Does Medicare Cover Dialysis?
- February 23, 2021
- Reviewed by John Krahnert
Original Medicare (Medicare Part A and Part B) does cover dialysis services and supplies for qualified beneficiaries who have End-Stage Renal Disease (ESRD).
Medicare Advantage plans (Part C) and a certain type of Medicare Advantage plan called a Medicare Special Needs Plan (SNP) can also cover dialysis. All Medicare Advantage plans include an annual out-of-pocket spending limit, and most plans include prescription drug coverage, both of which Original Medicare doesn’t cover.
Is dialysis covered under Medicare Part A or Part B?
Some of the kidney dialysis services and supplies that Original Medicare, Medicare Advantage plans and Medicare SNPs help cover include:
- Hospital inpatient dialysis
- Kidney transplants
- Outpatient dialysis from a Medicare-certified hospital or dialysis facility
- Immunosuppressant drugs after a kidney transplant (you must have had Medicare Part A at the time of transplant)
- Home dialysis training from a dialysis facility
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 ($203 per year in 2021), 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.
Is End-Stage Renal Disease covered by Medicare Advantage?
People with ESRD may qualify for Medicare, a Medicare Advantage plan or 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.
To qualify for Medicare coverage of ESRD, you must:
- Be under the age of 65 and diagnosed with ESRD by a doctor
- Have enough work history to qualify for Social Security Disability Insurance or Social Security Retirement Benefits or enough work history to qualify for benefits through the Railroad Retirement Board
You can also qualify through the work history of your spouse or parent.
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