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Coverage

Does Medicare Cover Dialysis?

Christian Worstell

by Christian Worstell | Published December 16, 2020 | Reviewed by John Krahnert

In most cases, Medicare Part A does cover dialysis in a Medicare-approved hospital. Medicare Part B covers outpatient dialysis treatment, supplies and doctor visits.

A Medicare Supplement (Medigap) plan can help cover dialysis costs such as Medicare deductibles, copays, coinsurance and more.

You may be able to apply for Medigap plans in some states if you have ESRD, but insurance companies aren't required to sell Medigap plans to beneficiaries under age 65 in all states.

Family visits with a patient and doctor in a hospital roomMedicare Part A and/or Part B can cover dialysis, depending on where you receive treatment.

What Dialysis and Kidney Transplant Services Does Medicare Cover?

Dialysis coverage

The chart below shows which dialysis services and supplies are covered by either Medicare Part A or Part B, according to Medicare.gov, and the costs you would face (in addition to Medicare Part A and Part B premiums and deductibles).

Service or supply Covered by Medicare Part A Covered by Medicare Part B Your Costs With Medigap Your Costs Without Medigap
Inpatient dialysis treatment (if admitted to a hospital for special care)   $0 for up to 365 days after Medicare coverage ends $352 per day in 2020 if hospital stay lasts longer than 60 days. Costs based on the number of days you spend in the hospital.
Outpatient dialysis treatment in a Medicare-approved dialysis facility   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service
Outpatient doctors’ services   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service
Home dialysis training for you and the person helping you   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service
Home dialysis equipment and supplies (such as the dialysis machine, water treatment system, basic recliner, alcohol, wipes, sterile drapes, rubber gloves, and scissors)   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service
Certain home support services (such as home visits by trained medical professionals to check dialysis equipment)   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service
Most drugs for home dialysis   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service
Other dialysis-related services and supplies (such as lab tests)   0-10% of Medicare-approved amount for service 20% of Medicare-approved amount for service

Although Medicare provides significant coverage for dialysis and related treatments, there are several things that Medicare does not cover, including:

  1. Blood or packed red blood cells for home dialysis, unless part of a doctor’s service;
  2. Paid dialysis aides to help with home dialysis;
  3. Any lost pay for you or your dialysis caregiver during home training; and
  4. A place to stay during dialysis treatment.

Kidney transplant coverage

The chart below shows which kidney transplant services and supplies are covered by either Medicare Part A or Part B, according to Medicare.gov, and the costs you would face (in addition to Medicare Part A and Part B premiums and deductibles).

Service or supply Covered by Medicare Part A Covered by Medicare Part B Your Costs With Medigap Your Costs Without Medigap
Inpatient services in an approved hospital   $0 for up to 365 days after Medicare coverage ends $352 per day in 2020 if hospital stay lasts longer than 60 days. Costs based on the number of days you spend in the hospital.
Kidney registry fee   No cost No cost
Laboratory and other tests needed to evaluate your medical condition   No cost No cost
Laboratory and other tests needed to evaluate the medical condition of potential kidney donors   No cost No cost
The costs of finding the proper kidney for your transplant surgery (if there is no kidney donor)   No cost No cost
The full cost of care for your kidney donor (including care before, during, and after surgery)   No cost No cost
Any additional inpatient hospital care for your donor in case of surgery complications   No cost No cost
Blood (whole or united of packed red blood cells, blood components and the cost of processing and giving you blood) No cost No cost if the hospital gets blood from a blood bank for free. Special conditions apply.
Doctors’ services for kidney transplant surgery (including care before, during, and after surgery)   0-10% of Medicare-approved amount for service 20% of the Medicare-approved amount for that service
Doctors’ services for your kidney donor during their hospital stay   No cost No cost
Immunosuppressive drugs (for a limited time after the surgery)   Cost is dependent on several factors. Cost is dependent on several factors.

Is There a Waiting Period for Medicare Dialysis Coverage?

Medicare coverage for dialysis treatments typically begins the first day of the fourth month of your dialysis treatments.

You may be able to reduce this waiting period if you complete training from an approved Medicare dialysis provider to give yourself in-home dialysis.

Does Medicare Cover End-Stage Renal Disease (ESRD)?

Although Medicare is widely known as a government-issued health insurance program for seniors, it also provides health insurance benefits to individuals under the age of 65 who have ESRD. 

According to Medicare.gov, you can get Medicare no matter how old you are if:

  • Your kidneys no longer work

  • You have had a kidney transplant or need regular dialysis

  • One of these applies to you:

    • You're the spouse or dependent child of a person who meets either of the requirements above

    • You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee

    • You are eligible to receive or are already receiving RRB or Social Security

In order to receive the full Medicare coverage for ESRD-related treatment such as dialysis and transplants, you must enroll in both Medicare Part A and Part B (Original Medicare).

Medigap Plans Can Help Pay for Dialysis

Original Medicare (Part A and Part B) requires recipients to pay several out-of-pocket costs.

Medicare Supplement Insurance (Medigap) plans help cover some of these out-of-pocket costs to save Medicare recipients money and provide them with more predictive health care costs.

A person with ERSD who is under the age of 65 may be able to enroll in a Medigap plan, depending on which state they live in.

The following states require insurance companies to offer at least one kind of Medigap policy to people with Medicare who are younger than 65 with ESRD:

The level of Medigap benefits depends on which Medigap plan you choose (and which plans are available in your state). All 10 standardized Medigap plans provide at least partial coverage for:

  • Medicare Part A coinsurance and hospital costs

  • Medicare Part B coinsurance or copayment

  • First three pints of blood

  • Medicare Part A hospice care coinsurance or copayment

Learn more about Medicare coverage of common procedures

A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live. 

Find Medigap plans that help cover dialysis.

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Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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