Medicare Dialysis Services Coverage

How Much Does Dialysis at Home Cost With Medicare?

As a starting point, Medicare Part B covers home dialysis supplies. This is the portion of Original Medicare that helps pay for medical services and outpatient care. Your doctor must determine they’re medically necessary. If you need equipment, you must get it through a Medicare-approved supplier that accepts the claim.

If your home dialysis equipment meets the qualifications and you’ve paid your Part B premium, Medicare will cover 80% of your Medicare-approved services and equipment. After that, you’ll be responsible for the remaining 20% of your costs (after you’ve paid your annual Part B deductible). This is known as coinsurance. If you need prescription drugs, you’ll need to sign up separately for a Medicare Prescription Plan (Part D).

For Original Medicare beneficiaries, dialysis coverage can come with high out-of-pocket costs after Medicare has paid its share. Many choose to enroll in a Medicare Supplement Insurance (Medigap) policy to help cover the deductibles and coinsurance payments that pile up with Part B.

Another option for Medicare beneficiaries with kidney failure is Medicare Advantage (Part C). Part C replaces Original Medicare (Part A & B) but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional dental, hearing, vision, and prescription drug coverage. Medicare Advantage is offered by private insurance companies and may charge different amounts for its services than Original Medicare. This often includes flat-rate copayments in lieu of the 20% coinsurance you’d pay with Part B. Another key feature of Part C plans is the out-of-pocket maximum; once you spend a certain amount, Medicare Advantage will cover the rest of your costs for the year. Original Medicare does not have an out-of-pocket max.

How long does Medicare pay for dialysis?

If you’re a Medicare beneficiary that’s 65 or older, Medicare will pay for your home dialysis and supplies as long as your doctor deems them medically necessary. Medicare will often pay for a face-to-face meeting between you and your doctor as part of its coverage. If your condition improves to the point of not needing dialysis, your doctor may choose to end your treatments.

What is the average cost of a dialysis treatment?

According to the Centers for Disease Control (CDC), Medicare pays an average of $80,000 each year for beneficiaries with kidney failure. After accounting for the portion paid by Medicare Part B, the remaining 20% averaged out to $16,000 per Medicare beneficiary needing dialysis treatments. The cost of treatment for dialysis and supplies will come down to what you need and how often you need them.

If you administer dialysis treatment at home, you remove some costs for doctors and providers and pay only your portion of services and equipment. On the other hand, home dialysis may have charges that facility-based dialysis doesn’t. Medicare beneficiaries that receive in-home dialysis may receive visits from trained professionals to check their equipment and help in emergencies. Medicare dialysis coverage also requires monthly face-to-face meetings with your doctor or provider as long as you receive home dialysis.