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
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.
Inpatient costs
Medicare Part A covers the cost of an inpatient dialysis as long as it’s at a Medicare-approved facility and you have met your deductible.
Medicare Part B covers doctors’ fees, including fees for transplant surgeons. You will pay a 20 percent coinsurance as long as your provider accepts the Medicare assignment.
Outpatient costs
Medicare Part B covers dialysis in a Medicare-approved outpatient dialysis facility. You will be responsible for a 20 percent coinsurance for the cost of each session.
In-home costs
Medicare Part B will pay certified home dialysis facilities a set fee that includes the cost of training you in how to administer dialysis yourself. You will pay a 20 percent coinsurance.
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.
