Does Medicare cover dialysis?

Dialysis is a lifesaving treatment that removes waste, toxins, and excess fluids from the blood when the kidneys are no longer able to.¹ It is a lifeline for people with advanced ESKD, sometimes referred to as end-state renal disease (ESRD).

Dialysis can be done in a hospital, at an outpatient dialysis center or at home. 

Each part of Medicare may play a role in coverage for dialysis. Let’s take a closer look.

Medicare Part A

Medicare Part A typically covers inpatient dialysis treatment if you’re hospitalized due to kidney failure or complications. This coverage includes services provided in a hospital or skilled nursing facility. However, you’ll need to pay the Part A deductible before your coverage kicks in.

Medicare Part B

After you pay the annual Medicare Part B deductible, you’ll pay 20% of the cost of your treatment, while Medicare pays 80%. That coverage may include:

• Dialysis treatments and services you get in a Medicare-certified dialysis facility
• Home dialysis equipment, supplies and support services
• Lab tests required to monitor your treatment
• Ambulance services to and from your home to the nearest dialysis facility, but only if traveling in any other vehicle could endanger your health

 Medicare Advantage (Part C)

People with advanced chronic kidney disease (CKD) or ESKD may opt for a Medicare Advantage (MA) Chronic Condition Special Needs Plan. These MA plans are specifically tailored for people with ongoing health conditions and may offer extra benefits like:

• Coordinated care management across all your healthcare providers

• Enhanced prescription drug coverage

• Telehealth services and in-home care options

• Medicare nutrition therapy
• Mental health resources

Medicare prescription drug coverage (Part D)

A Medicare Advantage Part D plan can help with medications for symptoms related to ESKD, such as anemia or fluid retention. Part D plans are not part of Original Medicare. They are stand-alone plans you can buy separately, and you’ll need to pay a monthly premium.

Eligibility criteria for people with ESKD

If you’ve been diagnosed with ESKD, you are eligible for Medicare regardless of your age if you meet these conditions:

• Your kidneys no longer work
• You need regular dialysis or have had a kidney transplant

You must also meet 1 of the following requirements:

• You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee
• You’re already getting or are eligible for Social Security or Railroad Retirement benefits
• You’re the spouse or dependent child of a person who meets either of the requirements listed above

Helping to ease the financial burden of chronic care

Back in the early 1970s, dialysis became more common. Instead of being a terminal disease, kidney failure was now a treatable chronic condition – but only for those who could afford it. In 1972, then-President Richard Nixon signed the legislation that established Medicare coverage for all people with end-stage kidney disease, helping to ease the financial burden of having ESKD.²