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medicare card over dialysis center; what medicare covers for dialysis

What Medicare Covers for Dialysis

Medicare is a nationwide healthcare program in the U.S. for people over 65 and some people with disabilities. Most people will age into the system at 65, but people under 65 with certain medical conditions may qualify for coverage as well. One of those conditions is kidney failure, or end-stage renal disease (ESRD), which requires dialysis to filter blood. Here’s what Medicare covers for this life-sustaining treatment.

Eligibility

Medicare may cover your dialysis treatment if the following applies to you:

  • You need regular dialysis treatment or have had a kidney transplant
  • Your kidneys no longer filter blood properly, and
  • You are currently receiving benefits from Social Security, the Railroad Retirement Board, or as a federal employee

Types of dialysis

There are two types of dialysis. The first is hemodialysis, which hooks a patient up to a machine that filters waste and fluid out of their blood. The second type is peritoneal dialysis, which filters blood by injecting the patient with a solution called dialysate. The dialysate must be drained from the patient’s abdomen periodically and then replaced with a new solution that continues to filter waste and fluid out of the blood. Your doctor will work with you to determine which type of dialysis is right for you.

Where to receive dialysis

Most people receive dialysis treatments at a dialysis center several times per week. You may qualify for self-dialysis, which can be performed at home after you’ve been trained in proper procedure.

What Medicare covers

You may not qualify for a Medicare Advantage plan if you have ESRD. Instead, you will need to rely on Original Medicare (Part A and Part B) for coverage.

If you are admitted to the hospital and need dialysis as part of your inpatient treatment, it will be covered by Medicare Part A.

Medicare Part B covers the following:

  • Outpatient dialysis treatment at a Medicare-approved facility
  • Doctor visits
  • Lab tests
  • Ambulance transportation to the nearest dialysis facility when medically necessary
  • Self-dialysis training at a Medicare-approved facility
  • Self-dialysis medication, equipment, and supplies

Medicare Part B will NOT cover:

  • Self-dialysis assistance
  • Blood or blood products for self-dialysis
  • Housing during dialysis treatments
  • Income lost due to dialysis treatments
  • Oral medications for ESRD (typically covered by Part D)

For more information on what Medicare covers for ESRD and dialysis treatment, call Medicare directly at 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.

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