Does Medicare Cover Home Dialysis?
Key takeaways:
Home dialysis is a viable option for many people with end-stage renal disease. Dialysis at home, instead of a dialysis center, may improve a person’s quality of life and reduce their costs.
Medicare covers most essential items and services associated with home dialysis. But there are some out-of-pocket costs. You can also have Medicaid or other insurance that covers home dialysis while you are covered by Medicare.
Without Medicare or other insurance, the price of a home dialysis machine can range from $26,000 to $47,000 or more.
Table of contents
Kidney dialysis traditionally happens at a dialysis center or hospital. A nurse or technician administers this life-sustaining treatment to people with kidney failure. But home dialysis offers people more flexibility with the timing of treatments. This can potentially improve their quality of life.
Medicare covers home dialysis for people of any age whose kidneys don’t function. They must need regular dialysis or have had a kidney transplant.
Which home dialysis costs does Medicare cover?
Original Medicare (Part A and/or Part B) covers many home dialysis services and supplies for people with end-stage renal disease (ESRD), such as:
Home dialysis training, which includes instruction for the people receiving and assisting with treatments.
Home dialysis equipment and supplies, which includes the dialysis machine, water treatment system, basic recliner, and wipes. A home dialysis machine can cost $47,000 or more without insurance.
Some home-support services, which may include visits by dialysis workers to check equipment and water supply.
Doctors’ services provided in the home
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If you have a Medicare Advantage plan, it equals or exceeds the benefits of original Medicare.
What is home dialysis?
There are two types of home dialysis. One is peritoneal dialysis, which uses the lining of your abdomen to filter blood. The other is home hemodialysis. This uses a dialyzer (artificial kidney) that’s outside the body. Some research has shown benefits to dialysis at home instead of an inpatient setting. Home dialysis can:
Elevate a person’s quality of life
Improve the effectiveness of treatment
Reduce costs for people using dialysis
According to the Advancing American Kidney Health initiative, up to 85% of people receiving dialysis are eligible for treatment at home.
How Medicare covers home dialysis
Medicare covers some of the costs of at-home treatment by a healthcare professional. After you meet the Part B yearly deductible, Medicare will cover 80% of these monthly costs. You pay the remaining 20% coinsurance. Providers are sometimes paid per day if their services are provided for less than a month.
Medicare also covers the training that’s needed to give home dialysis. The training time you will need depends on the type of dialysis, the equipment, and your care team. But you’ll have help with the costs if you use a Medicare-certified home dialysis training facility. You and your caregiver will receive instruction for your home dialysis treatments.
Dialysis can be costly. Without insurance, dialysis can cost $500 or more per session. With insurance, you still may have out-of-pocket costs for your dialysis.
You may be able to have at-home dialysis. You may be able to receive hemodialysis or peritoneal dialysis at home, which offers more flexibility than in-center care.
Your diet can affect your kidneys. The renal diet is healthy for your kidneys and, over time, can prevent declining kidney function.
Medicare also will compensate your kidney specialist for supervising the training. After you pay the Part B deductible, Medicare pays 80% of the costs; you pay the remaining amount.
Does Medicare cover home dialysis machines and equipment costs?
Yes, Medicare covers the durable medical equipment (DME) needed for home dialysis, including:
A home hemodialysis machine or a home peritoneal dialysis machine
A water treatment system
Dialysis catheters
A basic recliner
Alcohol
Wipes
Sterile drapes
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If you have original Medicare, you pay 20% of the approved amount for DME. With Medicare Advantage, your home dialysis coverage and out-of-pocket costs may be different.
How much does home dialysis cost without Medicare?
Without Medicare, home dialysis can cost less than treatment in a dialysis center. And home dialysis offers indirect savings because you can avoid lost income and transportation costs.
A home dialysis machine can range from $26,000 to $47,000 or more for a new unit. But most people do not pay the full price for a home dialysis machine if they have insurance or access to state-funded programs that defray the cost. You also have costs for dialysis supplies.
What home dialysis costs are not covered by Medicare?
