Medicare Coverage for End Stage Renal Disease (ESRD)

Medicare covers people of all ages who have ESRD. Many treatments and medications you need to manage ESRD will be covered, in part, by Original Medicare (Parts A and B).

Your eligibility for Medicare will begin 3 months after the date you start regular dialysis or the same month that you receive a kidney transplant.

Your doctor must fill out an End Stage Renal Disease Medical Evidence Report, which you will also need to sign.

If you only have Medicare because you have ESRD, your coverage will end 12 months after you stop dialysis treatment or 36 months after you have a kidney transplant.

Part A coverage and costs

Part A is hospital insurance. It covers any tests or services you need during an inpatient stay, including:

• diagnostic tests

• surgical procedures, such as arteriovenous fistula creation

• dialysis treatments

• blood transfusions

Part A also covers transplant services, including:

• kidney registry fee

• finding the proper kidney for your transplant surgery

• care before surgery, the actual surgery, and care after surgery for your kidney donor

It also covers:

• limited skilled nursing facility care

• certain home healthcare services

• hospice

Here are the basic costs for Part A in 2024:

• $278 to $505 monthly premium, if you have one

• $1,632 deductible for each benefit period

• 20% of all Medicare-approved costs during your stay

• $0 coinsurance for days 1 to 60 of treatment after you pay your deductible

• $408 coinsurance per day for days 61 to 90 of treatment

• $816 coinsurance per day for days 91 to 150 of treatment while using your 60 lifetime reserve days

• 100% of the treatment costs for days 151+

Part A covers the full cost of care for your kidney donor. You won’t have to pay a deductible, coinsurance, or any other costs for the donor’s hospital stay.

Part B coverage and costs

Part B is medical insurance. It covers outpatient prevention, diagnosis, and treatment of ESRD and other medical conditions. This includes:

• most screenings and diagnostic tests, including kidney function tests

• injectable or oral drugs required for outpatient or at-home dialysis

• home dialysis training, equipment, and supplies

• home support visits by medical professionals and dialysis facility personnel

• doctor’s fees for kidney transplant surgery

• doctor’s fees for your kidney donor while they’re in the hospital

• transplant drug therapy

It also covers:

• most vaccinations, including flu shots

• durable medical equipment

• emergency room visits

• emergency ambulance services

In 2024, most people will pay a monthly premium of $174.70. Your premium may be higher depending on your income.

After you pay a $240 deductible, you’ll generally pay 20% of all Medicare-approved costs for covered services.

Part C coverage and costs

If you have Medicare Advantage (Part C), your plan will cover the same basic services as Original Medicare. This includes:

• inpatient hospital care

• limited stays at a skilled nursing facility

• limited stays at an inpatient rehabilitation facility

• outpatient care at a doctor’s office, urgent care center, health center, or clinic

• inpatient and outpatient mental health services

• preventive care, including routine exams, shots, lab tests, and screenings

• limited outpatient prescription drugs

• durable medical equipment

• ambulance transport

However, unlike Original Medicare, Part C plans do not cover:

• clinical trials

• hospice care

• the cost of getting a kidney for an organ transplant

Each Part C plan sets its own cost and coverage amounts. The premiums, deductibles, copayments, and coinsurance amounts you’ll pay depend on your chosen plan.

Staying in network — which means getting care from a list of approved healthcare professionals and facilities — usually costs less than going out of network.

Part D coverage and costs

Some medications not covered under Original Medicare are covered by Part D. Part D is an optional prescription drug plan you can purchase from an insurance company.

Not all Part D plans cover the same medications, although every plan is required to provide a standard level of coverage established by Medicare.

The bottom line

Different parts of Medicare cover different treatments. For example, in-patient dialysis is covered by Part A, whereas outpatient or at-home dialysis is covered by Part B.

People with ESRD may enroll in Medicare at any age. To be eligible for Medicare, you will need to be on regular dialysis or have had a kidney transplant.

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