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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, though, 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.

FAQ’s

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, 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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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

10 thoughts on “Medicare Coverage for Dialysis Treatments

  1. Can a person qualify for medicare for Dialysis with ESRD; if they did not work enough hours to qualify for regular medicare?

    1. Hi Sharon! Yes, you’ll still qualify for Medicare. When you’re eligible for Medicare due to a disability, there is no minimum work requirement. Part A will be free, however, you’ll have to pay the monthly premium for Part B unless you have Medicaid. If you have Medicaid, they will pay your Part B premium. Once you stop dialysis, you’ll have 12 months left of Medicare coverage. When you qualify again at 65 due to aging in, those work requirements will need to be met at that point to qualify for premium-free Part A. I hope this helps!

  2. Where can I find information on coverage for dialysis? My wife (age 54) is in stage 4 kidney disease and at current rate will need to be on dialysis within the next 6 months. She has medical insurance through work with Aetna. We would (hopefully) like one of the home dialysis types so she can contiune to work. Any information you can share will be very much appreciated. I would like to be ahead of the game with this rather than scrambling when the dialysis becomes necessary. Thank you in advance.

    1. Hi M.W. Thank you for reaching out! Medicare will cover 80% of her treatments. I would contact your wife benefits administrator to discuss how her employers’ coverage will work with Medicare. They will be able to tell you if the employer coverage will be primary or if Medicare will be primary. This will also help you determine if your wife will need to get a supplemental Medigap plan or if the combination of Original Medicare & employer coverage will give her the benefits she needs. More than likely, her employer coverage in addition to Medicare Part A and Part B, she should have full coverage. Medicares will also cover home dialysis & training. I hope this helps and wish your wife the best throughout her treatment and recovery!

  3. Does Medicare reimburse for routine dialysis in an acute care hospital, when that is the only reason for the admission?

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