Medicare covers the following End-Stage Renal Disease (ESRD)-related care:
- Kidney transplants
- Hospital inpatient dialysis
- Outpatient dialysis from a Medicare-certified hospital or free-standing dialysis facility
- Home dialysis training from a dialysis facility
- Training for you and caregivers who will provide home dialysis
- Home dialysis equipment, supplies, and medications (medication is only covered when overseen by a physician)
- Immunosuppressive drugs after a Medicare-covered kidney transplant (as long as you still qualify for Medicare and have Part B)
Your costs for ESRD care depends on your treatment plan.
Inpatient transplant or dialysis
Inpatient transplant or dialysis is covered under Medicare Part A. The coverage includes ESRD-related services, supplies, labs and drugs. You pay a Part A deductible of $1,340 in 2018 and/or a hospital coinsurance.
Doctor’s fees (including fees for transplant surgeons) are billed separately under Part B. For doctor’s services in the hospital, you pay 20% of the Medicare-approved amount if you see a doctor who participates in Medicare.
Medicare will also pay for the full cost of care for a kidney donor. This means, that if someone donates a kidney to you, Medicare will cover his or her care completely and they will not have any cost sharing.
Medicare Part B covers dialysis overseen in an outpatient dialysis facility. The cost for each session includes equipment, supplies, lab tests and most dialysis medications. You pay 20% of the cost for each dialysis session after you meet the Part B deductible. Doctor’s services and certain items, such as intravenous iron therapy, are billed separately from the dialysis charges. You typically pay 20% of the Medicare approved amount for these services as well (after the Part B deductible).
Medicare Part B also covers self-dialysis equipment, supplies and training. Medicare pays certified home dialysis facilities a set fee that includes the cost of training you to administer dialysis yourself. The fee also includes most ESRD-related drugs you need and providing and setting up your home dialysis equipment. You pay 20% of the combined rate and Medicare pays 80% (after the Part B deductible). You also pay 20% of the Medicare approved amount for a doctor to oversee your training and supervise your care. This supervision includes a monthly face-to-face visit with your doctor.
Immunosuppressive drugs following a transplant
After you have a kidney transplant, you will need to take immunosuppressant drugs for the rest of your life to prevent your body from rejecting the organ.
Once you are discharged from the hospital, Medicare Part B will cover your immunosuppressive drugs if:
- You had Medicare Part A at the time of your transplant, and
- You have Medicare Part B.
Medicare pays 80% and you pay 20% of the Medicare approved amount for your immunosuppressant medications if you use a pharmacy that accepts Medicare. All pharmacies that accept Medicare must accept assignment for Part B-covered medications.
If you qualify for Medicare on the basis of ESRD alone, Medicare will end 36 months after a successful transplant. If you qualify for Medicare because you are over 65 or have a disability, Medicare Part B will continue to cover your immunosuppressive drugs.
Vitamins for dialysis patients
After each dialysis session, someone with ESRD needs to take various vitamins since dialysis removes vitamins from the blood. Medicare will not usually cover these vitamin supplements.
- Part B does not provide coverage for vitamins.
- If the vitamins require a prescription, Part D plans with basic coverage will not cover them. However, some Part D plans offer enhanced coverage that specifically covers these vitamins. You typically pay more for enhanced Part D plans. Make sure you check the plan formulary and contact the plan before joining to ensure it will cover all the vitamins you need. You should confirm each year, during Fall Open Enrollment that the plan will continue to cover your vitamins.