Your child will need Medicare Part A (Hospital Insurance) , Medicare Part B (Medical Insurance) , and possibly Medicare Part D (Medicare Prescription Drug Coverage) to get the full benefits available to them.
If your child is in a hospital:
- Part A covers dialysis treatments.
- Part B covers doctors' services.
If your child isn't in a hospital, Part B covers these dialysis services:
- Outpatient dialysis treatments & doctors' services (in a Medicare-certified dialysis facility).
- Home dialysis equipment and supplies
- Certain home support services
- Most drugs for home and outpatient dialysis (like an erythropoiesis-stimulating agent to treat anemia)
- Doctors' services
- Other services that are part of dialysis (like laboratory tests)
- Dialysis when you travel and use a Medicare-certified facility
Your costs in Original Medicare
- Inpatient hospital services: Part A pays for these services after you pay the hospital inpatient deductible .
- Doctors' services: Part B generally pays 80% of the Medicare-approved amount after you pay the Part B yearly deductible. You pay the remaining 20% coinsurance . This is in addition to the Part B monthly premium .
- Dialysis services — The amount you pay may vary based on your child's age and the type of dialysis they need. The rates Medicare pays to dialysis facilities are adjusted based on your child’s age and the type of dialysis they get. These adjustments allow for the special care needs of children. Your 20% coinsurance will be based on these special rates.
- Prescription drugs — To get Medicare drug coverage for your child, your child must have Part A or Part B, and you must enroll your child in a Medicare drug plan during an enrollment period. This would cover immunosuppressive and oral only drugs, but only if Part B doesn’t cover them. If your child joins a Medicare Advantage Plan with drug coverage, they'll get their drug coverage through their Medicare Advantage Plan, and can't enroll in a separate drug plan.
In most cases, Medicare doesn’t pay for transportation to dialysis facilities.
What it is
Dialysis is a treatment that cleans the blood when the kidneys don’t work. It gets rid of harmful waste, extra salt, and fluids that build up in the body. It also helps control blood pressure and helps the body keep the right amount of fluids. Dialysis treatments may help your child feel better and live longer, but they aren’t a cure for permanent kidney failure.
Things to know
If your child is eligible for Medicare due to permanent kidney failure, Medicare coverage will end:
- 12 months after the last month of your child’s dialysis treatment.
- 36 months after the month of your child’s kidney transplant.