Medicare covers most of the essential supplies and equipment required for home dialysis. But a few costs are not covered. These include:
Paid dialysis aides to help you with home dialysis treatments
Lost income during home dialysis training
Blood, or packed red blood cells, for home dialysis (unless this is part of a doctor’s service)
Can you appeal a Medicare denial of coverage for home dialysis equipment or services?
Sometimes, Medicare may deny coverage for a service or item for your home dialysis. If you disagree with the decision, you can submit an appeal. For example, you can file an appeal if your Medicare or Medicare Advantage plan denies you coverage for:
A service, supply, item, or prescription medication that you think should be covered
A service, supply, item, or prescription medication you have received
A service, supply, item, or prescription medication you believe you still need
Successful appeals are more likely if a healthcare professional deems the service, supply, item, or prescription medication medically necessary. If your coverage was denied because of a processing error, that is also more likely to be reversed on appeal. Medicare has an official booklet that explains the appeals process in detail.
What if you have commercial insurance and Medicare?
If you have coverage through both a commercial insurance plan and Medicare, you can use both. Your private plan or your Medicare plan can be the primary payer, depending on your individual circumstances.
There is one critical consideration for people 65 and older who are eligible for Medicare but want to keep their commercial insurance coverage. Medicare requires everyone in this age group to have adequate (“creditable”) prescription medication coverage. Your commercial insurance plan may not meet that requirement.
Regardless of your age, you may use commercial insurance as the primary payer if your spouse or dependents rely on that plan for coverage. (If your private plan is not your primary payer, your spouse or other dependents will lose coverage.) Or you may choose Medicare as your primary insurer. You’ll want to consider the deductibles, copayments, and coinsurances of each option.
Medicare and other insurance plans coordinate to avoid duplicate payments. If Medicare is your primary payer, it will pay first. Then your commercial plan will kick in to cover some or all of the remaining costs (and vice versa). Typically, Medicare cannot be changed from a primary payer to a secondary payer.
When should Medicare be the primary or secondary payer?
Whether Medicare is your primary or secondary payer depends on the source of your other health insurance. If you are not sure which plan is your primary payer, check with your insurance plan. Or call Medicare’s Benefits Coordination & Recovery Center at 855-798-2627.
Medicare Advantage and ESRD coverage
Previously, people with ESRD were not allowed to enroll in Medicare Advantage plans. These plans covered only people who developed ESRD after enrollment. But this enrollment restriction was lifted in 2021. People who have ESRD now have the option to choose a Medicare Advantage plan to get Medicare Part A and Part B coverage — and often Part D coverage for prescription medications. (Most Medicare Advantage plans include prescription medication coverage. Some require you to buy a stand-alone Part D plan.)
Who qualifies for original Medicare (Part A and/or Part B)?
People become eligible for Medicare in one of three ways:
When they reach age 65
If they have a disability
If they have permanent kidney failure (another description for ESRD) or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
Do other insurance policies or Medicare supplement (Medigap) plans cover home dialysis?
If you’re enrolled in original Medicare, you may have the option of buying Medicare supplement insurance, called Medigap. These plans require an additional premium, but they cover many out-of-pocket costs, such as deductibles, copays, and coinsurance. You cannot buy a Medigap plan if you are covered by Medicare Advantage.
If you qualify for both Medicare and Medicaid — known as dual eligibility — then Medicare is your primary payer. Medicaid as your secondary payer would cover most of your out-of-pocket costs.
How has the Advancing American Kidney Health plan changed dialysis coverage?
The Advancing American Kidney Health initiative aims to transform the way people with chronic kidney disease and kidney failure are diagnosed and treated, in an effort to improve their quality of life. This effort has three main goals:
Reduce the number of Americans developing ESRD by 25% by 2030. This is done through prevention and by addressing upstream factors, such as diabetes and hypertension (high blood pressure).
Provide more treatment options for people who have kidney failure. The aim by 2025 is for 80% of people with newly diagnosed ESRD to receive home dialysis or a transplant.
Double the number of kidneys available for transplant by 2030.
The bottom line
Home dialysis is increasingly available to people with end-stage renal disease. Home dialysis has many advantages, including a flexible treatment schedule and lower costs. Medicare covers most expenses associated with home dialysis. But it is important to be aware of what is covered and whether a supplemental plan (if you have original Medicare) is right for you.
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References
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