CMS Pub

A

www.medicare.gov/dialysis

KNOW YOUR RIGHTS

You have the right to be included in decisions about your treatment, the right to a fair process to appeal decisions about payment of services, and the right to privacy and confidentiality. For more 

information, read the free booklet “Your Medicare Rights and Protections,” visit www.medicare.gov, or 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 administrato r 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 fi le a grievance with the ESRD Network in your area, or call your State Survey Agency. (See back cover.) 

WHERE CAN I GET MORE INFORMATION?

You can view or print Medicare publications, fi nd helpful phone numbers and websites, 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, read the free booklet “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.” 

• For free health insurance counseling and personalized 

help, call your State Health Insurance Assistance Program (SHIP).

• To get a report on a particular Dialysis Facility, call your 

State Survey Agency. 

• For more information on dialysis and transplants, or to fi le 

a grievance, call your ESRD Network Organization.

CENTERS FOR MEDICA
w w w . m e d i c 

YO U’ V E B E E N D I AG N O S E D W I T H PERMANENT KIDNEY FAILURE

LET’S GET STARTED.

1 - 8 0 0 - M E D I C A R E

Learning that you have permanent kidney failure isn’t easy, but you can still take control of your life. For detailed information about kidney failure, dialysis treatments, and kidney transplants, talk with your health care team. You should also talk with your doctor about your treatment options to decide what’s best for your situation.Medicare coverage based on End-Stage Renal Disease (ESRD) covers people of all ages including children. If you have ESRD and are new to Medicare, you will most likely get your health care through Original Medicare, Part A and Part B.If you already have Medicare because you are age 65 or you are under age 65 and disabled, Medicare coverage for dialysis begins right away. However, if you are under age 65 and only eligible for Medicare because of ESRD, generally your Medicare coverage can’t start until the fourth month of dialysis. If you are already in a Medicare Advantage Plan (like an HMO or PPO), you can stay in the plan you are in. If you are new to Medicare, you may 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 in limited situations.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.)

W H A T ’ S C O V E R E D

Medicare helps pay for kidney dialysis and kidney transplant services.You need both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) to get the full benefi ts available under Medicare for people with ESRD.Kidney DialysisPart A covers dialysis treatments when you are a hospital inpatient.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• Certain drugs for home dialysis (like Epogen)• Doctors’ services (inpatient or outpatient)• Most 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 TransplantGenerally, Part A covers the foll• Inpatient services in an appr• Kidney Registry Fee• Laboratory and other tests n

condition and the conditions 

• The costs of finding the prope

• The full cost of care for your Part B helps pay for the followin• Inpatient services in an appr• Doctors’ services for kidney • Doctors’ services for your ki

hospital stay

• Immunosuppressive drugs (fo

hospital following a transplan

• The full cost of care for your • Blood