Medicare includes coverage for dialysis and some treatments that involve end-stage renal disease, also referred to as kidney failure. Dialysis is a medical procedure needed when the kidneys do not function as they should. Dialysis helps the body retain the right amount of fluids and remove harmful wastes, salt, and fluid that build up in the body over time. You can get dialysis treatments under Original Medicare.
Eligibility
You can be enrolled in Medicare even if you are under 65 if you have been diagnosed with end-stage renal disease and need regular dialysis. After you have enrolled in Medicare and you are currently on dialysis, your Medicare coverage will most likely begin on the first day of the fourth month of your dialysis treatment. However, the coverage may start during the first month if you meet the following requirements: you participated in a home dialysis training at a Medicare-certified facility during the first three months of dialysis, or your doctor requests that you finish training so you can get your own dialysis treatments.
If you are admitted to a hospital certified by Medicare for a kidney transplant, Medicare coverage can begin that month if the transplant takes place that month or during the next two months. In some cases, if the transplant is delayed for more than two months after you are admitted, Medicare coverage can start two months before the transplant. Suppose you only qualify for Medicare as a result of kidney failure. In that case, your coverage will end 12 months after you stop receiving dialysis treatments or 36 months after the month during which you receive a kidney transplant.
Services Covered and Costs
Original Medicare covers various services and supplies needed for dialysis, such as inpatient and outpatient dialysis treatments, outpatient doctor’s services, home dialysis training, home dialysis supplies and equipment, laboratory services, drugs needed during in-facility dialysis and at-home dialysis, and some home support services. If your doctor deems it medically necessary, Medicare will cover ambulance services to and from your location to the nearest approved dialysis facility.
Medicare Part D covers both oral and intravenous drugs that are included in the plan’s formulary. Outpatient dialysis treatments and services are covered under Medicare Part B.
Do you have any questions about Medicare and how it will pay for dialysis? Contact us today for more information!
