• Inpatient dialysis treatments: Medicare Part A (Hospital Insurance) covers dialysis if you’re admitted to the hospital for special care.
• Outpatient maintenance dialysis treatments: Medicare Part B (Medical Insurance) covers a variety of services if you get routine maintenance dialysis from a Medicare-certified dialysis facility.
• Training for home dialysis: Part B covers training if you’re a candidate for home dialysis, as well as training conducted during the course of your regular treatments for you and the person helping you with your home dialysis treatments. The training must be conducted by a dialysis facility that has been certified by Medicare to provide home dialysis training. You may qualify for training if you think you would benefit from self-dialysis training for at-home treatments, and your doctor approves. Training sessions will occur at the same time you get dialysis treatment and are subject to a maximum number of sessions.
• Home dialysis support services: Part B covers covers home dialysis support services provided by your dialysis facility. This may include visits by trained hospital or dialysis facility workers to check on your home dialysis, to help in emergencies when needed, and to check your dialysis equipment and water supply.
• Home dialysis equipment and supplies: Part B covers all kidney dialysis equipment and supplies, including alcohol, wipes, dialysis machines, sterile drapes, rubber gloves, and scissors for as long as you need dialysis at home.
Part B will pay for home dialysis equipment.
• Certain drugs for home dialysis: Part B covers heparin, the antidote for heparin (when medically necessary), and topical anesthetics. Part B also covers erythropoiesis-stimulating agents (ESAs) (like epoetin alfa or darbepoetin alfa) to treat anemia related to your renal disease.
• Outpatient doctors’ services
• Other services and supplies that are a part of dialysis (like laboratory tests)
Medicare doesn’t cover the following services or supplies:
• Paid dialysis aides to help you with home dialysis
• Any lost pay to you or the person who may be helping you during self-dialysis training
• A place to stay during your treatment
• Blood or packed red blood cells for home self-dialysis unless part of a doctors’ service
Medicare covers ambulance services to and from your home to the nearest dialysis facility for treatment of End-Stage Renal Disease (ESRD) only if other forms of transportation would be harmful to your health. You may need a note from your doctor.
There are some types of insurance that may pay some of the health care costs that Medicare doesn’t pay.
All people with Medicare with ESRD are covered.
Your costs in Original Medicare
• Inpatient dialysis treatments: In Original Medicare, Medicare pays most kidney doctors a monthly amount. After you pay the Part B yearly deductible, Medicare pays 80% of the monthly amount. You pay the remaining 20% coinsurance. In some cases, your doctor may be paid per day if you get services for less than one month. Find out how much you pay for inpatient hospital care.
• Outpatient maintenance dialysis treatments: Outpatient maintenance dialysis treatments include the cost of dialysis drugs and biologicals (except ESRD-related medications that only have an oral form of administration, which are covered only under Medicare prescription drug coverage (Part D). You pay 20% of the Medicare-approved amount for each dialysis treatment given in a dialysis facility or at home. Only dialysis facilities can bill Medicare for providing (directly or under arrangement) home dialysis training.
• Home dialysis (training, support services, equipment, and supplies): The cost of home training, home dialysis, and home dialysis equipment and supplies are included as part of the outpatient maintenance dialysis treatment. You pay 20% of the Medicare-approved amount.
• Certain drugs for home dialysis: The costs of home dialysis drugs and biologicals are included as part of the outpatient maintenance dialysis treatment (with the exception of ESRD-related medications that only have an oral form of administration (drugs taken by mouth that only come in capsule, tablet, or liquid forms), which are covered only under Part D). You pay 20% of the Medicare-approved amount.