Dialysis services & supplies
Medicare covers many kidney dialysis services and supplies if you have
- Inpatient dialysis treatments:
Medicare Part A (Hospital Insurance)covers dialysis if you’re in a Medicare-approved hospital.
- Outpatient maintenance dialysis treatments:
Medicare Part B (Medical Insurance)covers a variety of services if you get routine dialysis in a Medicare-certified dialysis facility. For example, Part B covers ESRD-related laboratory tests and drugs (like heparin, topical anesthetics, and erythropoiesis-stimulating agents used to treat anemia related to your ESRD), but excludes ESRD-related drugs that only have an oral form of administration (drugs taken by mouth that only come in capsule, tablet, or liquid forms), which are covered only under Medicare prescription drug coverage (Part D).
- Training for self-dialysis: Part B covers training if you're a candidate for self-dialysis. Part B covers training provided during the course of your regular treatments for you and the person helping you with your self-dialysis treatments. A dialysis facility that's been certified by Medicare to provide self-dialysis training must provide the training. Only dialysis facilities can bill Medicare (directly or under arrangement) for providing home dialysis training.
- Self-dialysis support services: Part B covers self-dialysis support services provided by your dialysis facility. This may include visits by trained hospital or dialysis facility workers to check on your self-dialysis, help in emergencies (when needed), and check your equipment and water supply.
- Self-dialysis equipment & supplies: Part B covers all dialysis equipment and supplies for as long as you need dialysis at home. Covered equipment and supplies include alcohol, wipes, dialysis machines, sterile drapes, rubber gloves, and scissors.
- Certain drugs for self-dialysis: Part B covers heparin, the antidote for heparin (when medically necessary), topical anesthetics, and erythropoiesis-stimulating agents (ESAs) (like epoetin alfa or darbepoetin alfa) to treat anemia related to your renal disease.
- Outpatient doctors’ services: Part B covers outpatient doctors’ services.
- Other dialysis services & supplies: Part B covers other services and supplies that are a part of dialysis (like laboratory tests).
- Ambulance transportation: In some cases, Medicare may cover ambulance transportation when you have ESRD, need dialysis, and need ambulance transportation to or from a dialysis facility.
- Inpatient dialysis treatments: If you have Original Medicare, Medicare pays most kidney doctors a monthly amount. After you pay the Part B yearly
Deductible [glossary], Medicare pays 80% of the monthly amount. You pay the remaining 20% Coinsurance. In some cases, your doctor may be paid per day if you get services for less than one month.
- Outpatient maintenance dialysis treatments:
Outpatient maintenance dialysis treatments [Definition]include the cost of most dialysis drugs and biologicals. You pay 20% of the Medicare-approved amountfor each dialysis treatment given in a dialysis facility or at home. The Part B deductible applies.
- Self-dialysis training, support services, equipment, & supplies: Outpatient maintenance dialysis treatment includes the cost of these. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. Only dialysis facilities can bill Medicare (directly or under arrangement) for providing self-dialysis training.
- Certain drugs for self-dialysis: Outpatient maintenance dialysis treatment includes the costs of self-dialysis drugs and biologicals. You pay 20% of the Medicare-approved amount. ESRD-related drugs that only have an oral form of administration are covered only by Part D. This means drugs taken by mouth that only come in capsule, tablet, or liquid forms.
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
Medicare doesn't cover these:
- Paid dialysis aides to help you with self-dialysis
- Any lost pay to you or the person who may be helping you during self-dialysis training
- A place to stay during your treatment
- Blood or packed red blood cells for self-dialysis unless part of a doctors' service
There are some types of insurance that may pay some of the health care costs that Medicare doesn't pay.
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).