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Medicare Coverage for Dialysis Treatments


Medicare covers most forms of dialysis treatment. Medicare will cover a range of treatments, including tests, medications, and equipment. We know how important it is to understand your coverage. You need to know what isn’t covered just as much as you need to know what is covered. Below we’ll review how Medicare works with each treatment you may need. Then, you can make decisions for your care based on services that have coverage.

Does Medicare Cover Kidney Dialysis?

Yes, Medicare will cover you should you need dialysis treatments. Dialysis can come in many different forms. Below we’ll go over different types of dialysis treatments that have coverage.

Medicare will cover:

  • Inpatient dialysis within a hospital
  • Outpatient dialysis at a dialysis center
  • Self-dialysis training
  • Dialysis equipment and supplies for home use
  • Prescriptions related to your treatment
  • Immunosuppressant medications

What Dialysis Care Isn’t Covered by Medicare?

While Medicare covers a lot of dialysis services, but it doesn’t cover everything.

For instance, Medicare doesn’t cover:

  • Home health care aides for in-home dialysis
  • The cost of housing for in-home dialysis
  • Costs associated with loss of income while doing self-dialysis training

Does Medicare Cover Dialysis Treatment?

Two different types of dialysis treatments are available – Hemodialysis and peritoneal dialysis. Medicare will cover both forms of dialysis. In further detail, Medicare will cover up to 15 dialysis training sessions for peritoneal dialysis and pay for up to 25 dialysis sessions for hemodialysis.

Does Part A Cover Dialysis?

Part A will cover dialysis treatments at an approved center. Any doctor fees you get with dialysis Part B benefits cover.

Does Medicare Pay for Outpatient Dialysis?

When you go to dialysis in an outpatient setting Part B will cover 80% of the costs, and you’ll pay the rest. Part B pays for lab tests, equipment, and other supplies.

Immunosuppressant Drugs for Dialysis

You’ll need immunosuppressant drugs for life when you get a kidney transplant. While this sounds scary and costly, you can take a breath of relief.

Part B will cover these drugs under a few different factors:

  • Part A benefits covered your transplant.
  • You have Part B coverage when it’s time to fill the prescription.
  • You’re eligible for Medicare ESRD.

Part B wouldn’t cover immunosuppressants if you didn’t have Part A during your surgery. If this situation applies to you, you may need to buy a Part D plan to cover the medications you need.

Self-Dialysis Medications

Part B will cover any necessary medications you’ll need to conduct self-dialysis. Medicare will cover most of the costs.

Some of these medications can include:

  • Topical Anesthetics
  • Heparin
  • Erythropoiesis-Stimulating Agents

How to Choose a Medicare Dialysis Center?

You can get dialysis in several different types of facilities. If you qualify, your dialysis can take place within the comforts of your own home. Or, you can also get dialysis at a certified dialysis center.

For Medicare to cover your treatment, the center must be Medicare-certified.

Does Medicare Cover Transportation to Dialysis?

Medicare will cover ambulance transportation that you may need to get to your dialysis facility. If you need non-emergency transportation, your doctor needs to provide the ambulance company with a written order. Your doctor will need to specify that transportation is medically necessary.

Often, Medicare Advantage plans will cover transportation services too.

Additional Dialysis Services & Equipment

In addition to your actual dialysis treatment, Part B will cover all other services.

Durable Medical Equipment, all lab tests, and transportation can fall under Part B benefits.

Dialysis Treatment and Traveling

You still have coverage if traveling in the United States. You can contact your dialysis center to help find other centers along your trip.

The dialysis center needs to be Medicare-certified for you to continue getting coverage. Medicare may only cover dialysis nationally or on an emergency basis.

How Much Does Medicare Pay for Dialysis?

Just one year of hemodialysis may cost you $72,000. And a single year of peritoneal dialysis can cost you around $53,000 each year.

Keep in mind, Medicare will only cover 80%, you’ll be left with the remaining costs. Even with the majority of your treatment covered, you’ll still have costly bills.

You can opt into buying a Medigap plan, or Advantage policy. If you’re on costly medications, a Part D drug plan can help lower your costs.

FAQs

When do dialysis patients qualify for Medicare?
Medicare coverage will take effect depending on the route of treatment. If you’re a Hemodialysis patient, coverage will start in your 4th month of dialysis. When you’re a home dialysis patient, Medicare is active in the first month of treatment. If you’re a transplant patient, coverage starts the first day of the month you go in for your transplant.
Will Medicare Advantage plans cover dialysis?
Medicare Advantage plans have to cover what Medicare covers. So yes, Medicare Advantage plans will cover dialysis treatment.
Is home dialysis covered by Medicare?
Part B benefits will cover dialysis from within your home. The coverage also includes training to teach you how to administer dialysis yourself. Coverage also includes lab tests, equipment, and other supplies you may need.

How to Get Help with Your Dialysis Out Of Pocket Costs Under Medicare

Dialysis treatments can put a strain on you. Medigap can help ease some of the financial burdens you may be facing. We want to make sure you find the policy that gives you the most benefit and saves you the most money. We'll compare all carriers and plans that in your area. Our goal is to help you feel confident in your insurance plan. Contact one of our agents today at the number above. Or, fill out an online rate form to get your rates now!

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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