CENTERS FOR MEDICARE & MEDICAID SERVICES CMS Publication No. 11360

Revised December 2010

www.medicare.gov/dialysis

Medicare’s Coverage 

of Dialysis and Kidney 

Transplant Benefits

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

OT H E R WAYS TO PAY H E A LT H C A R E 

COSTS

In addition to Medicare, your state may have programs 

that offer additional help to cover your health care costs. 

Call your State Medical Assistance (Medicaid) office to 

get information about the following programs:

•	 Medicare Savings Programs

•	 Medicaid

•	 Kidney Disease Programs

KNOW YOUR RIGHTS

You have the right to be included in decisions about your 

treatment, the right to appeal decisions about payment 

of services, and the right to privacy and confidentiality. 

Please review your Medicare Summary Notice carefully 

for instructions on how to appeal. For more information, 

visit http://go.usa.gov/low to view the booklet “Your 

Medicare Rights and Protections.” You can also call 

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

call 1-877-486-2048.

H O W TO F I L E A G R I E VA N C E 

(COMPLAINT)

If you have a problem with the dialysis services you get, talk 

with your doctor, nurse, or facility administrator first to see 

if they can help you solve your problem. If necessary, you 

can file a grievance (a written complaint) with your facility. 

If that doesn’t solve your problem, you also have the right to 

file a grievance with the ESRD Network in your area, or call 

your State Survey Agency. 

WHERE CAN I GET MORE INFORMATION?

You can view or print Medicare publications, find helpful phone 

numbers and Web sites, and compare dialysis facilities in your 

area by visiting www.medicare.gov or calling 1-800-MEDICARE 

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

•	 To learn more details about eligibility, coverage, and

cost information, visit http://go.usa.gov/lov to view the 

booklet “Medicare Coverage of Kidney Dialysis and Kidney 

Transplant Services.”

•	 To find

a Medicare-approved dialysis facility in your area, 

visit www.medicare.gov/dialysis. 

•	 For

free health insurancecounselingandpersonalized help, 

call your State Health Insurance Assistance Program (SHIP).*

•	 To get

a report ona particular dialysis facility, call your 

State Survey Agency.* 

•	 For more information on dialysis and transplants, or to file

a

grievance, call your ESRD Network Organization.*

*Visit www.medicare.gov or call 1-800-MEDICARE to get the 

phone numbers for your local SHIP, State Survey Agency, or 

ESRD Network. 

“Medicare’s Coverage of Dialysis and 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 and Kidney Transplant Services” booklet.
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. You should 

also talk with your health care team about your treatment 

options to decide what’s best for your situation. 

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 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 

generally start the fourth month of dialysis. 

If you have ESRD and are new to Medicare, you will 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. 

Call your State Health Insurance Assistance Program (SHIP) to 

learn more about Medicare coverage rules. See “Where can I 

get more information?” on the back cover.

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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 the following 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 United States and use a 

Medicare-approved facility

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

to dialysis facilities.

Kidney Transplant

Generally, Part A covers the following 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 the following 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)

WHAT DO I PAY?

Generally, Part A pays for inpatient hospital services, and you pay 

a deductible. 

For Part B services, Medicare generally pays 80% of the Medicareapproved amount, after you pay the Part B yearly deductible. You 

pay the remaining 20% coinsurance. You also must pay the Part B 

monthly premium. If you have other insurance, your costs may be 

different. 

Note: In Original Medicare, if you get dialysis in a Medicareapproved facility, your Part B covered services will be “bundled” 

together under a new payment system starting January 2011. 

Medicare will pay 80% of the Medicare-approved amount 

for dialysis-related services. You will pay the remaining 20% 

coinsurance that Medicare doesn’t pay. The amount you pay may 

vary based on your individual care needs under the new payment 

system.

WHEN MEDICARE COVERAGE ENDS

If you’re eligible for 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.