Call to speak to a Licensed Insurance Agent
Having and seeing a loved one undergo dialysis can be difficult. And because dialysis is a long-term treatment, having to pay for many sessions can add even more stress to the situation.
So a common question many people have is, “does Medicare cover dialysis?” In this article, we answer that question in clear, plain English. You will also find the average costs of dialysis treatment and other helpful info.
Does Medicare Cover Dialysis?
The short answer is yes; Medicare will cover the cost of dialysis treatment. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your dialysis treatment. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for dialysis treatment. If you are not enrolled in Medicare or missed the enrollment period but you are eligible for Medicare based on End-Stage Renal Disease (ESRD), Medicare may provide retroactive coverage for your dialysis up to 12 months after you enrolled.
If you enroll on Medicare based on ESRD and you are currently on dialysis, Medicare will begin to provide coverage for your dialysis treatment on the first day of the fourth month of your dialysis treatment. However, Medicare can begin to provide coverage for your dialysis treatment in the first month if:
- You participate in in-home dialysis training at a Medicare-approved facility during the first 3 months of your dialysis treatment
- Your healthcare provider suggests that you should finish your dialysis training so that you can do your own dialysis treatments
Medicare can also provide coverage early for your dialysis treatment if you are to have a kidney transplant within the month or in the next 2 months, if you are admitted to a Medicare-approved hospital for the kidney transplant.
Medicare’s coverage for your dialysis treatment can also begin 2 months before your kidney transplant if it has been delayed for more than 2 months after being admitted to a Medicare-approved hospital.
Coverage for dialysis treatments is provided by Medicare Part A for inpatient treatment. On the other hand, coverage for dialysis treatments is provided by Medicare Part B for outpatient treatments and services including home service.
Part C Coverage for Dialysis
Medicare Advantage plans (Medicare Part C) also provide coverage for nursing home care. They cover everything Original Medicare covers, but will usually include some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
How Much Does Dialysis Treatment Cost?
A single dialysis treatment session costs around $500. Dialysis treatment may run up to $72,000 per year.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Hepatitis A vaccines?