Medicare covers the following care related to End-Stage Renal Disease (ESRD):
- Kidney transplants
- Hospital inpatient dialysis
- Outpatient dialysis from a Medicare-certified hospital or free-standing dialysis facility
- Home dialysis training, sometimes called self-dialysis, from a dialysis facility
- Training for you and caregivers who will provide home dialysis
- Home dialysis equipment and supplies
- Medications related to treatment (medication is only covered when overseen by a doctor)
- Immunosuppressant drugs after a kidney transplant, as long as you had Medicare Part A at the time of the transplant
Medicare covers most services associated with ESRD treatment, with standard Original Medicare cost-sharing. This means that Original Medicare pays some of the cost of your services, and you pay the rest. Your costs for ESRD care also depend on your treatment plan.
Inpatient transplant and inpatient dialysis
Part A covers the cost of an inpatient kidney transplant or dialysis at a Medicare-approved facility after you meet your deductible ($1,408 in 2020). If the length of your hospital stay exceeds your benefit period, you may have to pay a daily hospital coinsurance.
Part B covers doctors’ fees, including fees for transplant surgeons. You will typically pay a 20% coinsurance as long as your provider accepts Medicare assignment.
Medicare also pays for costs related to your kidney donor’s hospital stay and their follow-up care—without charging you or them any cost-sharing. You should not be asked to pay for your donor’s care.
Part B covers dialysis overseen in a Medicare-approved outpatient dialysis facility. You will typically pay a 20% coinsurance for the cost of each session, which includes equipment, supplies, lab tests, and most dialysis medications. Doctors’ fees for certain services and items, such as intravenous iron therapy, are billed separately from the dialysis charges.
Note: ESRD Medicare does not cover surgery or services that are required to prepare you for dialysis before your Medicare eligibility begins. For example, Medicare will not pay for the surgery you need to create an access point for a dialysis machine.
Part B pays certified home dialysis facilities a set fee that includes the cost of training you to administer dialysis yourself. The fee also covers supplies, lab tests, most dialysis medications, and home dialysis equipment. You will typically pay a 20% coinsurance.
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, Part B will cover your immunosuppressants if:
- You had Part A at the time of your transplant
- You have Part B when getting your prescription filled
- And, you are only eligible for ESRD Medicare
- If your kidney transplant was successful, your Medicare coverage will end 36 months after the month of your transplant
Remember: Part B will not pay for your immunosuppressants if you did not have Part A at the time of your surgery, even if you had other insurance that paid for your transplant. If you did not have Part A at the time of your transplant, you may need Part D to provide coverage for your immunosuppressants.