Does Medicare Part A Cover Dialysis?

Medicare, a federal health insurance program, covers millions of Americans, including older adults, individuals with certain disabilities, and people of any age diagnosed with End-Stage Renal Disease (ESRD). For individuals with ESRD, dialysis is a necessary, life-sustaining treatment. Understanding Medicare’s coverage for this ongoing treatment is important.

Medicare Part A Coverage for Dialysis

Medicare Part A, often referred to as hospital insurance, covers dialysis treatments provided in an inpatient setting. Services such as room, board, nursing care, and medical supplies are typically covered during such stays.

Beyond acute hospital care, Part A extends to limited stays in a skilled nursing facility (SNF) following a qualifying hospital discharge. If medically necessary, Part A covers dialysis treatments received in an SNF, assisting with daily facility costs, nursing services, and necessary medical equipment.

Part A also covers home health care services for ESRD patients, including intermittent skilled nursing care, physical therapy, or other therapeutic services provided at home.

Hospice care, for individuals certified as terminally ill, is also covered under Medicare Part A. While hospice focuses on comfort and palliative care rather than curative treatments, it can provide support for ESRD patients nearing the end of life. This benefit covers services to manage symptoms and provide emotional and spiritual support.

Medicare Eligibility for End-Stage Renal Disease

Eligibility for Medicare due to End-Stage Renal Disease (ESRD) allows individuals of any age to qualify. A diagnosis of permanent kidney failure requiring regular dialysis or a kidney transplant is a primary requirement, allowing enrollment regardless of age or disability.

To qualify, an individual must also meet work history requirements. This includes having worked a required amount of time under Social Security, the Railroad Retirement Board, or as a government employee. Eligibility also extends to those already receiving or eligible for Social Security or Railroad Retirement benefits, or who are the spouse or dependent child of someone meeting these conditions.

The application process for Medicare based on ESRD involves contacting the Social Security Administration or the Railroad Retirement Board. Enrollment in both Medicare Part A and Part B is recommended for comprehensive coverage.

Medicare coverage for ESRD typically begins on the first day of the fourth month of dialysis treatments. Exceptions allow coverage to start as early as the first month if an individual participates in a home dialysis training program during the initial three months. For those awaiting a kidney transplant, coverage may begin the month of the transplant, or up to two months prior if admitted to a Medicare-approved hospital for the transplant or related pre-transplant services.

A 30-month coordination period applies when a person with ESRD has existing employer or union group health plan coverage. During this time, the group health plan is generally the primary payer for Medicare-covered services. Medicare becomes the secondary payer, then the primary payer once this period concludes.

Coverage Under Other Medicare Parts

Medicare Part B covers many essential outpatient services related to dialysis, including treatments performed in a facility or at home. It also covers doctor services, laboratory tests, and necessary medical supplies and equipment for home dialysis, such as the machine and water treatment system.

Certain medications administered in a dialysis facility are covered under Part B. These include injectable or infused drugs like erythropoiesis-stimulating agents for anemia, heparin, and phosphate binders. Part B also covers home dialysis training for the individual and their care partner.

After a kidney transplant, Medicare Part B covers immunosuppressant drugs to prevent organ rejection. This coverage requires the individual to have had Part A at the time of transplant and Part B when filling the prescription. If these conditions are not met, Part D may be necessary.

Medicare Part D covers prescription drugs taken at home. For individuals with ESRD, Part D plans cover oral medications and other drugs for their kidney condition or related health issues, including immunosuppressants not covered by Part B. These plans are offered by Medicare-approved private insurance companies, with varying formularies and costs.

Out-of-Pocket Costs for Dialysis

Even with Medicare coverage, beneficiaries incur out-of-pocket costs for dialysis and related services. For Medicare Part A, the inpatient hospital deductible is $1,676 per benefit period in 2025. Coinsurance applies for extended hospital stays: $419 daily for days 61-90, and $838 daily for lifetime reserve days beyond day 90.

For skilled nursing facility care, Part A beneficiaries face a coinsurance of $209.50 per day for days 21-100 in 2025. Most individuals do not pay a monthly premium for Part A if they have worked and paid Medicare taxes for at least 40 quarters; otherwise, a premium may apply.

Medicare Part B has a standard monthly premium ($185 for most in 2025), with higher-income individuals paying more. There is also an annual deductible of $257 in 2025. After the deductible is met, beneficiaries typically pay 20% of the Medicare-approved amount for most covered Part B services, including outpatient dialysis treatments and doctor visits.

Medicare Part D costs include monthly premiums (projected to average around $46.50 per month in 2025, varying by plan). Plans may also have an annual deductible, which cannot exceed $590 in 2025. After the deductible, beneficiaries pay copayments or coinsurance, such as 25% of the drug cost, during the initial coverage phase.

In 2025, a $2,000 annual cap on out-of-pocket spending for covered Part D prescription drugs is implemented, eliminating the coverage gap (often called the “donut hole”). To manage these expenses, some beneficiaries explore Medicare Supplement Insurance (Medigap) or Medicare Advantage (Part C) plans. While Medigap can help cover deductibles and coinsurance, its availability to ESRD patients varies by state. Medicare Advantage plans, bundling Part A, Part B, and often Part D benefits, are now available to individuals with ESRD.