Medicare covers most dialysis costs, but you will still have out-of-pocket expenses
Medicare Part B covers in-center hemodialysis — the most common type — at 80% after you meet your yearly deductible. That means you pay 20% of the cost for each treatment. In 2024, the Part B deductible is $240 per year; once you reach it, you pay 20% coinsurance for the rest of the year.
For home dialysis (peritoneal dialysis or home hemodialysis), Medicare Part B also covers 80% after your deductible. The actual dollar amounts you pay depend on your specific treatment plan, how often you dialyze, and which dialysis center or home care provider you use — costs vary by region and facility.
If you have a Medigap policy (supplemental insurance), it may cover some or all of your 20% coinsurance, depending on which plan you chose. If you have Medicaid in addition to Medicare, Medicaid may cover costs Medicare does not. If you have employer coverage or retiree health insurance, that may be primary instead of Medicare.
Key Takeaways
- Medicare Part B covers in-center hemodialysis at 80% after you pay the yearly deductible, leaving you responsible for 20% coinsurance per treatment.
- Home dialysis (peritoneal or home hemodialysis) is also covered at 80% by Part B, with the same deductible and coinsurance structure.
- Your actual out-of-pocket cost depends on your dialysis center's charges, how many treatments you need per week, and whether you have supplemental insurance.
- Medigap plans, Medicaid, or employer coverage can reduce or eliminate your 20% coinsurance if you have those policies alongside Medicare.
What Medicare Part B actually pays for dialysis
Medicare Part B covers the dialysis treatment itself, the supplies used during treatment (needles, tubing, dialysate), and lab work to monitor your kidney function and electrolytes. It also covers the vascular access procedure — the surgery to create a fistula or graft in your arm, or the placement of a catheter — and follow-up care related to that access.
Part B does not cover transportation to and from dialysis, meals, or medications you take at home (though Part D may cover those). It also does not cover the cost of a kidney transplant evaluation or the transplant surgery itself — that falls under Part A (hospital insurance) if you are admitted for the procedure.
If you receive dialysis at an End-Stage Renal Disease (ESRD) facility, Medicare automatically covers you even if you have not yet turned 65. This is one of the few conditions that qualifies someone under 65 for Medicare coverage. You become may be able to access the month you start dialysis or the month you are referred for a transplant evaluation, whichever comes first.
Your 20% coinsurance: what the numbers look like
The 20% you pay is coinsurance on whatever the dialysis center charges. A typical in-center hemodialysis treatment costs between $200 and $300 before insurance, though this varies widely by region and facility. If your center charges $250 per treatment and you dialyze three times per week, that is roughly $3,000 per month in charges. Your 20% coinsurance would be about $600 per month — but only after you have paid your $240 yearly deductible.
These are rough figures and will differ based on your location, the specific facility, and your treatment plan. Some dialysis centers charge more or less; some patients need more frequent or longer treatments. The best way to know your actual costs is to ask your dialysis center for an estimate based on your prescribed treatment schedule.
Once you reach your Part B deductible early in the year, you will pay 20% coinsurance for the rest of that calendar year. In December, the deductible resets, so if you need dialysis in January you will owe the deductible again before coinsurance kicks in.
How to reduce your out-of-pocket costs
If you have a Medigap Plan G, Plan F, or Plan C, these plans cover your Part B coinsurance in full. That means once you pay the yearly deductible, Medigap pays the 20% you would otherwise owe. Other Medigap plans cover coinsurance partially or not at all, so check your plan documents or call your Medigap insurer to confirm what dialysis costs they cover.
If you have Medicaid in your state, it may pay your Part B deductible and coinsurance as a "spend-down" benefit. Medicaid rules vary by state, so contact your state Medicaid office or your dialysis center's financial counselor to learn what Medicaid covers where you live.
If you have employer coverage or retiree health insurance, that plan may be primary (meaning it pays first) and Medicare is secondary. In that case, your employer plan may cover costs that Medicare would not, or it may have a lower deductible or coinsurance rate. Always tell your dialysis center about all insurance you have so they bill in the correct order.
Many dialysis centers have financial counselors on staff who can help you understand your costs and find programs that might help pay them. Ask to speak with a counselor at your center — this is a free service.
Medicare Part D and dialysis medications
Medications you take at home — such as phosphate binders, blood pressure drugs, or erythropoiesis-stimulating agents (ESAs) — are covered by Medicare Part D (prescription drug coverage), not Part B. You will pay whatever your Part D plan's copay or coinsurance is for those drugs, depending on which tier they fall into and whether you have met your deductible.
Some dialysis-related drugs are given during your treatment at the center and are covered by Part B as part of the dialysis service. Your dialysis center can tell you which medications are included in your treatment and which you will need to fill at a pharmacy and pay for through Part D.
If you do not have Part D coverage, you can enroll during the annual enrollment period (October 15 to December 7) or within 63 days of losing other creditable drug coverage. Missing this window can result in a late enrollment penalty added to your Part D premium for as long as you have the coverage.
What happens if you switch dialysis centers
If you move or change to a different dialysis center, your Medicare coverage does not change — Part B still covers 80% of dialysis costs at any Medicare-certified facility. However, different centers may charge different amounts, so your 20% coinsurance could be higher or lower depending on the new center's fees.
When you switch centers, bring your Medicare card and any other insurance cards. Tell the new center about all your coverage so they can bill correctly. Your new center's financial counselor can give you an estimate of what you will owe based on their charges and your insurance.
Frequently Asked Questions
Do I have to pay the Part B deductible every month?
No. You pay the deductible once per calendar year (January through December). Once you reach it, you pay only 20% coinsurance for the rest of that year. The deductible resets on January 1.
What if I cannot afford my 20% coinsurance?
Talk to your dialysis center's financial counselor. They can tell you about Medicaid, pharmaceutical information programs, nonprofit organizations that help dialysis patients, and payment plans. Some centers also have funds to help patients in financial hardship.
Does Medicare cover home dialysis the same way as in-center dialysis?
Yes. Medicare Part B covers home peritoneal dialysis and home hemodialysis at 80% after your deductible, just like in-center treatment. Your out-of-pocket costs depend on the supplies and equipment your home dialysis program charges.
What if I have both Medicare and Medicaid?
Medicaid is secondary and may cover your Part B deductible and coinsurance. Rules vary by state. Contact your state Medicaid office or ask your dialysis center's financial counselor what Medicaid covers in your state.
Will my costs change if I get a kidney transplant?
Yes. Once you have a working transplant, you no longer need dialysis, so those costs stop. Medicare Part B covers immunosuppressant drugs (the medications you take to prevent rejection) for life, even if you lose Medicare coverage for other reasons. You will pay 20% coinsurance for those drugs after your deductible.