease. Generally, you cannot enroll in a Medicare Advantage plan (Part C) if you have already been diagnosed. But there are two prominent exceptions.
- You can enroll in your employer’s insurance company if that insurance company provides a 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.
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.
Generally, you’ll have to pay the regular out-of-pocket Medicare costs associated with Medicare Part A and Part B. This includes coinsurance or copayments and deductibles.
Under Medicare Part B, that means you’ll have to pay your deductible and 20% of the Medicare-approved amount. Medicare will pick up the other 80%.
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% 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.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, November 6). 2021 Medicare Parts A and B Premiums and Deductibles. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles
- 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