Medicare and Dialysis
Dialysis is a medical procedure that is performed to replace some of the essential functions of the kidneys. It is done when kidney functions fall below critical levels and poses life-threatening complications.
These treatments filter the blood to help eliminate waste, excess salt and regulate water. People suffering from kidney failure visit these clinics several times a week to receive treatment.
There are two main types of dialysis. Hemodialysis, also referred to as an artificial kidney is a machine located in specialized clinics or hospitals. The second type is Peritoneal dialysis which uses a fluid that is placed in the lining of your abdomen (peritoneal membrane) to remove waste products or filter blood from the body.
Who is Eligible for Medicare Coverage for Dialysis?
Any person, regardless of age suffering from End-Stage Renal Disease (ESRD), is eligible for Medicare coverage for dialysis treatments. Original Medicare (Part A and Part B) provides coverage for dialysis treatments. It covers hemodialysis and peritoneal dialysis if one of these conditions are met:
- Has met the required amount of time under Social Security, government employee, or Railroad Retirement Board (RRB)
- Currently getting or those entitled to Social Security or RRB benefits
- Dependent child or spouse of a person who is entitled to Medicare benefits
Does Medicare Help Pay for Dialysis?
Medicare covers dialysis treatments (hemodialysis and peritoneal dialysis). These treatments include those performed in special clinics, doctor’s offices, and hospitals.
Medicare Part A generally covers all dialysis treatments in hospitals while Medicare Part B or medical insurance cover treatments at dialysis centers. Medicare Part B pays for dialysis treatments and services such as:
- Home dialysis training (patient and care provider)
- Home dialysis equipment and supplies
- Home services for dialysis patients
- Home dialysis medications
- Outpatient doctor visits
- Ambulance transportation
People suffering from End-Stage Renal Disease (ESRD) who require dialysis are entitled to Original Medicare benefits. The effective date of coverage is based on the type of treatment. ESRD patients who are undergoing home dialysis can immediately qualify for Medicare upon the start of treatment.
Original Medicare pays 80 percent of the Medicare-approved amounts for dialysis services performed in a dialysis facility. The patient then pays the remaining 20 percent or coinsurance.
Patients who undergo dialysis in a non-Medicare approved facility may expect higher out-of-pocket expenses. People enrolled in a Medigap policy that covers all or part of the 20 percent coinsurance can expect different costs.
Dialysis performed for inpatients are covered under Medicare Part A (hospital insurance). Inpatient doctor services are billed separately for Medicare-covered ESRD services.
The amount that Medicare pays for kidney doctor’s services is based on the patient’s hospital stay. For outpatient kidney doctors, payments are based on a monthly amount. Medicare only makes the 80 percent payment of the monthly amount after the patient pays for the yearly deductible.
Medicare also covers outpatient maintenance dialysis treatments, which include self-dialysis training, support services, supplies, and equipment. Medicare Part B pays for 20 percent of the Medicare-approved amount. Payments are directly made to dialysis facilities which provide self-dialysis training.
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