Your Medicare Coverage
Is my test, item, or service covered?
How often is it covered?
If your child is in a hospital:
- Medicare Part A (Hospital Insurance) covers dialysis treatments.
- Medicare Part B (Medical Insurance) covers doctors' services.
If your child isn't in a hospital, Part B helps pay for these dialysis services:
- Outpatient dialysis treatments (in a Medicare-approved dialysis facility)
- Home dialysis equipment and supplies
- Certain home support services
- Most injectable drugs and their oral forms for outpatient or home dialysis (like an erythropoiesis stimulating agent to treat anemia)
- Doctors' services (inpatient or outpatient)
- Other services that are part of dialysis, like laboratory tests
Your child can get dialysis at any Medicare-certified facility anywhere in the U.S.
All children with Part A and/or Part B are covered. Your child is eligible for Medicare if both you and your child meet these conditions:
|One of these conditions must apply to you:||One of these conditions must apply to your child:|
|You (or your spouse) have earned at least 6 credits within the last 3 years by working and paying Social Security taxes.||Your child needs regular dialysis because his or her kidneys no longer work.|
|You (or your spouse) are getting, or are eligible for Social Security or Railroad Retirement Board benefits.||Your child has had a kidney transplant.|
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.
Your costs in Original Medicare
- Inpatient hospital services — Medicare Part A pays for these services; you pay a deductible.
- Doctor's services — Medicare 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. Learn more about Part B premiums and deductibles.
- 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