Does Medicare Cover Dialysis?

When your kidneys stop functioning properly, your body progresses into End-Stage Renal Disease (ESRD). In most cases, the treatment is dialysis to clean your blood artificially.

This article will explain how Medicare covers kidney dialysis and other ESRD treatments and who is eligible.

What Is Dialysis?

Dialysis is a system that manually filters your blood when your kidneys are no longer able to do the job. Dialysis is usually performed with a hemodialysis machine at a dialysis center, which filters the waste in your bloodstream that your kidneys would normally filter out. Some self-dialysis options can be done from home if needed, such as peritoneal dialysis, which uses a medical fluid to flush out the waste from your blood vessels.¹Mayoclinic.org, “End-stage renal disease: Diagnosis & treatment“, Accessed November 24, 2021.

While receiving dialysis treatments, you may be required to adhere to a strict dietary regimen to minimize the amount of work and stress your kidneys experience. A dialysis diet plan may include instructions to:¹Mayoclinic.org, “End-stage renal disease: Diagnosis & treatment“, Accessed November 24, 2021.

• Eliminate foods with added salt, such as canned goods, fast food, and processed meats and cheeses.
• Avoid high-potassium foods, such as bananas, oranges, potatoes, spinach, and tomatoes.
• Reduce the amount of protein you eat each day.

How Does Medicare Cover Dialysis?

Medicare covers most supplies and services needed for dialysis, including:²Medicare.gov, “Dialysis services & supplies“, Accessed November 24, 2021

• Inpatient dialysis treatments
• Outpatient dialysis treatments
• Outpatient doctor visits
• Home dialysis training
• Home dialysis equipment and supplies
• Certain home support services
• Most drugs for in-facility and at-home dialysis
• Other services and supplies, such as laboratory tests
• Dialysis when you travel in the U.S. and its territories

If you’re under the age of 65 and have End-Stage Renal Disease (ESRD), you may qualify for enrollment in Medicare without meeting the normal age limit. Medicare coverage obtained this way is not limited only to ESRD services and treatments. You can use Medicare for all the services that it normally covers.³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

When Will My ESRD-Based Medicare Coverage Begin?

If you qualify for Medicare benefits based on ESRD and you’re currently on dialysis, your Medicare coverage typically starts the first day of your fourth month of dialysis treatment. Coverage can begin on the first month of treatment if:³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

1. During the first 3 months of dialysis, you participate in home dialysis training at a Medicare-certified facility.
2. Your doctor indicates that you should finish training so you can do your own dialysis treatments.

If you’re admitted for a kidney transplant and the transplant takes place within two months, Medicare benefits will begin the month you are admitted. Medicare coverage can begin two months prior to your transplant if the transplant is delayed more than two months.³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

When Will My ESRD-Based Medicare Coverage End?

If your Medicare eligibility is based on permanent kidney failure only, your coverage will end:³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

1. 12 months after the month your dialysis treatments ended
2. 36 months after the month of your kidney transplant

Medicare coverage may resume if:³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

1. Within 12 months of your last dialysis treatment you require dialysis treatment again or have a kidney transplant; or
2. Within 36 months after the month you get a kidney transplant you require dialysis or need another kidney transplant.

Transportation To Dialysis Facilities

Medicare generally covers ambulance services, when required, to and from home and the closest dialysis facility. Your doctor may need to provide written orders certifying that it’s a medical necessity for non-emergency situations.⁴Medicare.gov, “Ambulance services“, Accessed November 24, 2021

Prescription Drug Coverage

Medicare Part B will cover any prescription medication that requires a health care provider to administer it to you. This includes injectables, intravenous (IV), and certain oral drugs that treat or manage conditions associated with ESRD (like anemia) or are used in the treatment of ESRD.²Medicare.gov, “Dialysis services & supplies“, Accessed November 24, 2021

Medicare Part D will cover any prescription medications you need for your dialysis treatments that are not covered by Part B. Part D plan members may have to pay an annual deductible before the plan begins paying its share, as well as a co-payment with each prescription.⁵Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 24, 2021

Medicare Advantage Dialysis Coverage

As of January 2021, people with ESRD can join a Medicare Advantage plan. Previously, only Original Medicare was available to people diagnosed with ESRD. Special Needs Plans (SNPs) may be available in some areas to address the specific needs of ESRD patients. SNP-C plans are customized to the particular needs of their covered condition, providing benefits and additional services that go beyond what Medicare usually covers, which can include:³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

• A care team of specialists for the special condition
• A case coordinator to optimize the coordination of services you need
• Extra hospital days
• Drug coverage formularies tailored to your condition

These benefits may not be available for every Medicare Advantage SNP. Ask your local Medicare Advantage providers about which SNPs they offer and what benefits they provide.³Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021

Medicare Supplement Dialysis Coverage

Medicare supplement insurance (Medigap) covers some or all of the out-of-pocket costs associated with Medicare-approved dialysis treatments. These costs include:⁶Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021

• Deductibles
• Coinsurance
• Copayments
• Blood

Medigap policies are not widely available to people under the age of 65, even if you qualify for Medicare benefits due to a disability or (ESRD). It varies from area to area, so you will have to check the Medigap providers in your area for an appropriate Medigap plan.

Summary

Once your kidneys have failed, they cannot be brought back to life. However, dialysis treatments can help you with the strain of ESRD and keep your health from trending down while waiting for kidney transplant services. Thankfully, Medicare does cover dialysis and other ESRD treatments for beneficiaries of any age.

Citations

• 1
  Mayoclinic.org, “End-stage renal disease: Diagnosis & treatment“, Accessed November 24, 2021
• 2
  Medicare.gov, “Dialysis services & supplies“, Accessed November 24, 2021
• 3
  Medicare.gov, “I have End-Stage Renal Disease (ESRD)“, Accessed November 24, 2021
• 4
  Medicare.gov, “Ambulance services“, Accessed November 24, 2021
• 5
  Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 24, 2021
• 6
  Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021