How Does Dialysis Help People with Kidney Failure or ESRD?

Medicare pays for the dialysis services of anyone suffering from end-stage renal disease (ESRD) or kidney failure. Dialysis treatment does what your kidneys have stopped doing: it cleans the blood by getting rid of harmful salts, wastes and fluids. Dialysis treatment will help you feel better and live longer, but will not cure permanent kidney failure.

Where Do I Get Dialysis Treatment?

Trained technicians perform dialysis at the hospital or dialysis medical facility. Dialysis can even be performed in your home with the help of a friend or family member with Medicare-provided training.

How Do I Qualify for Dialysis Treatments?

You will qualify for Medicare coverage if you are diagnosed with end-stage kidney failure or ESRD and your doctor has written an order (prescription) for dialysis treatments. For people already on Medicare, coverage starts right away. For those under 65, coverage will not start until the fourth month of dialysis.

In order for Medicare to pay for your treatments, your facility must be Medicare-approved to provide dialysis.

Can Everybody Choose Home Dialysis?

Home dialysis is a good option for some, but not for everyone. You and your kidney doctor will work together to decide which type of dialysis is right for you. In order to do that, your doctor will consider:

• Body size
• Living situation
• Lab test results
• Your ability to follow and complete the steps in dialysis

What Dialysis Treatments Does Medicare Pay For?

Medicare will pay for the following services:

• Inpatient dialysis treatments
• Outpatient dialysis treatments
• Home dialysis equipment and supplies: This may include alcohol, wipes, sterile drapes, rubber gloves and scissors
• Home support services: This may include visits by trained hospital or dialysis facility staff to monitor home dialysis, help in emergencies when needed, and check on dialysis equipment and other supplies
• Certain drugs for home dialysis
• Outpatient doctor and other related services as a part of the dialysis treatment

Medicare does not pay for:

• Paid dialysis aides to help with home dialysis
• Lost pay to you and your helper during self-dialysis training
• A place to stay during treatment
• Blood or packed red blood cells for home self-dialysis unless it is part of a doctor’s service or is needed to prime the dialysis equipment
• Transportation to a dialysis facility

If you get your coverage through a Medicare Advantage plan, call your plan and ask them what they cover. Your plan must cover at least what Medicare does, and it may cover more.

How Much Will I Have to Pay?

Dialysis treatment is very complicated, so the exact amount of payment you will be responsible for depends on the services required. The following is general information regarding your share of costs:

• Medicare covers 80% of their approved amount; you are responsible for the remaining amount.
• Make sure your supplier is enrolled in Medicare and has a Medicare supplier number.
• Ask the supplier or provider if they accept assignment. Providers and suppliers that accept assignment have agreed to the Medicare-approved amount as payment for the service or supplies.
• If you have a MediGap/Medicare Supplemental Plan, call and ask what is covered by the plan. Many times with MediGap plans you will pay little or nothing.
• If you have a Medicare Advantage Plan, call your plan and ask what is covered and what your share of cost is. Remember, the plan must cover at least what Medicare does; many cover more.

Here are a few important notes:

• If your provider or supplier does not accept assignment, you may be required to pay the entire cost out-of-pocket. Medicare will reimburse you for their share, but that often takes several weeks.
• Medicare will not pay your claim if your supplier is not enrolled in Medicare.

How Do I Find a Dialysis Facility?

Your doctor will recommend a facility. Most kidney doctors have a facility with whom they work closely, so they can ensure your treatment is helping you. If you do not like the facility your doctor recommends, you have the right to choose another. Keep in mind, this could mean that you may have to change doctors. The Centers for Medicare & Medicaid Services (CMS) is a great resource for comparing local dialysis treatment centers.  Visit www.cms.gov for more information.

If you are covered by a Medicare Advantage or MediGap/Medicare Supplemental plan, you may have to use the dialysis centers they have on contract.