Yes, Medicare covers dialysis for people with end-stage renal disease

Medicare Part B covers the cost of dialysis treatment itself — the procedure, the supplies, and the medications given during treatment. Medicare Part D covers some of the oral medications you take at home related to your kidney disease. If you need a kidney transplant, Medicare also covers the surgery and follow-up care. The amount you pay depends on which type of Medicare you have and whether you have other insurance.

You do not need to wait for your regular Medicare enrollment period to sign up if you have end-stage renal disease. You can enroll in Medicare as soon as your doctor determines you need dialysis, even if you are younger than 65. This is one of the few situations where age does not determine your Medicare start date.

Key Takeaways

  • Medicare Part B covers dialysis treatment, supplies, and medications given during the procedure at a dialysis center or at home.
  • You can enroll in Medicare when your doctor confirms you need dialysis, regardless of your age.
  • Your out-of-pocket costs depend on whether you have Original Medicare, a Medicare Advantage plan, or other insurance alongside Medicare.
  • Medicare covers both in-center hemodialysis and home dialysis options, though the specific coverage details differ slightly between them.
  • Transplant-related care, including surgery and immunosuppressant medications, is covered by Medicare for the first three years after transplant.

How dialysis coverage works under Original Medicare

Under Original Medicare (Part A and Part B), you pay a copayment for each dialysis session. The copayment amount is set by Medicare each year and covers your share of the treatment cost. For 2024, the copayment is $266 per session for in-center hemodialysis, though this amount changes annually. You are responsible for this copayment whether you receive treatment three times a week or on a different schedule.

Part B also covers the medications given to you during dialysis, such as erythropoiesis-stimulating agents (ESAs) that help prevent anemia. These are included in your dialysis copayment — you do not pay separately for them. However, oral medications you take at home for kidney disease or related conditions are covered under Part D, which requires a separate prescription drug plan. You will have a copayment or coinsurance for those medications depending on your plan.

You also pay a Part B deductible once per year before your copayments begin. For 2024, the Part B deductible is $240, though this changes yearly. After you meet your deductible, you pay only the copayment for each dialysis session for the rest of that year.

Medicare Advantage plans and dialysis coverage

If you have a Medicare Advantage plan (Part C), your dialysis coverage works differently. Instead of paying a copayment per session, you typically pay a copayment or coinsurance amount set by your specific plan. Some Medicare Advantage plans cover dialysis with no copayment, while others charge $50 to $200 per session depending on the plan. You need to check your plan documents or call your plan to learn your exact cost.

Medicare Advantage plans must cover all the same dialysis services that Original Medicare covers, but they can organize the coverage differently. Some plans require you to use dialysis centers within their network, while others allow you to go to any Medicare-certified center. If you travel or move, check whether your plan covers dialysis at your new location before you relocate.

Most Medicare Advantage plans include prescription drug coverage (Part D) built in, so your oral kidney medications are covered under the same plan. This can simplify your coverage compared to Original Medicare, where you need a separate Part D plan.

Home dialysis and peritoneal dialysis coverage

Medicare covers both home hemodialysis and peritoneal dialysis (PD), which you can perform at home. The copayment structure is the same as in-center dialysis under Original Medicare — you pay per session regardless of where treatment happens. Home dialysis gives you more flexibility in scheduling and may allow you to dialyze more frequently, which some people find improves their health outcomes.

For home dialysis, Medicare covers the equipment, supplies, and training you need to perform treatment yourself. This includes the dialysis machine, tubing, needles or catheters, and the solution used in peritoneal dialysis. Your dialysis center or home training program will work with Medicare to may support all supplies are covered. You do not pay separately for equipment or supplies — they are included in your dialysis copayment.

If you choose home dialysis, you still need to work with a Medicare-certified dialysis facility for oversight and support, even though you perform treatment at home. The facility provides training, monitors your health, and manages your care plan. Medicare covers this supervision as part of your dialysis benefit.

