Dialysis services & supplies
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. It gets rid of harmful waste, extra salt, and fluids that build up in the body. It also helps control blood pressure and helps the body keep the right amount of fluids. Dialysis treatments may help you feel better and live longer, but they aren’t a cure for permanent kidney failure. Generally, Medicare covers 3 hemodialysis (or equivalent peritoneal dialysis) treatments per week if you have ESRD.
If you have Original Medicare, you need Part A (Hospital Insurance), Part B (Medical Insurance), and possibly Medicare drug coverage (Part D) 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 & doctors' services (like ESRD-related laboratory tests) you get in a Medicare-certified dialysis facility or your home.
- 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 (directly or under arrangement) for providing home dialysis training.
- Home dialysis equipment & 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 doesn’t cover phosphate binders (ESRD-related drugs taken by mouth that only come in a capsule, tablet, or liquid form). Only Part D covers phosphate binders. 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).
- Dialysis treatments from a Medicare-certified dialysis facility when traveling in the U.S.
Note: Part B only covers ambulance services to and from your home to the nearest dialysis facility when traveling in any other vehicle could endanger your health.
Paying for dialysis services
Medicare pays your dialysis facility to give you these Part B-covered dialysis services and items:
- Direct nursing services including registered nurses, licensed practical nurses, technicians, social workers, and dietitians.
- All equipment and supplies used for renal dialysis in the facility, or in your home, that are reasonable and medically necessary
- Injectable, intravenous (IV), and certain oral drugs that treat or manage conditions associated with ESRD (like anemia) or are used in the treatment of ESRD*
- Laboratory tests
- Home dialysis training by a Medicare-certified home dialysis training facility (if you choose to get dialysis at home)
- 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.
Your dialysis facility must provide these items and services, either directly or through an arrangement with another provider.
*Medicare drug coverage (Part D) covers certain medications that are only available in an oral form. Talk with your doctor or health care team about the use of any drugs, including over-the-counter products.
Your costs in Original Medicare
What will I pay for dialysis services in a dialysis facility?
If you have Original Medicare, after you pay the Part B yearly deductible, you’ll continue to pay a 20% of the for all covered dialysis services. Medicare will pay the remaining 80%.
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 Medicare Part B and Part D (if applicable) premiums.
What will I pay for dialysis in a hospital?
If you’re admitted to a hospital and get dialysis, your treatments will be covered by
as part of the costs of your covered inpatient hospital stay.
What will I pay for inpatient doctors’ services in Original Medicare?
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.
What will I pay for outpatient doctors’ services in Original Medicare?
Medicare pays most kidney doctors a monthly amount. After you pay the Part B yearly deductible, 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.
What will I pay for home dialysis training services?
In Original Medicare, Medicare pays your kidney doctor a fee to supervise home dialysis training. After you pay the Part B yearly deductible, Medicare pays 80% of the fee and you pay the remaining 20%.
What will I pay if I have a Medicare Advantage Plan?
If you’re in a Medicare Advantage Plan, what you pay may be different. Learn more about Medicare Advantage Plans if you have ESRD.
Things to know
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.