April 22nd 2024
By Ari Parker
Learn about Medicare's coverage for dialysis treatment. Understand eligibility, costs, and benefits to ensure you receive the care you need.
Kidney dialysis is a treatment used to filter and clean out the kidneys when they aren't functioning properly. 69% of people with End-Stage Renal Disease (ESRD) rely on dialysis treatments, but they can be costly without insurance. Medicare covers dialysis, enabling people to receive the treatment they need to treat kidney issues.
This comprehensive guide will explain everything you need to know about how Medicare covers dialysis treatment—from services and supplies to facilities and transportation.
If you have ESRD or other kidney problems, Medicare covers dialysis including treatment, drugs, home support services, home supplies, and more.
You must find a Medicare-certified dialysis center to receive coverage for treatment.
You can also opt for dialysis at home. In this case, Medicare covers home training for you and/or a loved one.
Original Medicare doesn’t provide coverage for transportation to a dialysis facility, but some Medicare Advantage plans have transportation benefits.
Your kidneys are responsible for filtering and cleaning your blood. When your kidneys don’t work properly, harmful waste and excess fluids can build up and cause serious issues in your body. Dialysis treatment helps clean your blood, maintain blood pressure, and balance your fluids. While dialysis regulates your body and manages conditions like ESRD, it doesn’t cure permanent kidney failure.
There are two options for dialysis treatment: hemodialysis and peritoneal dialysis. You and your healthcare provider can discuss which type of dialysis you need based on your condition.
Hemodialysis involves using a machine to circulate blood through a filter (dialyzer) to remove waste and extra fluids. After the machine cleanses your blood, it then returns it back into circulation. Hemodialysis is typically performed at a dialysis center several times a week, and each session can last for a few hours.
With peritoneal dialysis, a special fluid called dialysate flows into the abdomen through a catheter. Waste and excess fluids pass from the blood vessels in the abdomen into the dialysate. The dialysate is then drained, which removes the waste products and extra fluids from your body. Some people prefer peritoneal dialysis because it can be done at home.
Yes, Medicare has comprehensive coverage of dialysis for hemodialysis and peritoneal dialysis. You must find a Medicare-approved facility for coverage. Medicare also covers dialysis at home if you prefer to treat yourself or get help from a loved one.
Medicare covers dialysis differently depending on where you receive your treatment.
Medicare Part A (hospital insurance) covers:
Inpatient dialysis treatment for special care or hospital visits
Medicare Part B (medical insurance) covers:
Outpatient dialysis treatment at a Medicare-approved facility or at home
Doctor visits
Lab tests
Home dialysis training for you and your family or friends
Home dialysis equipment and supplies
Home support services
Drugs for dialysis
Injectable, intravenous, and oral drugs to treat conditions related to ESRD
Other devices and services to monitor and manage health of kidneys
For covered dialysis services, Medicare pays 80% of the Medicare-approved amount for each bill. You’re responsible for the remaining 20%. If you have ESRD or a kidney condition that requires dialysis, a Medicare Supplement plan could save you a lot of money. These plans can help cover your out-of-pocket costs and limit your healthcare expenses. Make sure you also have a drug plan that pays for all the drugs you need for your condition.
Medicare Advantage plans have varying out-of-pocket costs. Contact your plan administrator or check your summary of benefits to see how much you’ll have to pay for dialysis. Because you need frequent treatment, you should look at plans with a low out-of-pocket maximum to limit how much you pay for dialysis each year.
Here’s what Medicare doesn’t cover for dialysis:
Paid nurses or dialysis aides for home dialysis
Place to stay during treatment
Lost pay to you or anyone helping you during home dialysis training
Blood for home dialysis (unless it’s part of a doctor’s service)
You can receive dialysis at home or at a Medicare-approved dialysis center. In either case, Medicare will cover the treatment. Typically, you’ll get dialysis at the facility where you see your kidney doctor, but you can choose a different place to receive treatment.
If you need help finding a Medicare-certified dialysis facility near you, you can use Medicare’s online search tool. This resource provides information about each center’s quality of patient care and types of services so you can compare places. If you enrolled in Medicare through Chapter, we can also help you find a dialysis facility and in-network doctors.
Original Medicare and Medicare Supplement doesn’t cover transportation to dialysis appointments. Some Medicare Advantage plans provide transportation benefits to help you get to dialysis facilities and doctor appointments.
There’s a lot of information to digest when it comes to how Medicare covers dialysis and kidney issues. If you need help understanding your costs for dialysis at home or at a facility, We’re happy to help! You can reach us at 855-900-2427, or you can schedule a time to chat.
