provide coverage for different items and services for children’s (pediatric) dialysis.
If your child is in a hospital:
- Part A covers the cost of dialysis treatments for children.
- Part B covers doctors' services.
If your child isn't in a hospital, Part B helps pay for these dialysis services:
- Outpatient pediatric dialysis treatments (in a Medicare-approved dialysis facility)
- Home pediatric dialysis equipment and supplies
- Certain home support services
- Most injectable drugs and their oral forms for outpatient or home pediatric dialysis (like an erythropoiesis-stimulating agent to treat anemia)
- Doctors' services (inpatient or outpatient)
- Other services that are part of dialysis for children, like laboratory tests
- Dialysis when you travel and use a Medicare-certified facility
Your child is eligible for Medicare if both you and your child meet these conditions:
- One of these conditions applies to you:
- You (or your spouse) have earned at least 6 credits within the last 3 years by working and paying Social Security taxes.
- You (or your spouse) are getting, or are eligible for Social Security or Railroad Retirement Board benefits.
- One of these conditions applies to your child:
- Your child needs regular dialysis because his or her kidneys no longer work.
- Your child has had a kidney transplant.
- Inpatient hospital services — Part A pays for these services. You pay a deductible.
- Doctor's services — Part B generally pays 80% of the
Medicare-approved amount, after you pay the Part B yearly Deductible [glossary]. You pay the remaining 20% Coinsurance. This is in addition to the Part B monthly premium.
- Pediatric dialysis services — the amount you pay may vary based on your child's age and the type of dialysis they need.
- In most cases, Medicare doesn't pay for transportation to dialysis facilities.
If your child has other insurance, your costs may be different.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
- Other insurance you may have
- How much your doctor charges
- Whether your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service
If your child is eligible for Medicare only because of permanent kidney failure, Medicare coverage will end:
- 12 months after the last month of dialysis treatments
- 36 months after the month of a kidney transplant
Medicare coverage can be extended if your child meets certain conditions.
If you have a problem finding a dialysis facility that’s willing to take you as a patient, you have the right to file a complaint (grievance).