When chronic kidney disease leads to kidney failure, also known as end-stage renal disease, treatment options will include dialysis or a kidney transplant. Many people who are diagnosed with ESRD have concerns about the potential cost of medications, procedures, and surgery they might need. Medicare can help cover the costs related to kidney failure regardless of your age.
If you are diagnosed with ESRD, you will become eligible for Medicare. You will qualify if you have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee. You also qualify if you already receive Social Security or RRB benefits or if you are the spouse or dependent child of someone who meets the criteria.
Many people automatically get Medicare Part A (Hospital Insurance), but when you are diagnosed with ESRD, you will be eligible to sign up for Part B (Medical Insurance) without any late enrollment penalty. Most people diagnosed with ESRD receive their benefits through Original Medicare. If you are already enrolled in a Medicare Advantage plan when you are diagnosed with kidney failure, you may be able to remain in that plan.
Medicare Can Help Pay for Kidney Failure Treatment
Medicare can help cover a wide array of services and care for patients with kidney failure. Part A can help cover the cost of inpatient services at a Medicare-approved hospital for dialysis treatments and transplant services. Part A will cover the kidney registry fee and laboratory tests to evaluate your condition and potential donors. The full cost of surgery and care for you and the donor will be covered, along with any blood needed during surgery.
Medicare Part B will cover doctor services and maintenance dialysis treatments in an outpatient setting. Part B will also cover training if you are a candidate for self-dialysis. Training must take place in a Medicare-approved dialysis facility which will provide support services and equipment you will need. Covered supplies and equipment may include:
- Dialysis machine
- Sterile drapes
- Alcohol wipes
Medicare Part B will also help cover the cost of ambulance transportation when you have ESRD, need dialysis, and need transportation to and from your treatment.
Certain drugs are covered by Part B, such as heparin, topical anesthetics, and erythropoiesis-stimulating agents (ESAs) used to treat anemia related to renal disease. Part B will also help pay for transplant drugs, also known as immunosuppressive drugs for a limited time. Oral drugs that may be prescribed for ESRD-related medical needs may be covered by Part D. Each Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage will have its own formulary and tiers of pricing for medications.
You will likely pay 20% of the Medicare-approved amounts for your dialysis services and supplies. The Part B deductible applies. If you need a kidney transplant, you will pay 20% of the Medicare-approved amount. You will pay nothing for a living donor or for Medicare-approved lab tests.
Medicare Part D: Medicare Prescription Drug Coverage