Dialysis services & supplies
Medicare covers certain dialysis services and supplies if you’re eligible
Description
People with End-Stage Renal Disease (ESRD) have permanent kidney failure that requires dialysis or a kidney transplant. Dialysis is a treatment that cleans the blood when the kidneys don't work.
Coverage details
If you have Original Medicare, you need both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) to get the full benefits available under Medicare for people with ESRD.
Part A covers inpatient dialysis treatments when you’re in a hospital.
Part B helps cover:
- Outpatient dialysis treatments and doctors' services you get in a Medicare-certified dialysis facility or your home. This includes dialysis treatments for acute kidney injury.
- Home dialysis training, if you’re a candidate for home dialysis. Part B covers training for you and the person helping you with your home dialysis treatments. A Medicare-certified home dialysis training facility must provide the training. Only Medicare-certified dialysis facilities can bill Medicare for providing home dialysis training.
- Home dialysis equipment and supplies (like the dialysis machine, water treatment system, basic recliner, alcohol, wipes, sterile drapes, rubber gloves, and scissors).
- Certain home support services you get from your dialysis facility. This may include:
- Visits from trained hospital or dialysis facility workers to monitor your home dialysis, help in emergencies (when needed), and check your equipment and water supply.
- A face-to-face visit between you and your doctor (or certain non-doctor providers, like physician assistants and nurse practitioners) once a month.
- Drugs for outpatient and home dialysis, including heparin, the antidote for heparin (when medically necessary ), topical anesthetics, and erythropoiesis-stimulating agents (like epoetin alfa or darbepoetin alfa) to treat anemia related to your ESRD. Part B also covers phosphate binders and other phosphate-lowering treatments if they're used to control phosphorous levels in people who have ESRD. Talk with your doctor or health care team about the use of any drugs, including over-the-counter products.
- Other dialysis services and supplies (like laboratory tests that are renal dialysis services).
- Direct nursing services including registered nurses, licensed practical nurses, technicians, social workers, and dietitians.
- Other items and services, like heart monitoring during your dialysis treatments, oxygen given (if needed) during your dialysis treatments (if you’re in a dialysis facility), monitoring of your access site, and certain nutritional services.
Medicare doesn't cover:
- Paid dialysis aides to help you with home dialysis
- Any lost pay to you or the person who may be helping you during home dialysis training
- A place to stay during your treatment
- Blood or packed red blood cells for home dialysis unless part of a doctors' service
There are some types of insurance that may pay some of the health care costs Medicare doesn't pay.
Your dialysis facility must provide these items and services, either directly or through an arrangement with another provider.
Who's eligible
You must have ESRD.
Costs
Dialysis services in a dialysis facility
After you meet the Part B deductible , you’ll pay 20% of the Medicare-approved amount.The dollar amount of your coinsurance may vary. If you’re in a Medicare Advantage Plan or have a Medicare Supplement Insurance (Medigap) policy that covers all or part of your 20% coinsurance, then your costs may be different. Read your plan materials or call your benefits administrator to get your cost information. You must also continue to pay your monthly Part B and Part D (if applicable) premiums .
- Dialysis services in a hospital:
Part A pays for these services after you pay the hospital inpatient deductible. - Inpatient doctors’ services:
Your kidney doctor bills separately for the Medicare-covered ESRD services you get as an inpatient. In this case, your kidney doctor’s monthly payment will be based on the number of days you stay in the hospital. - Outpatient doctors’ services:
After you meet the Part B deductible you pay the remaining 20% of the Medicare-approved amount - Home dialysis training services:
After you meet the Part B deductible you pay 20% of Medicare approved amount.
If you’re in a Medicare Advantage Plan, what you pay may be different. Learn more about Medicare Advantage Plans if you have ESRD.
If you have other insurance, your costs may be different. Read your plan materials or call your benefits administrator to get your cost information.
How often
Generally 3 hemodialysis (or equivalent peritoneal dialysis) treatments each week if you have ESRD.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service