CENTERS FOR MEDICARE & MEDICAID SERVICES CMS Product No. 11360

Revised February 2015

Medicare.gov/dialysis

Medicare’s Coverage of 

Dialysis & Kidney 

Transplant Benefits

G E T T I N G S T A R T E D

Know your rights

If you have Medicare, you have certain guaranteed rights to help protect 

you. One of these is the right to a process for appealing decisions about 

health care payment or services. Whether you have Original Medicare or 

a Medicare Advantage Plan (like an HMO or PPO), you have the right to 

appeal and to file grievances.

End Stage Renal Disease (ESRD) Networks and State Survey 

Agencies work together to help you with complaints (grievances) 

about your dialysis or kidney transplant care.

State Survey Agencies

State Survey Agencies also deal with complaints about dialysis and 

transplant centers (as well as hospitals and other health care settings). 

Your State Survey Agency can help you with complaints, like: 

•	 Claims of abuse

•	 Mistakes in giving out or prescribing drugs

•	 Poor quality of care

•	 Unsafe conditions (like water damage or electrical or fire safety 

concerns)

“Medicare’s Coverage of Dialysis & Kidney Transplant Benefits: Getting 

Started” isn’t a legal document. Official Medicare Program legal guidance 

is contained in the relevant statutes, regulations, and rulings. More 

details are available in the “Medicare Coverage of Kidney Dialysis & 

Kidney Transplant Services” booklet.

Know your rights (continued)

ESRD Networks

ESRD Networks monitor and improve the quality of care given to people with 

End-Stage Renal Disease (ESRD) and can help you with complaints about your 

dialysis facility or transplant center care. Here are some important things to 

know if you have a complaint or grievance about your care: 

•	 You can file any complaint directly with your ESRD Network, instead of 

with your facility.

•	 Your facility or Network must treat every complaint as a grievance – which 

means the Network will investigate the issue, work on your behalf to try to 

solve it, and help you understand your rights.

•	 Your Network can still investigate a complaint and represent you, even if 

you wish to remain anonymous

•	 Your facility can’t take any action against you for filing a grievance with 

your ESRD Network.

Contact your ESRD Network for complaints like:

•	 The facility staff didn’t treat you with respect.

•	 The staff won’t let you eat during dialysis, and you’re always hungry.

•	 The dialysis shifts conflict with your work hours, and the facility won’t let 

you change your shift.

Get more information

You can view or print Medicare publications, find helpful phone numbers 

and websites, and compare dialysis facilities in your area by visiting 

Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227). TTY users 

should call 1-877-486-2048.

There are special organizations that can give you more information about 

kidney dialysis and kidney transplants. Visit Medicare.gov/contacts, or 

call 1-800-MEDICARE to get the phone numbers for your local ESRD 

Network, State Health Insurance Assistance Program (SHIP), or State 

Survey Agency.

End-Stage Renal Disease (ESRD) Networks

You can call your local ESRD Network Organization to get information 

about these:

•	 Dialysis or kidney transplants

•	 How to get help from other kidney-related agencies

•	 Problems at your facility

•	 Location of dialysis facilities and transplant centers

Your ESRD Network makes sure that you’re getting the best possible care 

and keeps your facility aware of important issues about kidney dialysis and 

transplants.

State Health Insurance Assistance Programs (SHIP)

Call your SHIP if you have questions about:

•	 Medigap policies

•	 Medicare health plan choices

•	 Filing an appeal

•	 Other general health insurance questions
L earning that you have permanent kidney failure isn’t easy, but 

you can still take control of your life. Talk with your health care 

team to get detailed information about kidney failure, dialysis 

treatments, and kidney transplants. Your health care team can also 

help you decide which treatment options are best for you. 

Medicare coverage for people with End-Stage Renal Disease 

(ESRD) (permanent kidney failure requiring dialysis or a 

kidney transplant) covers people of all ages, including 

children.

If you already have Medicare because you’re 65 or older, 

or if you’re under 65 and disabled, Medicare coverage for 

dialysis begins right away. However, if you’re under 65 and 

only eligible for Medicare because of ESRD, your Medicare 

coverage will usually start on the first day of the fourth 

month of your dialysis treatments.

