Medicare covers dialysis for as long as you need it, with no time limit

If you have end-stage renal disease (ESRD) — kidney failure requiring dialysis — Medicare will pay for your treatment indefinitely. There is no maximum number of months or years. As long as you remain enrolled in Medicare and continue dialysis, your coverage continues.

The coverage applies whether you receive in-center hemodialysis three times a week, nocturnal dialysis, peritoneal dialysis at home, or twice-weekly dialysis if you have significant remaining kidney function. Medicare also covers the related services: lab work, imaging, medications given during treatment, and supplies.

Key Takeaways

  • Medicare covers dialysis with no time limit — you are covered for as long as you need treatment, whether that is months or decades.
  • Coverage begins the first month you need dialysis, even if you have not yet turned 65, because ESRD automatically qualifies you for Medicare.
  • You pay a monthly Part B premium and a copay per dialysis session, but Medicare covers the bulk of the cost once you meet your deductible.
  • If you stop dialysis, your Medicare coverage for ESRD ends, but you may remain covered under Medicare for other reasons.
  • A successful kidney transplant ends your need for dialysis and your ESRD Medicare coverage, though you stay on Medicare if you are 65 or older.

When your Medicare coverage for dialysis starts

Your coverage begins the first full month you need dialysis, regardless of your age. If you are under 65, ESRD automatically qualifies you for Medicare — you do not have to wait until your 65th birthday. This is one of the few conditions that grants Medicare coverage before age 65.

If you are already on Medicare for another reason (disability, age), your dialysis coverage is added when ready. The coverage applies to all types of dialysis: in-center treatment, home-based peritoneal dialysis, and home hemodialysis.

What Medicare pays and what you pay

Medicare Part B covers the dialysis treatment itself, the supplies used during treatment, and related lab work and imaging. You pay a monthly Part B premium (the amount changes yearly) and a copay per dialysis session. After you meet your Part B deductible for the year, Medicare covers 80 percent of the approved amount, and you pay 20 percent.

The copay structure varies slightly depending on whether you receive in-center dialysis or home dialysis, but the principle is the same: Medicare covers the majority once your deductible is met. Medications you take at home to manage kidney disease or related conditions may be covered under Part D (prescription drug coverage) if you have that coverage, or under Part B if they are given during your dialysis session.

If your income is low, you may be able to reduce or eliminate your premiums and copays through Medicaid or a Medicare Savings Program. These programs are run by your state, and rules vary by state. Your dialysis center's social worker can help you find out whether you may have access to.

What happens if you stop dialysis

If you stop dialysis — whether temporarily or permanently — your Medicare coverage for ESRD ends. However, if you are 65 or older, you remain on Medicare for other reasons. If you are under 65 and dialysis was your only reason for Medicare coverage, your coverage ends, though you may be able to continue it through COBRA or by paying premiums yourself.

Some people pause dialysis for a few weeks due to illness or other circumstances and then resume. When you resume, your ESRD coverage restarts. If you are considering stopping dialysis, talk with your nephrologist and your dialysis center's social worker about how it affects your Medicare coverage and what your options are.

Coverage if you receive a kidney transplant

A successful kidney transplant means you no longer need dialysis, so your ESRD Medicare coverage ends. However, Medicare continues to cover the transplanted kidney and related medications for life, even if the transplant eventually fails. If the transplant fails and you return to dialysis, your ESRD coverage restarts.

If you are 65 or older, you remain on Medicare regardless. If you are under 65 and the transplant was your only reason for Medicare coverage, you can stay on Medicare for up to 36 months after the transplant ends (whether it fails or you choose to stop immunosuppression). After 36 months, you lose coverage unless you may have access to for Medicare for another reason.

Dialysis coverage if you travel or move

Medicare covers dialysis at any Medicare-approved dialysis center in the United States. If you travel, you can receive treatment at any center that accepts Medicare. Let your regular dialysis center know you will be away, and contact the center where you plan to receive treatment to schedule appointments.

If you move to a different state, your coverage does not change — Medicare is federal and works the same way everywhere. You will straightforward switch to a dialysis center in your new location. Some states have different Medicaid programs or Medicare Savings Programs, so if you use those, check what is available in your new state.

How dialysis coverage works with other insurance

If you have employer health insurance or coverage through a spouse's employer, that coverage is primary — it pays first — and Medicare is secondary. This is true even though you are on Medicare because of ESRD. Your employer plan pays what it owes, and Medicare pays its share of what remains.

If you have Medicaid in addition to Medicare, Medicaid can help pay your Medicare premiums and copays. The order of payment depends on your state's rules, but generally Medicare pays first and Medicaid fills in gaps. Your dialysis center's social worker can explain how your specific coverage works.

Frequently Asked Questions

Does Medicare stop paying for dialysis after a certain number of years?

No. Medicare covers dialysis indefinitely as long as you need it and remain enrolled. There is no year limit, month limit, or age limit on coverage. The only way coverage ends is if you stop dialysis, receive a successful transplant, or lose Medicare may be able to access for another reason.

What if I want to switch dialysis centers — will Medicare still pay?

Yes. Medicare covers dialysis at any Medicare-approved center. You can switch centers at any time. Notify your current center and contact the new center to arrange your schedule. Your medical records will be transferred, and your coverage continues without interruption.

If I go on vacation, does Medicare cover dialysis away from home?

Yes. Medicare covers dialysis at any Medicare-approved center in the United States. Contact the center where you plan to receive treatment ahead of time to schedule your sessions. You may need to bring records from your regular center, but coverage is automatic.

What happens to my Medicare coverage if I get a kidney transplant?

Your ESRD coverage ends because you no longer need dialysis. However, Medicare continues to cover the transplanted kidney and related medications for life. If the transplant fails and you return to dialysis, your ESRD coverage restarts when ready.

Can I choose not to have Medicare pay for dialysis?

You can decline Medicare coverage, but you would need to pay for dialysis out of pocket or through other insurance. Most people keep Medicare because dialysis is expensive — treatment costs thousands of dollars per month. Talk with your nephrologist and social worker if you are considering this.