Medicare Coverage of Kidney Dialysis Treatment

What It Is

Kidney dialysis treatment as an inpatient, or as an outpatient at a dialysis facility or at home

What's Covered

Medicare Part A covers kidney dialysis provided to a hospital or skilled-nursing-facility inpatient.

Medicare Part B covers kidney dialysis provided on an outpatient basis at a dialysis facility or in the patient's home. If dialysis is provided in a patient's home, Medicare Part B coverage includes:

• Rental of the kidney dialysis machine.

• Training in performing self-dialysis, for the patient and a family member or other personal helper.

• Equipment and supplies, such as alcohol, wipes, sterile drapes, rubber gloves, medical scissors, and a water purification system (if necessary).

• Support services, such as visits by dialysis technicians to check procedures, equipment, and supplies as well as to provide help in dialysis emergencies.

• Drugs for the dialysis, including heparin, the antidote for heparin (if necessary), and topical anesthetics.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for kidney dialysis treatment, contact the plan directly.

What Medicare Pays

If the dialysis is for a hospital or skilled-nursing-facility inpatient, the cost of the dialysis and drugs are part of the total hospital or nursing-facility charges paid by Medicare Part A, subject to patient deductible and coinsurance amounts.

If dialysis is for an outpatient at a dialysis facility or in the patient's home, Medicare Part B pays 80 percent of the Medicare-approved amount for treatment, supplies, support, equipment, and drugs.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

• The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

• The care must be performed or delivered by a healthcare provider who participates in Medicare.