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Insurance and costs for dialysis

dialysis technician
Health insurance pays for some, if not all, of your dialysis treatment. There are different types of health insurance and insurance plans. Each insurance plan may have different costs. 

Medicare, Medicaid and private insurance plans cover most of the health care costs of dialysis. Most people who are starting dialysis can get Medicare insurance, usually after a waiting period of three months. Health insurance helps pay for the costs of dialysis, but you may still need to pay some costs such as premiums, deductibles, co-insurance, and copayments.

What are the main types of health insurance?

The most common types of health insurance for people on dialysis are:

Medicare

More than 90% (9 out of 10) of Americans with kidney failure have Medicare. Medicare beneficiaries older than the age of 65, and younger than 65 in some states, also have access to a Medigap plan.

Private health insurance

Through an employer or the Affordable Care Act (ACA) health insurance marketplace, such as healthcare.gov

Medicaid

Government health insurance for people who have a low income or disabilities

What is Medicare?

Medicare is a government health insurance program for people who are age 65 and older or have:

  • Kidney failure, also called end-stage renal disease (ESRD) and end-stage kidney disease (ESKD) or 
  • Disabilities

To qualify, you must be a U.S. citizen or legal resident and have worked or are the spouse or dependent of someone who has worked 40 quarters (10 years) and paid the required amount in Social Security and Medicare taxes through employment. 

Parts of Medicare

The table below shows the parts of Medicare. Each part helps pay for different health services

 

Traditional Medicare

Traditional Medicare

Part

Part A: Hospital insurance

Part B:Medical insurance

Part D:Prescription drug coverage

What it covers

Helps pays for:

  • Inpatient care in a hospital
  • Care in a nursing home
  • Lab tests
  • Some hospice care
  • Some home health care

Helps pay for most of the other services and supplies that Part A does not cover, such as:

  • Doctors' visits
  • Dialysis in a center or your home
  • Home dialysis training, equipment and supplies
  • Medicines you take during dialysis
  • Outpatient hospital care
 

It covers 80% of the cost of dialysis. 

Helps pay the cost of prescription medicines

Costs you may pay

Premium: There is no monthly bill if you have paid the required amount in taxes through your job.

Deductible: You must pay a certain amount out-of-pocket before Medicare will pay for the costs of health services. 

Co-insurance: You may have to pay a percentage of the costs after you meet your deductible.

Premium: You will pay a monthly bill.

Deductible: You must pay a certain amount before Medicare will pay.

Co-insurance: You have to pay 20% of outpatient services, such as dialysis.

The amount you pay depends on your income. For most plans, you will pay:

  • Monthly premium (bill)
  • Deductible
  • Copay, which is a set amount you pay each time you get a prescription

 

Other Medicare options

  • Supplemental (Medigap) plans: Supplemental plans help cover what Medicare Parts A and B do not cover, such as copays, co-insurance and deductibles. For example, it can help pay for the 20% of outpatient dialysis services that Part B does not cover. 
  • Medicare Advantage plans (previously called Part C): Private insurance companies contract with Medicare to offer these plans. They cover all Part A and Part B benefits, and some also cover Part D.  

Learn more about Medicare and apply through the Social Security Administration.

How much does dialysis cost with insurance? 

If you have questions about the costs of dialysis, you can:

  • Call your insurance company. Find the phone number on the back of your insurance card.
  • Talk with your social worker. They can help you understand your insurance plan and apply or reapply for health insurance.

Can I get help to pay for the costs of dialysis?

There are programs to help people who qualify pay for out-of-pocket costs, such as copays. The American Kidney Fund (AKF) may be able to help through our grant programs. Learn more about financial help AKF offers. You can also talk with your social worker about financial help programs.

AKF's financial assistance program helped Della pay for dialysis