Insurance and costs for dialysis
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.
How will I pay for dialysis?
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 Part B pays 80% of the costs of dialysis. You are responsible to either pay for the other 20% of the costs or find a supplemental plan (like a Medigap policy) to cover this amount. If you do not have health insurance, talk with the social worker at your dialysis clinic. They can help you understand your insurance options, understand costs you may have to pay for dialysis without insurance and apply for health insurance
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: | Part B: | Part D: |
What it covers | Helps pays for:
| Helps pay for most of the other services and supplies that Part A does not cover, such as:
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:
|
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
