Medicare pays for dialysis if you have end-stage renal disease (ESRD), which means your kidneys no longer filter waste from your blood. Original Medicare (Part A and Part B) covers in-center hemodialysis, peritoneal dialysis at home, and related lab work and doctor visits. You become covered for dialysis the moment you start treatment, even if you are not yet 65 — dialysis is one of the few services that makes you may be able to access for Medicare regardless of age.

Key Takeaways

  • Medicare covers dialysis treatment itself, the vascular access surgery needed to prepare for dialysis, and monthly check-ups with your nephrologist.
  • Part A covers inpatient dialysis if you are admitted to a hospital, and Part B covers outpatient dialysis at a dialysis center or at home.
  • You pay a copay for each dialysis session under Part B, and you are responsible for Part B premiums and any deductible that applies.
  • Medicare does not cover the cost of transportation to dialysis appointments, but some dialysis centers and non-profit organizations offer free or low-cost rides.
  • If you also have private insurance or Medicaid, those programs may cover costs that Medicare does not, such as copays or transportation.

How Medicare Part A and Part B Cover Dialysis

Part A covers dialysis if you are admitted to a hospital for treatment. This includes the cost of the dialysis procedure, the equipment, and the supplies used during your stay. Part A also covers any complications that arise during your hospital stay.

Part B covers outpatient dialysis — the kind most people receive at a dialysis center three times a week, or at home on a schedule you and your doctor choose. Part B pays for the dialysis treatment itself, the needles and tubing, saline solution, heparin (a blood thinner), and the nurse and technician time. Part B also covers your monthly visits with your nephrologist (kidney doctor) and lab tests that check how well your dialysis is working.

Part B does not cover all costs out of pocket. You pay a copay for each dialysis session — the exact amount depends on whether you are on hemodialysis or peritoneal dialysis. You also pay the Part B monthly premium and any Part B deductible that applies in that year.

What Medicare Covers Before and After Dialysis Starts

Before you begin dialysis, you usually need surgery to create a vascular access — a way for needles to reach your blood vessels safely. This is most often a fistula (a connection between an artery and vein in your arm) or a graft (a small tube that connects them). Medicare Part B covers the surgery to create this access and any follow-up procedures to keep it working.

Once you start dialysis, Medicare also covers the lab work that monitors your kidney function, electrolytes, and blood counts. These tests happen regularly — usually monthly — and are part of your treatment plan. Your nephrologist uses these results to adjust your dialysis prescription.

If you develop complications related to your kidney disease or dialysis — such as anemia, bone disease, or infection — Medicare covers the treatment of those conditions as well. This includes medications, additional doctor visits, and any hospital stays needed.

What Medicare Does Not Cover

Medicare does not pay for transportation to and from your dialysis appointments, even though most people need to go three times a week. This is one of the largest out-of-pocket costs for dialysis patients. However, many dialysis centers arrange free or low-cost transportation through partnerships with local services, and some non-profit organizations also offer rides.

Medicare also does not cover meals, lodging, or time off work. If you travel for dialysis — for example, if you are on vacation or need to relocate — you are responsible for finding a dialysis center in that location and arranging your own care.

Certain medications and supplies used at home may not be covered if they are not considered medically necessary by Medicare. Your dialysis center or nephrologist can tell you which items are covered and which you may need to pay for yourself.

Your Out-of-Pocket Costs Under Medicare

Your costs depend on which type of dialysis you receive and whether you have other insurance. Under Part B, you typically pay a copay per dialysis session. The copay amount is set by Medicare and changes each year. You also pay the Part B monthly premium, which in 2024 is $174.70 per month (though this amount changes yearly).

If you have not yet met your Part B deductible for the year, you pay the full cost of dialysis until you reach that deductible. Once you meet it, you pay only your copay for each session.

If you receive dialysis at home — either peritoneal dialysis or nocturnal hemodialysis — your copay may be different. Home dialysis often costs less out of pocket because you do the treatment yourself rather than paying for a dialysis center's overhead, but you are responsible for supplies and equipment maintenance.

If You Have Other Insurance Along With Medicare

If you have Medicaid in addition to Medicare, Medicaid may cover your copays and deductibles, and sometimes transportation. Medicaid rules vary by state, so contact your state Medicaid office to learn what dialysis costs they cover.

If you have employer insurance or retiree health coverage, that insurance may be your primary payer for dialysis, and Medicare becomes secondary. This means your employer plan pays first, and Medicare covers what it does not. You should tell your dialysis center about all insurance you have so they bill in the correct order.

If you have a Medigap policy (supplemental insurance), it may cover some of your Part B copays and deductibles, depending on which plan you chose. Review your Medigap policy documents or call your insurance company to confirm what dialysis costs are covered.

Questions to Ask Your Doctor and Dialysis Center

Before you start dialysis, ask your nephrologist which type of dialysis is best for your situation — in-center hemodialysis, home hemodialysis, or peritoneal dialysis. Each has different costs and schedules. Ask what your copay will be and whether your center offers transportation or can connect you with services that do.

Ask your dialysis center's billing department which Medicare costs you are responsible for and whether they can estimate your annual out-of-pocket costs. Ask whether they bill other insurance you have and in what order. If you are struggling to pay your copays or other dialysis costs, ask whether the center has a social worker who can help you find financial resources or non-profit information programs.

Frequently Asked Questions

Do I have to be 65 to get Medicare coverage for dialysis?

No. If you have end-stage renal disease and start dialysis, you become covered by Medicare when ready, regardless of your age. This is one of the few situations where Medicare covers people under 65. You must be a U.S. citizen or permanent resident and have worked long enough to have Medicare may be able to access, or you may be covered through a family member's work history.

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

Your Medicare coverage continues for 36 months after a successful kidney transplant, even if you are under 65. This gives you time to recover and make sure the transplant is working. After 36 months, your coverage depends on your age and work history. Talk to your doctor and Medicare about your coverage before your transplant.

Can I choose home dialysis instead of going to a center, and does Medicare cover it the same way?

Yes, you can choose home dialysis if your doctor agrees it is safe for you. Medicare covers home hemodialysis and peritoneal dialysis under Part B. Your copay may be different, and you pay for supplies and equipment maintenance at home. Many people find home dialysis gives them more flexibility, though it requires training and commitment.

What if I cannot afford my dialysis copays?

Talk to your dialysis center's social worker or financial counselor. Many centers have programs to help patients pay copays, and non-profit organizations such as the National Kidney Foundation and American Renal Association offer financial information. If you have Medicaid, it may cover your copays. Some pharmaceutical companies also offer copay information for dialysis-related medications.

Does Medicare cover dialysis if I travel or move to another state?

Yes, Medicare coverage for dialysis works the same in any state. However, you must find a dialysis center in your new location and arrange your own care. Contact your current dialysis center before you travel or move, and ask them to help you find a center near your destination. Medicare will cover your treatment at any Medicare-certified dialysis facility.