Medicare Coverage for Dialysis
How Medicare covers kidney failure at any age: when coverage starts, what Parts A and B pay for, employer plans, and Medicare Advantage.
Medicare at any age for kidney failure
Most people get Medicare at 65, but kidney failure is an exception. According to Medicare.gov, you can get Medicare at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these applies:
- You have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee.
- You already get, or are eligible for, Social Security or Railroad Retirement benefits.
- You are the spouse or dependent child of someone who meets either requirement above.
You also have to apply through the Social Security Administration, for example at your local Social Security office. If you do not qualify for Medicare, your state may be able to help pay for dialysis.
When coverage starts
Medicare for kidney failure has its own timing rules, explained in the official booklet Medicare Coverage of Kidney Dialysis & Kidney Transplant Services:
- If you are on dialysis: coverage usually starts on the first day of the fourth month of regular dialysis. This is called the waiting period. If you start dialysis in July, coverage begins October 1.
- The home training exception: coverage can start in the first month of dialysis if you take part in a home dialysis training program at a Medicare-certified training facility during your first three months, and your doctor expects you to finish training and do your own treatments.
- If you get a kidney transplant: coverage can begin the month you are admitted to a Medicare-certified hospital for the transplant, or for care you need before it, if the transplant happens that month or within the next two months.
If you sign up late, coverage can be retroactive up to 12 months before the month you apply, but not earlier than when you first became eligible. Note that Medicare will not cover surgery to prepare for dialysis, such as creating a fistula, before your coverage begins, unless you already have Medicare because of age or disability.
What Part A and Part B cover
Part A (hospital insurance) covers dialysis you receive while admitted to a hospital, as part of your covered inpatient stay.
Part B (medical insurance) covers most other dialysis care, according to Medicare's dialysis coverage page and the booklet:
- Outpatient dialysis treatments and doctors' services, in a Medicare-certified facility or at home
- Home dialysis training for you and the person who helps you
- Home dialysis equipment and supplies
- Certain home support services, like visits to check your equipment and water supply
- Most drugs for outpatient or home dialysis, plus lab tests that are part of dialysis
In Original Medicare, you generally pay the yearly Part B deductible and then 20% coinsurance. Most people pay a monthly Part B premium. Signing up for Part B is your choice, but you need both Part A and Part B to get the full dialysis and transplant benefits. Medicare does not cover lost pay during home training, a place to stay during treatment, or paid aides for home dialysis unless included in the dialysis payment.
Original Medicare covers ambulance trips to the nearest dialysis facility only when other transportation could endanger your health. A Medicare Advantage Plan may cover some other rides.
If you also have an employer or union health plan
If you have coverage through your or your spouse's job or union, that plan pays alone during the first three months of dialysis. After you become eligible for Medicare, a 30-month coordination period begins. During those 30 months, your group plan pays first and Medicare pays second. After that, Medicare pays first.
- The 30 months start in the first month you could get Medicare because of kidney failure, even if you have not signed up.
- If you do home dialysis training or get a transplant during the waiting period, the coordination period starts earlier.
- If your group plan covers nearly everything, you may choose to delay Part A and Part B until the coordination period ends. You will not pay a higher Part B premium for delaying while you have job-based coverage.
- Tell your providers about your group plan so claims are billed correctly.
Medicare Advantage since 2021
Before 2021, people with kidney failure could join a Medicare Advantage Plan only in limited situations. The 21st Century Cures Act changed that. As CMS explained, beginning January 1, 2021, all Medicare-eligible people with kidney failure can enroll in Medicare Advantage, and plans cannot deny enrollment because of kidney failure.
Medicare Advantage Plans must cover everything Original Medicare covers, and some add extra benefits. But many use provider networks. Before you join, confirm that your dialysis facility, your kidney doctor, and any transplant center you may use are in the plan's network. Out-of-pocket costs vary by plan.
When coverage ends
If you have Medicare only because of kidney failure, coverage ends 12 months after the month you stop dialysis, or 36 months after the month of a kidney transplant. It resumes if you start dialysis again or get another transplant within those windows. Medicare also offers a limited benefit that helps pay for anti-rejection (immunosuppressive) drugs after the 36 months end, for people without certain other coverage.
Where to get help
Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), contact your local State Health Insurance Assistance Program, or ask the social worker at your dialysis facility. Rules and costs change, so confirm details with Medicare or Social Security. This guide is general information, not legal or medical advice.