Medicare Part B helps cover home dialysis supplies, including dialysis machines, water purifiers, and some medical supplies.
Part B typically covers 80% of all Medicare-approved home dialysis costs after you’ve paid your annual deductible .
Medicare Advantage can now cover the treatments for ESRD, or kidney failure, and may have different costs than Original Medicare’s Part B.
Medicare will also help pay for you and/or another person to receive the training needed to perform your at-home dialysis treatments safely.
Receiving a kidney failure diagnosis can be devastating news that leaves you with more questions than answers. Does Medicare cover dialysis? Can it be done at home? If so, does Medicare pay for dialysis equipment and supplies?
You may take some comfort in learning the answer to all three questions above is yes; if you’re on Medicare and dialysis is needed to treat your kidney failure, your treatments are covered. If you receive that treatment at home, Medicare dialysis coverage generally includes the supplies and equipment you’ll need.
To get a better idea of how Medicare dialysis coverage helps pay for supplies and which Parts of Medicare you’ll need, here is a guide to Medicare and dialysis supplies.
Find a local Medicare plan that fits your needs
Yes. Medicare will typically cover your home dialysis treatments if you or a loved one live with kidney failure. Dialysis treatments are often time-consuming and can leave a patient exhausted. Receiving this treatment at home can ease the physical burden on the patient while eliminating the need to travel to regular appointments for care. To help with this, Medicare not only covers in-facility dialysis treatments but will help pay for at-home supplies, equipment, and even training for a loved one to help with your care.
There are different kinds of home dialysis, and each uses different equipment to remove toxins from your bloodstream. While there are differences between the machines and how they operate, all Medicare beneficiaries who need at-home dialysis can expect Medicare to cover some standard supplies, including:
- Dialysis machine
- Water treatment system
- Basic reclining chair
- Rubber gloves
- Alcohol for sterilizing
- Sterile drapes
What are the different kinds of home dialysis?
There are two main types of home dialysis: Peritoneal Dialysis and Home Hemodialysis. Medicare will typically cover whichever form your doctor prescribes as medically necessary. Here’s a brief explanation of each:
This needle-free treatment uses a catheter to deliver a cleansing fluid that removes toxins from your blood with the help of your stomach lining.
An artificial kidney, or dialyzer, filters your blood to remove toxins. The machine then delivers the clean blood back into your body.
You can administer either treatment during the day or night at your doctor’s recommendation. Each uses different equipment, and the length of your treatments depends on your specific health needs. Talk to your doctor to find out what kind of home dialysis is in your care plan.
Who performs at-home dialysis treatments?
Medicare dialysis coverage does not pay for nurses or doctors to administer your treatments. Instead, it will pay to train someone to aid in your care. For example, spouses and other loved ones can learn how to help administer your home dialysis treatments. The training periods can last 10 to 12 hours per day for several weeks. [i] Some Medicare beneficiaries choose to hire nurses or other aids to help with their care, but Medicare will not pay for this assistance.
Are you eligible for cost-saving Medicare subsidies?
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. [i] 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.
Still asking, “How much does Medicare pay for dialysis?” It’s best to know how Medicare calculates your costs because it will help you make sense of your Medicare Summary Notice when you get it.
- Deductible: This is the annual amount you need to pay out of pocket before Medicare begins to pay its portion (80%) of your approved costs. In 2021, the Part B deductible is $203.
- Premium: This is the monthly cost of Part B. You must pay your monthly Part B premium to have active Part B coverage. In 2021, the Part B premium is $148.50 per month, though some individuals with high income may have to pay a higher premium.
- Coinsurance: Once you’ve paid your deductible, coinsurance is the portion (20%) you’ll pay out of pocket for a service or home dialysis supplies.
Again, Medicare Advantage beneficiaries often have different costs they’re responsible for paying. For example, many Part C plans offer no-cost monthly premiums or flat-rate copayments instead of coinsurance. If you’re on Original Medicare and want more info on Part C, give GoHealth a call. We’ll explain the difference and shop for plans in your area that fit your needs.
What extra benefits and savings do you qualify for?
End Stage Renal Disease occurs when your kidneys can no longer function enough to meet your body’s needs. With ESRD, toxins and fluids can build up in your kidneys and cause serious medical issues. Due to its serious nature, Medicare does cover End Stage Renal Disease even if you’re not old enough to enroll in Medicare.
If you’re on Medicare because of ESRD, your coverage begins on the first day of your fourth month of coverage. [i] You may be able to get your Medicare dialysis coverage to begin with the first month of dialysis if you meet the following criteria:
- Take part in home dialysis training during the first three months of your regular dialysis. A Medicare-certified training facility must offer the training.
- Your doctor expects that you can finish your training and perform home dialysis treatments.
Beneficiaries receiving Medicare only because of ESRD will stop receiving benefits either:
- 12 months after the month you end dialysis treatments
- 36 months after the month you have a kidney transplant
Medicare Advantage and ESRD
Until recently, private insurance companies offering Medicare Advantage (Part C) were allowed to deny coverage to those living with ESRD. Starting in 2021, patients can enroll in Medicare Advantage. Part C plans generally have maximum out-of-pocket limits, meaning that your plan will cover 100% of your costs for the remaining benefit period after you reach the limit.
If you’re considering a switch to Medicare Advantage, make sure to check that any plan you are considering includes your doctors and providers. If you need help with details like these or want to discuss your options, give GoHealth a call. Our licensed insurance agents can discuss your dialysis needs and shop for plans in your area that provide benefits to meet your health requirements.