Does Medicare Cover Dialysis? What You Pay
Yes — Medicare covers dialysis for anyone with end-stage renal disease (ESRD), at any age, with enough work history. Medicare Part B pays 80% of the approved cost of each treatment after the annual deductible; you, or supplemental coverage, pay the other 20%. Coverage works at every Medicare-certified facility — which is every center listed on this site.
Who qualifies
You can get ESRD-based Medicare regardless of age if all three hold:
- Your kidneys have failed permanently and you need regular dialysis (or you've had a transplant);
- You've worked long enough under Social Security/Railroad Retirement — or you're the spouse or dependent child of someone who has;
- You apply (enrollment isn't automatic for ESRD — contact Social Security).
When coverage starts
For in-center hemodialysis, Medicare typically starts the first day of the fourth month of treatment. Two important exceptions move that earlier:
- Home dialysis fast-track: start a Medicare-certified home training program (PD or home hemo) before month four, and coverage can begin in month one.
- Transplant admission in the waiting period also triggers earlier coverage.
If you have employer group coverage, it stays primary for a 30-month "coordination period" before Medicare takes over as primary payer.
What each part covers
| Coverage | What it pays for dialysis patients |
|---|---|
| Part A | Inpatient dialysis during hospital stays |
| Part B | Outpatient treatments, home dialysis equipment/supplies/training, most ESRD drugs given at the center, nephrologist fees — 80% after deductible |
| Part D | Self-administered prescription drugs (e.g., phosphate binders) |
| Medigap / Medicaid / MA cap | Some or all of the remaining 20% coinsurance |
The 20% problem — and how patients solve it
Dialysis runs ~150 treatments a year, so an uncapped 20% adds up fast. The common routes to capping it: Medigap (federal access rules for under-65 ESRD patients vary by state — check yours), Medicaid for dual-eligibles, a Medicare Advantage ESRD-eligible plan (annual out-of-pocket maximum, but check the center is in-network), or staying on employer coverage through the 30-month period. A center's social worker can walk through which applies to you — ask before your first treatment, not after the first bill.
Frequently asked questions
Can I get Medicare for kidney failure under age 65?
Yes. End-stage renal disease (ESRD) is one of the few conditions that qualifies people of any age for Medicare, provided you (or a spouse/parent) have enough work history under Social Security and you need regular dialysis or a transplant.
When does Medicare ESRD coverage start?
For in-center hemodialysis, coverage generally begins the first day of the fourth month of dialysis. The three-month wait is waived if you start a home dialysis training program promptly or are admitted for a kidney transplant.
What share of dialysis costs does Medicare Part B pay?
After the annual Part B deductible, Medicare pays 80% of the approved amount for each dialysis treatment and related services. You owe the remaining 20% unless a Medigap policy, Medicaid, an employer plan, or a Medicare Advantage out-of-pocket cap picks it up.
Does Medicaid cover dialysis?
Yes — Medicaid covers dialysis in every state, and for people with both Medicare and Medicaid ("dual eligibles"), Medicaid typically pays the 20% Medicare coinsurance. Rules and eligibility vary by state.
Do dialysis centers help with insurance questions?
Yes. Every Medicare-certified center has a social worker, and chains employ insurance counselors. Ask them to review your coverage before your first treatment — and always confirm a specific center is in-network before committing.
Does Medicare cover home dialysis equipment and supplies?
Yes. Medicare Part B covers home dialysis machines, supplies, water treatment, and the training you and a care partner need, on the same 80/20 basis as in-center care.
Educational summary of public Medicare rules, not insurance or medical advice; individual situations vary. Primary source: Medicare.gov — dialysis services & supplies.