Transplant coverage and immunosuppressant medications

If you receive a kidney transplant, Medicare covers the transplant surgery, hospital stay, and follow-up care. Part A covers the inpatient hospital costs, and Part B covers the surgeon's fees and outpatient follow-up visits. You pay your regular Part A and Part B cost-sharing amounts (deductibles and coinsurance) for transplant-related care, just as you would for any other hospital or doctor visit.

Medicare also covers the immunosuppressant medications you must take after transplant to prevent your body from rejecting the new kidney. These medications are covered under Part B for the first three years after your transplant. After three years, coverage for immunosuppressant drugs ends unless you have other insurance. Many people with transplants continue dialysis coverage under Medicare even after transplant in case the transplant fails, so you maintain your dialysis benefit.

What you need to know about Medicare enrollment with kidney disease

When your doctor determines you have end-stage renal disease and need dialysis, contact Social Security or Medicare to enroll. You do not need to wait until you turn 65 or until the standard enrollment period. Your Medicare coverage can start the first day of the month in which your doctor certifies you need dialysis, or the first day of the following month depending on when you contact Medicare.

If you are already receiving Social Security benefits, Medicare will be added to your account automatically once your doctor submits the required medical documentation. If you are not yet receiving Social Security, you will need to contact Social Security directly to enroll in Medicare. Bring documentation from your nephrologist (kidney doctor) showing your diagnosis and the date dialysis began or will begin.

If you have employer health insurance or coverage through a spouse's employer, you can keep that coverage alongside Medicare. In many cases, your employer plan will be primary (pay first) and Medicare will be secondary, which may lower your out-of-pocket costs. Tell your employer's benefits office that you now have Medicare so they can coordinate coverage correctly.

Other costs not covered by Medicare dialysis benefit

Medicare dialysis coverage does not include transportation to and from dialysis appointments. Some dialysis centers offer free or low-cost transportation, and some communities have medical transportation programs. Ask your dialysis center's social worker about transportation options in your area.

Certain medications related to kidney disease but not given during dialysis may not be fully covered. For example, some blood pressure medications or phosphate binders taken at home are covered under Part D, which has its own copayments and may have a coverage gap (donut hole) depending on your plan. Review your Part D plan documents to understand which kidney-related medications are covered and at what cost.

Nutritional counseling and dietary supplements are not covered by Medicare, though your dialysis center may offer nutrition education as part of your care. Some dialysis centers employ registered dietitians who can advise you on diet, though the counseling itself is not a separate Medicare benefit.

Frequently Asked Questions

Do I have to use a specific dialysis center, or can I choose any center?

Under Original Medicare, you can receive dialysis at any Medicare-certified dialysis facility. If you have a Medicare Advantage plan, your plan may require you to use centers in its network. Check your plan documents or call your plan to learn which centers are covered. If you need to travel, ask your dialysis center to help you find a Medicare-certified center at your destination.

What happens to my dialysis coverage if I move to a different state?

Your Medicare coverage for dialysis continues in any state. Original Medicare is accepted nationwide at all Medicare-certified dialysis centers. If you have a Medicare Advantage plan, check whether your plan operates in your new state. If not, you can switch to Original Medicare or a different Medicare Advantage plan during your move, which counts as a may have access to life event.

Does Medicare pay for dialysis if I also have Medicaid?

Yes. If you have both Medicare and Medicaid, Medicare is primary and pays first. Medicaid then covers some or all of your Medicare copayments and deductibles, depending on your state's rules. This is called "dual coverage." Contact your state Medicaid office to learn whether you are may be able to access and what additional costs Medicaid will cover.

Will my dialysis copayment change if I switch from in-center to home dialysis?

Under Original Medicare, your copayment per session remains the same whether you receive dialysis in a center or at home. However, home dialysis may allow you to dialyze more frequently or for longer sessions, which could change your total monthly costs. Discuss the financial impact with your dialysis center before switching to home dialysis.

Are there any dialysis-related costs Medicare does not cover?

Medicare does not cover transportation to dialysis, most nutritional supplements, or certain medications not related to kidney disease. Some oral medications taken at home are covered under Part D but have separate copayments. Ask your dialysis center's social worker or financial counselor about programs that may help with costs not covered by Medicare.