Does Medicare Cover Dialysis?

In most cases, Medicare Part A does cover dialysis in a Medicare-approved hospital. Medicare Part B covers outpatient dialysis treatment, supplies and doctor visits.

A Medicare Supplement (Medigap) plan can help cover dialysis costs such as Medicare deductibles, copays, coinsurance and more.

You may be able to apply for Medigap plans in some states if you have ESRD, but insurance companies aren't required to sell Medigap plans to beneficiaries under age 65 in all states.

Medicare Part A and/or Part B can cover dialysis, depending on where you receive treatment.

What Dialysis and Kidney Transplant Services Does Medicare Cover?

Dialysis coverage

The chart below shows which dialysis services and supplies are covered by either Medicare Part A or Part B, according to Medicare.gov, and the costs you would face (in addition to Medicare Part A and Part B premiums and deductibles).

Although Medicare provides significant coverage for dialysis and related treatments, there are several things that Medicare does not cover, including:

1. Blood or packed red blood cells for home dialysis, unless part of a doctor’s service;
2. Paid dialysis aides to help with home dialysis;
3. Any lost pay for you or your dialysis caregiver during home training; and
4. A place to stay during dialysis treatment.

Kidney transplant coverage

The chart below shows which kidney transplant services and supplies are covered by either Medicare Part A or Part B, according to Medicare.gov, and the costs you would face (in addition to Medicare Part A and Part B premiums and deductibles).

Is There a Waiting Period for Medicare Dialysis Coverage?

Medicare coverage for dialysis treatments typically begins the first day of the fourth month of your dialysis treatments.

You may be able to reduce this waiting period if you complete training from an approved Medicare dialysis provider to give yourself in-home dialysis.

Does Medicare Cover End-Stage Renal Disease (ESRD)?

Although Medicare is widely known as a government-issued health insurance program for seniors, it also provides health insurance benefits to individuals under the age of 65 who have ESRD. 

According to Medicare.gov, you can get Medicare no matter how old you are if:

• Your kidneys no longer work

• You have had a kidney transplant or need regular dialysis

• One of these applies to you:

  • You're the spouse or dependent child of a person who meets either of the requirements above

  • You've worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee

  • You are eligible to receive or are already receiving RRB or Social Security

In order to receive the full Medicare coverage for ESRD-related treatment such as dialysis and transplants, you must enroll in both Medicare Part A and Part B (Original Medicare).

Medigap Plans Can Help Pay for Dialysis

Original Medicare (Part A and Part B) requires recipients to pay several out-of-pocket costs.

Medicare Supplement Insurance (Medigap) plans help cover some of these out-of-pocket costs to save Medicare recipients money and provide them with more predictive health care costs.

A person with ERSD who is under the age of 65 may be able to enroll in a Medigap plan, depending on which state they live in.

The following states require insurance companies to offer at least one kind of Medigap policy to people with Medicare who are younger than 65 with ESRD:

• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Hawaii
• Illinois
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan 
• Minnesota
• Mississippi
• Missouri
• New Hampshire
• New Jersey
• New York
• North Carolina
• Oklahoma
• Oregon
• Pennsylvania
• South Dakota
• Tennessee
• Texas
• Oklahoma
• Wisconsin

The level of Medigap benefits depends on which Medigap plan you choose (and which plans are available in your state). All 10 standardized Medigap plans provide at least partial coverage for:

• Medicare Part A coinsurance and hospital costs

• Medicare Part B coinsurance or copayment

• First three pints of blood

• Medicare Part A hospice care coinsurance or copayment

Learn more about Medicare coverage of common procedures

A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live. 

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.