Financial Help for 

Treatment of Kidney Failure 

Before the development of dialysis and 

transplantation in the 1950s and 60s, 

having permanent kidney failure, 

also called end-stage renal disease (ESRD), 

was a death sentence. While life-saving, 

these treatment methods are expensive, 

and few people can afford them without 

assistance. 

In 1972, Congress passed legislation making people of any age with permanent 

kidney failure eligible for Medicare, a 

program that helps people age 65 or older 

and people with disabilities pay for medical 

care, usually up to 80 percent. The remaining 20 percent can still pose a significant 

financial burden on patients. Fortunately, 

other public and private resources can help. 

Anyone with permanent kidney failure who 

does not have adequate insurance coverage should seek the help of a certified or 

licensed social worker. Every dialysis and 

transplant center has a social worker who 

can help people with kidney failure locate 

and apply for financial assistance. Social 

workers who specialize in helping kidney patients are called nephrology social 

workers. 

Patients can also enlist the assistance of the 

State Health Insurance Assistance Program 

(SHIP). The SHIP is a national program 

that provides free counseling and assistance 

to Medicare beneficiaries on a wide range 

of Medicare and supplemental insurance 

matters. Patients can find a state program 

by visiting www.shipusa.org. 

Medicare 

To qualify for Medicare on the basis of kidney failure, a person must 

n	 require regular dialysis 

or 

n	 have had a Medicare-covered kidney 

transplant 

and must 

n	 have paid into Social Security through 

an employer—or be the child or spouse 

of someone who has 

or 

n	 have worked under the Railroad 

Retirement Board, or as a government 

employee—or be the child or spouse of 

someone who has 

or 

n	 already be receiving Social Security, 

Railroad Retirement, or Office of Personnel Management benefits. 

The Original Medicare Plan has two parts: 

Part A is hospital insurance, and Part B is 

medical insurance. Part B covers most outpatient services, including kidney dialysis, 

doctors’ services, outpatient hospital services, and many other health services and 

supplies. While Part A has no premiums, 

most Part B services require premiums, 

deductibles, and coinsurance. 

U.S. Department of Health
 

and Human Services
 

NATIONAL INSTITUTES OF HEALTH 

National Kidney and Urologic Diseases 

Information Clearinghouse
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Some people who are not eligible for Medicare 

because they have not worked at a job that pays into 

Social Security may still be eligible to buy Medicare 

coverage by paying premiums for Part A. 

Starting in the late 1990s, Medicare gave recipients 

the option to choose a plan managed by a private 

insurance company that functions like a health maintenance organization (HMO) or a preferred provider 

organization (PPO). These plans are called Medicare Advantage, or Part C, plans. In most areas of 

the United States, Medicare recipients with kidney 

failure are not eligible for the Medicare Advantage option, unless they participated in Medicare 

Advantage prior to kidney failure. However, a few 

programs, called Medicare Special Needs plans, 

offer coverage designed specifically for people with 

kidney failure. Patients should contact Medicare 

at 1–800–MEDICARE (1–800–633–4227) to learn 

about possible programs in their area. 

In 2006, Medicare added Part D, prescription drug 

coverage. People with permanent kidney failure are 

eligible but not required to enroll in Part D. When 

enrolling in Part D, a person chooses from a list of 

available plans in that person’s region. People who 

have employer group health plans that include prescription coverage should ask their employer whether 

enrolling in Part D will have any negative impact on 

their medical coverage. Some private plans will drop 

anyone who elects a Part D plan. A patient’s existing prescription coverage with an employer group 

plan may be as good as or better than a Part D plan. 

Employers and unions that provide prescription drug 

coverage must notify Medicare enrollees each year 

about how their current coverage compares to Medicare’s basic prescription drug coverage. This information may come in a letter, in a notice from the 

group plan, or in a benefits handbook. People should 

use this information to help in deciding whether to 

join a Medicare drug plan. Beneficiaries should note 

that a penalty may apply if they don’t join a Part D 

plan when they are first eligible, don’t otherwise have 

prescription drug coverage, and then later decide to 

join a Medicare program. The amount of the penalty 

will depend on how long the beneficiary went without prescription drug coverage before joining a 

Part D plan. 