If you have ESRD and are new to Medicare, you’ll most likely 

get your health care through Original Medicare. You may also 

have the option of joining a Medicare Special Needs Plan, if 

one is available in your area for people with ESRD, or another 

Medicare Advantage Plan (like an HMO or PPO), if you meet 

certain limited conditions. If you’re already in a Medicare 

Advantage Plan, you can stay in that plan.

If you have questions about Medicare after reading this 

pamphlet, visit Medicare.gov, or call 1-800-MEDICARE 

(1-800-633-4227). TTY users should call 1-877-486-2048.

M e d i c a r e . g o v

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W H A T ’ S C O V E R E D

Medicare helps pay for kidney dialysis and kidney transplant services.

You need Medicare Part A (Hospital Insurance), Medicare Part B 

(Medical Insurance), and possibly Medicare Part D (prescription drug 

coverage) to get the full benefits available under Medicare for people 

with ESRD.

Kidney dialysis 

•	 Part A covers dialysis treatments when you’re in a hospital

•	 Part B helps pay for these dialysis services:

– Outpatient dialysis treatments (in a Medicare-approved 

dialysis facility)

– Self-dialysis training

– Home dialysis equipment and supplies

– Certain home support services

– Most injectable drugs and their oral forms for outpatient 

or home dialysis (like an erythropoiesis stimulating agent 

to treat anemia)

– Doctors’ services (inpatient or outpatient)

– Other services and supplies that are part of dialysis 

(like laboratory tests)

– Dialysis when you travel in the U.S. and use a Medicareapproved facility

Note: In most cases, Medicare doesn’t pay for transportation to 

dialysis facilities.

Kidney transplant

A kidney transplant is a type of surgery that’s done to put a healthy kidney 

from another person into your body. This new kidney does the work that 

your own kidneys can no longer do. 

To be covered by Medicare, your kidney transplant must be done in a 

hospital that’s approved by Medicare to do kidney transplants.

Generally, Part A covers these transplant services: 

•	 Inpatient services in an approved hospital

•	 Kidney registry fee

•	 Laboratory and other tests needed to evaluate your medical condition, 

and the conditions of your potential kidney donors

•	 The costs of finding the proper kidney for your transplant surgery

•	 The full cost of care for your kidney donor 

•	 Blood (if a transfusion is needed)

Part B helps pay for these transplant services:

•	 Doctors’ services for kidney transplant surgery

•	 Doctors’ services for your kidney donor during his or her hospital stay

•	 Immunosuppressive drugs (generally for a limited time after you leave 

the hospital following a transplant)

•	 Blood (if a transfusion is needed) 

When Medicare coverage ends

If you have Medicare only because of permanent kidney failure, Medicare 

coverage will end:

•	 12 months after the month you stop dialysis treatments

•	 36 months after the month of your kidney transplant

Your Medicare coverage may be extended if you meet certain conditions.

What do I pay?

What you pay will vary based on what coverage you have and what 

services you get. Here’s some general information about what you’ll pay: 

•	 If you have Original Medicare, you’ll continue to pay 20% of the 

Medicare-approved amount for all covered dialysis related services. 

Medicare will pay the remaining 80%.

•	 If you need a kidney transplant, Medicare will pay the full cost of care 

for your kidney donor.

•	 You pay nothing for Medicare-approved laboratory tests.

•	 In most cases, the hospital gets blood from a blood bank at no charge, 

and you won’t have to pay for it or replace it.

For more information on specific costs, visit Medicare.gov, or call 

1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-877-486-2048. Note: If you’re in a Medicare Advantage Plan, your 

costs may be different. Read your plan materials, or call your plan to get 

information about your costs.

Other ways to pay health care costs

There are other kinds of health coverage that may help pay for services

and treatment related to permanent kidney failure. They include:

•	 Employee or retiree coverage from an employer or union

•	 Medicare Supplement Insurance (Medigap) policies

•	 Medicaid

•	 Veterans’ Administration benefits

In most states there are agencies and state kidney programs that help 

with some of the health care costs that Medicare doesn’t pay. Call your 

State Health Insurance Assistance Program if you have questions about 

health coverage. Visit Medicare.gov/contacts or call 1-800-MEDICARE 

or to get the phone number.