Original Medicare (Medicare Part A and Part B) does cover dialysis services and supplies for qualified beneficiaries who have End-Stage Renal Disease (ESRD).
A type of Medicare Advantage plan (Part C) called a Medicare Special Needs Plan (SNP) can also cover dialysis. All Medicare SNPs also include an annual out-of-pocket spending limit and prescription drug coverage, both of which Original Medicare doesn’t cover.
Is End-Stage Renal Disease covered by Medicare Advantage?
People with ESRD may qualify for a Medicare Special Needs Plan (SNP).
A Medicare SNP is a type of Medicare Advantage plans that helps cover people with specific characteristics or diseases, including ESRD. These plans tailor benefits, provider choices, coordination of care and prescription drug formularies to best meet the specific needs of the groups they serve.
And unlike Original Medicare, all Medicare Special Needs Plans must cover prescription drugs.
To qualify for a Medicare SNP, you must get a note from your doctor confirming that you have the condition (in this case, ESRD) addressed by the Special Needs Plan.
A Medicare SNP also includes all of the ESRD coverage offered by Original Medicare, which are outlined below. Your Medicare SNP deductible costs and copays may be lower than what is listed, so be sure to check with your plan to learn more about the costs of your services.
Is dialysis covered under Medicare Part A or Part B?
Some of the kidney dialysis services and supplies that Original Medicare and Medicare SNPs help cover include:
Inpatient dialysis treatment
Inpatient dialysis treatment is typically covered by Medicare Part A (hospital insurance) if you go to a Medicare-approved hospital.
- How much does it cost to get inpatient dialysis?
Once you pay your Part B deductible ($185 per year in 2019), Medicare pays 80 percent of the monthly amount of your inpatient dialysis treatments, and you pay the remaining 20 percent coinsurance. If you get services for less than one month, your doctor may be paid per day.
Outpatient maintenance dialysis treatments
Routine dialysis, ESRD-related lab tests and other outpatient care is typically covered by Medicare Part B if you get these services at a Medicare-certified dialysis facility.
- How much does Medicare pay for outpatient dialysis treatment?
Once you pay your Part B deductible, you pay 20 percent of the Medicare-approved amount for each dialysis treatment given in a dialysis facility or at home.
Certain drugs for self-dialysis
Medicare Part B covers some drugs used in self-dialysis, including heparin and topical anesthetics (when medically necessary). ESRD-related drugs that only have an oral form of administration are only covered by Medicare Part D and Medicare SNPs.
Medicare Part D plans (also known as Medicare Prescription Drug Plans) are sold by private insurance companies to help cover the cost of prescription drugs, as most drugs are not covered by Medicare Part A or Part B. If you enroll in a Medicare SNP, you don’t need to enroll in (and aren’t eligible for) a separate Part D plan.
- How much does Medicare pay for self-dialysis drugs?
If your drug is covered by Medicare Part B, you pay 20 percent of the Medicare-approved amount for the drug.
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