A person may apply for Medicare when starting 

dialysis treatments. Medicare benefits then begin the 

third month after regular dialysis treatments begin. 

For example, if regular dialysis treatments begin in 

July, Medicare coverage would start on October 1. 

Coverage can begin earlier if a person takes self-care 

dialysis training for home hemodialysis or peritoneal 

dialysis before the third month or has a transplant 

within the first 3 months. 

For a person covered by a group health plan, Medicare is a secondary payer during a 30-month coordination period. The group health plan pays at its 

regular level for this period. Since Medicare is usually not available in the first 3 months, the group 

health plan is the only payer for health services. In 

the fourth month, Medicare begins to cover only that 

portion of health services that is not covered by the 

group health plan. Medicare then becomes the primary payer for health insurance claims at the end of 

the 30-month period. 

A person may wish to wait to enroll in Parts A and B 

until the end of the 30-month coordination period 

if the group health plan will pay for all health care 

expenses. In doing so, the person will avoid paying 

the Part B premium. 

Enrolling in Parts A and B could help pay a yearly 

deductible or coinsurance payment required by some 

group health plans. 

A person can enroll in Medicare at a local Social 

Security office listed in the blue pages in the phone 

directory. The nationwide toll-free number for 

Social Security is 1–800–772–1213, and that number 

can be used to schedule an appointment at a local 

office. More information about local Social Security offices is also available online at www.ssa.gov. 

Often, the social worker at a hospital or dialysis 

center can guide applicants through the enrollment 

process. 

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Private Insurance 

Private insurance frequently pays for the entire cost 

of treatment. Or it may pay for the 20 percent Medicare doesn’t cover. Private insurance may also pay 

for prescription drugs. People with kidney failure 

should read their private health insurance policy carefully to make sure it covers kidney failure treatment. 

They should talk with their insurance agent or company benefits counselor if they have any questions 

about their benefits. People who do not have private 

insurance can work with a social worker, nurse, or 

doctor to locate and apply for other sources of financial aid. SHIPs may also be a good resource. 

State Disability and Employment 

Programs 

Many state social services agencies will help with 

medical expenses. For people with kidney failure 

who want to work, many states have specific vocational rehabilitation programs to help people with 

disabilities train for and find a job. Local or regional 

offices of state government agencies are listed in the 

blue pages of the phone directory. Additionally, 

the New Freedom Initiative’s online resource for 

people with disabilities at www.disabilityinfo.gov has 

a search tool to locate state and local resources. A 

social worker at a hospital or dialysis center can also 

guide patients to community resources for vocational 

rehabilitation. 

Medicaid 

Medicaid is a joint federal and state program that is 

primarily income based. The guidelines for the program vary by state. For people to receive Medicaid 

funds, the value of their assets and annual income 

must be below a certain level. Medicaid may pay for 

dialysis or transplantation if a person is not eligible 

for Medicare. In some states, Medicaid pays the 

20 percent that Medicare doesn’t cover. It may also 

pay for some medicines. Applications for Medicaid 

can be obtained by contacting a local human services 

or social services department. A nephrology social 

worker can provide guidance on how to apply. 

State Children’s Health Insurance 

Program (SCHIP) 

The U.S. Department of Health and Human 

Services has established the SCHIP to help children 

without health insurance. SCHIP provides health 

coverage for children whose families earn too 

much to qualify for Medicaid but too little to 

afford private health insurance. Consumers can 

obtain information about the program by calling 

1–877–KIDS–NOW (1–877–543–7669) or by 

checking www.insurekidsnow.gov. 

U.S. Department of Veterans Affairs 

(VA) Benefits 

The VA can help pay for treatment or provide 

other benefits for veterans. Veterans should contact their local VA office for more information or 

call 1–800–827–1000 to reach the national office. 

The number for health care benefits at the VA is 

1–877–222–8387. People who are retired from the 

military may also call the U.S. Department of Defense 

at 1–800–538–9552. 

Social Security Disability Insurance 

(SSDI) and Supplemental Security 

Income (SSI) 

These benefits from the Social Security Administration (SSA) help with the costs of daily living. To 

receive SSDI, a person must be unable to work and 

have earned the required number of work credits. 

