Dialysis Medicare Coverage for People with ESRD

Original Medicare is government-sponsored health insurance that provides health coverage to qualified U.S. citizens and legal residents. Medicare comes in several parts that cover different services, Medicare Parts A, B, and D, along with a plan option called Medicare Advantage, or Medicare Part C.

You are eligible for Medicare at age 65—or earlier if you have certain health conditions. People who are diagnosed with end stage renal disease (ESRD) at any age are usually eligible for Medicare after 3 months of dialysis or after completing home dialysis training. Talk to your insurance coordinator to find out more.

Understanding Medicare: Parts A, B, C, & D

Medicare Part A

Offered by: Government
Type of coverage: Hospital coverage
What it covers: Inpatient hospital care, hospice care, and some nursing home and home healthcare

Usually chosen: Together with Medicare Part B
Premium: No
Coverage: 80%
Annual Deductible: Yes

Medicare Part B

Offered by: Government
Type of coverage: Medical coverage
What it covers: All outpatient care, including dialysis services and doctor visits

Usually chosen: Together with Medicare Part A
Premium: Yes
Coverage: 80%
Annual Deductible: Yes

Medicare Part C

Offered by: Private companies, contracted through Medicare
What it covers: Hospital and medical coverage, plus many plans offer coverage for prescription drugs and other benefits not typically covered by Medicare.

Replaces: Separate traditional Medicare Parts A, B, and D, plus Medigap plans.
Premium: Yes
Coverage: Co-pays and co-insurance, with a cap on annual out-of-pocket costs
Annual Deductible: None for many plans, but there may be a deductible for prescription drug coverage.

Medicare Part D

Offered by: Private companies, contracted through Medicare
What it covers: The cost of prescription medications that aren't covered by Part B which may cover dialysis or transplant medications

Usually chosen: Chosen with Parts A and/or B. Cannot be combined with Part C or a Medigap plan that includes drug coverage.
Premium: Yes—varies by income
Coverage: Co-pays that vary, based on the drug tier and your total spend on drugs annually.
Annual Deductible: Usually, though some Part D plans don't have a deductible

Before you make any health insurance changes, Talk to your insurance coordinator

It's helpful to make sure you understand your insurance before making any changes to your insurance plan. Your current coverage may still be the right option.

Have insurance through your employer?

Your current plan might be the right coverage for you. If you decide to switch to Medicare, you can keep your employer group coverage and Medicare together for 30 months. After that, Medicare becomes your primary insurance, and you can keep your employer plan as secondary insurance. Talk you your insurance coordinator about the right option for you.

Questions about your insurance?

Talk to one of our insurance coordinators. We can help you understand your insurance.

Understanding dialysis treatment costs

Find out more about coverage for dialysis and key insurance terms.

Learn more