Medicare Coverage for Dialysis Treatments and Services

Dialysis is a treatment that takes over for the kidneys, removing toxins and wastes from the body and is considered life-sustaining for those with kidney failure. Individuals who experience serious injuries, who have diabetes or conditions such as lupus or high blood pressure, which may damage the kidneys, can also develop kidney disease.

There are two types of dialysis, including hemodialysis and peritoneal dialysis. Enrollees who receive hemodialysis may receive treatment in a hospital, a treatment center or at home. Beneficiaries who have peritoneal dialysis typically receive treatment at home.

Does Medicare Cover Dialysis Treatment and Supplies?

You are eligible for Medicare if you have End-Stage Renal Disease (ESRD), no matter how old you are at the time you or a loved one receives the diagnosis, if all of the following apply, including:

Your kidneys no longer work.
You need regular dialysis treatments, or you have had a kidney transplant.
You worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee or you already receive or are eligible for Social Security or Railroad Retirement benefits.
You are either the spouse or the dependent child of someone who meets either of the above requirements.

The eligibility for Medicare coverage for enrollees who have ESRD is different compared to other types of Medicare coverage eligibility. If you do not sign up for Medicare right away, and you are eligible based on ESRD, you can still possibly receive coverage up to 12 months before you apply for Medicare.

Those who have ESRD may sign up for either Original Medicare or a Medicare Advantage Plan. If you decide to apply for Original Medicare, you also have the opportunity to enroll in a Part D prescription drug plan.

What Dialysis Supplies and Services Does Medicare Cover?

Medicare provides a list of the services and the supplies that are covered when a person who has ESRD needs dialysis which include:

Inpatient dialysis treatments, which are covered under Medicare Part A if you are admitted to the hospital for special care.
Outpatient dialysis treatments and doctor services: These services are covered by your Medicare Part B if you receive dialysis at a Medicare-approved dialysis center or in your home.
Home dialysis training for yourself and a person helping you if you are a candidate for home dialysis treatments are covered by Part B.
Home dialysis support services.

Medicare Part B covers the home dialysis support services that you receive from your dialysis facility, including:

Home visits by trained hospital or dialysis facility workers who monitor your home dialysis treatments.
Providers that check your water and equipment supplies, and who help in emergencies.
A monthly face-to-face visit with your physician or other trained medical professionals.
Medicare Part B also covers certain drugs and approved dialysis-related services and supplies.

Your coverage ends 12 months after the month that you stop dialysis treatment or 36 months after you have a kidney transplant.

How Much Does Medicare Pay for Dialysis?

The coverage for dialysis is similar to other coverage benefits. After you pay the annual deductible and your applicable Part B premium or deductible, you pay 20% of the Medicare-approved amount for most Part B services.

Most Medicare beneficiaries do not pay a monthly Part A premium. You pay the required deductible and inpatient coinsurance, which typically starts on day 61 of being a hospital inpatient.