SSI is available to disabled children and adults with 

limited income and resources. People who get SSI 

usually qualify for food stamps and Medicaid, too. 

Eligibility for SSDI and SSI is determined by the SSA 

office. Applications can be completed by contacting 

Social Security at 1–800–772–1213 or by visiting a 

local Social Security office. More information about 

SSDI and SSI is available online at www.ssa.gov. 

People who qualify for SSI may also be eligible for 

the Ticket to Work and Self-Sufficiency program. 

The SSA sponsors this program to help people with 

disabilities, including permanent kidney failure, to 

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train for and find a job they can perform. Participants in the program receive a voucher that can be 

used to receive training or placement services at a 

state or federal employment agency. More information is available at www.yourtickettowork.com. 

Patient Assistance Programs (PAPs) 

from Prescription Drug Companies 

Medicare Part B pays for erythropoietin to treat anemia in kidney failure and for immunosuppressants 

to prevent rejection of a transplanted kidney. But 

Part B only covers 80 percent of immunosuppressant 

medicine costs, which can be $2,000 a month. That 

means that a person who does not have additional 

prescription coverage will still owe $400 a month for 

these medicines. And other self-administered drugs 

may not be covered by Medicare. Also, patients 

should note that Medicare eligibility typically ends 

36 months after a kidney transplant is received unless 

the patient is otherwise eligible for Medicare. 

People who have trouble paying for all the medications their doctor prescribes may qualify for 

assistance from private programs. Most drug manufacturers have PAPs that give discounts to people 

who can show they can’t afford the cost of their prescribed medications. Nephrology social workers are 

well versed in assisting patients with the completion 

of these applications. 

The Partnership for Prescription Assistance provides a website that directs patients, caregivers, 

and doctors to more than 275 public and private PAPs, including more than 150 programs 

offered by pharmaceutical companies. The website features an application wizard that helps 

a person determine which programs might be 

available. The web address is www.pparx.org. 

Medicare has also compiled information to help 

beneficiaries pay pharmaceutical expenses. Visit 

www.medicare.gov/bridging-the-gap.asp for more 

information or read Bridging the Coverage Gap at 

www.medicare.gov/publications. 

NeedyMeds is a 501(c)(3) nonprofit organization 

that helps people find appropriate PAPs. The NeedyMeds website provides a directory of PAPs that can 

be searched by a drug’s brand or generic name or 

by a program or company name. Applications for 

these programs are usually available online. The web 

address is www.NeedyMeds.org. 

Additional PAPs 

The United Network for Organ Sharing (UNOS) 

offers a website called Transplant Living, which 

includes a section about financing a transplant. 

The web address is www.transplantliving.org/ 

beforethetransplant/finance/finance.aspx. For more 

information about UNOS, see the National Institute of Diabetes and Digestive and Kidney Diseases 

(NIDDK) booklet Treatment Methods for Kidney 

Failure: Kidney Transplantation. 

Additional Reading 

The following publication offers more information about financial assistance for kidney failure 

treatments: 

Medicare Coverage of Kidney Dialysis and Kidney 

Transplant Services 

Publication Number CMS–10128 

U.S. Department of Health and Human Services 

Centers for Medicare & Medicaid Services 

7500 Security Boulevard 

Baltimore, MD 21244–1850 

Phone: 1–800–MEDICARE (1–800–633–4227) 

Internet: www.medicare.gov 

Points to Remember 

n	 In 1972, Congress passed legislation making 

people of any age with permanent kidney failure 

eligible for Medicare. 

n	 People with kidney failure should read their private health insurance policy carefully to make 

sure it covers kidney failure treatment. They 

should talk with their insurance agent or company benefits counselor if they have any questions 

about their benefits. 

n	 Anyone with permanent kidney failure who does 

not have adequate insurance coverage should seek 

the help of a certified or licensed social worker 

or a State Health Insurance Assistance Program 

(SHIP). 

