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
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.
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