Does Medicaid Cover Dialysis?
- Does Medicaid cover dialysis? Find out how Medicaid and Medicare coverage for dialysis works, who's eligible for funded treatment and how much you'll pay.
Dialysis is a treatment that takes over some of the vital roles performed by healthy kidneys, and it's usually required for people with end-stage renal disease. Dialysis cleans your blood either inside or outside your body to remove waste products, maintain healthy blood pressure and ensure the correct levels of various chemicals.
If your doctor says you need dialysis, you'll usually require treatment for the rest of your life. Therefore, it's essential to plan for the costs of dialysis treatment. So, does Medicaid cover dialysis? Below, you can find out about Medicaid and Medicare dialysis coverage and who's eligible.
Does Medicaid Cover Dialysis?
Medicaid covers dialysis for enrollees with end-stage renal disease (ESRD), and the coverage should meet most of your dialysis costs. Just under half of all Americans receiving dialysis to treat ESRD use Medicaid coverage to fund part or all of their treatment.
Many Medicaid enrollees also have Medicare coverage. Medicaid is often used to fund treatment for the first 90 days before Medicare begins covering dialysis.
Does Medicare Cover Dialysis?
Medicare generally covers medically necessary dialysis for its enrollees. Unlike most other forms of Medicare eligibility, you can apply for retroactive coverage if you need dialysis for ESRD, and you'll likely qualify for coverage even if you're younger than 65. Your coverage could be backdated up to 12 months if you don't apply for Medicare immediately following your diagnosis.
Medicare coverage for dialysis usually begins at the start of the fourth month following your first treatment session. This means that you won't generally receive funding for your first three months of treatment. If you have dual eligibility for Medicare and Medicaid, you can often use your Medicaid coverage for the qualifying period until Medicare kicks in.
However, Medicare may agree to begin your coverage sooner if you complete a Medicare-approved dialysis training course so that you can perform your own dialysis treatment at home. You'll also need to maintain a regular dialysis schedule at home to keep your eligibility for immediate funding.
Medicare doesn't usually cover the costs of surgery or other procedures required before you start dialysis, such as fitting a blood access port. However, it may pay if you complete a home dialysis training program.
Is Dialysis Covered Under Medicare Part A or B?
Medicare Part A covers the costs of dialysis if you have the treatment at an inpatient facility. You are responsible for paying the Part A deductible, which is $1,484 as of 2021.
If you receive dialysis treatment in an outpatient clinic or perform your own treatment at home following a dialysis training program, Medicare will pay 80% of the approved amount. You are responsible for paying the 20% coinsurance costs. Medicare also covers the costs of completing an approved training course.
Who Is Eligible for Dialysis?
Generally, people with ESRD who have lost between 85% and 90% of their normal kidney function are eligible for dialysis treatment. Doctors also use your glomerular filtration rate (GFR) to decide whether you need dialysis, which measures how efficiently your kidneys can filter blood. They may recommend dialysis if your GFR drops to 15 or less.