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Hope through Research 

The NIDDK’s Division of Kidney, Urologic, and 

Hematologic Diseases supports several programs and 

studies devoted to improving treatment for people 

with progressive kidney disease and permanent kidney failure, including people on hemodialysis. 

n	 The End-Stage Renal Disease Program promotes 

research to reduce medical problems from bone, 

blood, nervous system, metabolic, gastrointestinal, 

cardiovascular, and endocrine abnormalities in 

kidney failure and to improve the effectiveness of 

dialysis and transplantation. The research focuses 

on reusing hemodialysis membranes and using 

alternative dialyzer sterilization methods; devising 

more efficient, biocompatible membranes; refining high-flux hemodialysis; and developing criteria for dialysis adequacy. The program also seeks 

to increase kidney graft and patient survival and 

to maximize quality of life. 

n	 The U.S. Renal Data System (USRDS) collects, 

analyzes, and distributes information about kidney 

failure in the United States. The USRDS is funded 

directly by the NIDDK in conjunction with the 

Centers for Medicare & Medicaid Services. The 

USRDS publishes an Annual Data Report, which 

characterizes the total population of people 

with kidney failure; reports on incidence, prevalence, mortality rates, and trends over time; and 

develops data on the effects of various treatment 

modalities. The report, available at www.usrds.org, 

also helps identify problems and opportunities for 

more focused special research on kidney issues. 

Participants in clinical trials can play a more active 

role in their own health care, gain access to new 

research treatments before they are widely available, and help others by contributing to medical 

research. For information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

Council of Nephrology Social Workers 

of the National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016–5337 

Phone: 1–800–622–9010 x130 

Fax: 212–689–9261 

Email: maritzao@kidney.org 

Internet: www.kidney.org/professionals/CNSW 

American Association of Kidney Patients 

3505 East Frontage Road, Suite 315 

Tampa, FL 33607 

Phone: 1–800–749–2257 

Fax: 813–636–8122 

Email: info@aakp.org 

Internet: www.aakp.org 

American Kidney Fund 

6110 Executive Boulevard, Suite 1010 

Rockville, MD 20852 

Phone: 1–800–638–8299 or 301–881–3052 

Fax: 301–881–0898 

Email: helpline@akfinc.org 

Internet: www.kidneyfund.org 

Life Options Rehabilitation Program 

c/o Medical Education Institute, Inc. 

414 D’Onofrio Drive, Suite 200 

Madison, WI 53719 

Phone: 1–800–468–7777 or 608–232–2333 

Email: lifeoptions@MEIresearch.org 

Internet: www.lifeoptions.org 

www.kidneyschool.org 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 212–889–2210 

Fax: 212–689–9261 

Internet: www.kidney.org 

5 
Acknowledgments

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK 

scientists and outside experts.  This publication was reviewed by Thomas Dudley, 

Maria Ciccanti, Eva Fung, Emerson 

Carvalho, and Kelly Anderson, Centers 

for Medicare & Medicaid Services; Leslie 

Pionke, M.S.W., Inova Transplant Center, 

Fairfax, VA; and Cindy Cornejo, M.S.W., 

DaVita Dialysis Clinic, Fairfax, VA.

About the Kidney Failure Series

The NIDDK Kidney Failure Series includes 

booklets and fact sheets that can help the 

reader learn more about treatment methods 

for kidney failure, complications of dialysis, 

financial help for the treatment of kidney 

failure, and eating right on hemodialysis.  

Free single printed copies of this series can 

be obtained by contacting the National 

Kidney and Urologic Diseases Information 

Clearinghouse.

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) or 

visit www.fda.gov. Consult your health care provider 

for more information.

National Kidney and Urologic 

Diseases Information Clearinghouse

3 Information Way 

Bethesda, MD  20892–3580 

Phone:  1–800–891–5390 

TTY:  1–866–569–1162 

Fax:  703–738–4929 

Email:  nkudic@info.niddk.nih.gov 

Internet:  www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is a 

service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK).  

The NIDDK is part of the National Institutes 

of Health of the U.S. Department of Health 

and Human Services.  Established in 1987, 

the Clearinghouse provides information 

about diseases of the kidneys and urologic 

system to people with kidney and urologic 

disorders and to their families, health care 

professionals, and the public.  The NKUDIC 

answers inquiries, develops and distributes 

publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about 

kidney and urologic diseases.

This publication is not copyrighted.  The Clearinghouse encourages users of this publication to duplicate 

and distribute as many copies as desired.

This publication is available at  

www.kidney.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health

NIH Publication No. 09–4765

April 2009