Dialysis is a major treatment option for individuals diagnosed with chronic kidney disease (CKD), kidney failure, or end-stage renal disease (ESRD). Although dialysis is often a necessity for patients with these conditions, it can be an incredibly costly procedure. Depending on your insurance status and the type of dialysis you are receiving, costs can vary anywhere from $10,000 - $90,000 annually.
The Cost of Dialysis With and Without Insurance
The costs of dialysis will vary depending on your insurance status, the type of dialysis you are receiving, and where you are receiving the procedure. In addition, people with CKD who have to do consistent dialysis may have medicare or private insurance programs that can cover parts of the cost.
On the other hand, people who experience sudden kidney failure may have to pay high fees, especially if they do not have insurance. The following costs are what you can roughly expect to pay for dialysis in various situations:
- If Medicare covers you: $100 per session
- If you are paying without insurance: $500+ per session
- If you are experiencing an emergency: $9,000+ per session
Dialysis Costs with Medicare
Since 1972, all individuals diagnosed with ESRD are eligible for Medicare benefits. Medicare will cover inpatient and outpatient dialysis, home dialysis training, dialysis equipment and supplies, and prescriptions related to dialysis. Medicare Part A and Part B cover the majority of dialysis costs. Once enrolled, Medicare will cover 80% of your dialysis costs, leaving you to pay the remaining 20%.
Each part of Medicare has a different monthly premium and deductible you need to meet. Below is a breakdown of how much Medicare Part A and B cost in 2022.
Medicare Part A + B Pricing for 2022
|Part A||Inpatient||No premium for individuals with ESRD||$1,556|
Medicare Coverage of Dialysis
Although Medicare will cover dialysis for all individuals with ESRD, it is essential to understand what parts of your dialysis treatment will be covered and by which sections of Medicare. Below is a breakdown of what Medicare Part A and B cover, respectively.
Dialysis Services Covered by Medicare
|Service||Medicare Part A||Medicare Part B|
|Home Dialysis Training||✓|
|Home Dialysis Equipment||✓|
|Home Dialysis Medications||✓|
Inpatient Dialysis vs. Outpatient Dialysis
Part A of Medicare will cover your dialysis procedure as long as the procedure is performed at a Medicare-approved facility. Find a Medicare-approved dialysis facility near you with this website.
Part B will cover 80% of the costs for outpatient dialysis once you reach your annual deductible. Part B will also cover lab testing, dialysis equipment, and all medications needed to conduct outpatient dialysis. These medications include topical pain relievers, heparin, and agents to treat anemia associated with dialysis.
Hemodialysis vs. Peritoneal Dialysis Costs
Medicare covers both major types of dialysis: hemodialysis and peritoneal dialysis. Medicare will cover 80% of these costs, leaving you to cover 20%. Additionally, for patients opting for home dialysis, Medicare covers training sessions for the patient or the caregiver. The number of covered sessions differs based on the type of dialysis.
Hemodialysis is a type of dialysis that requires the use of an external dialyzer. For hemodialysis, the access point is in the arm, and the external machine filters out waste products from the blood, which is then returned to the body. On the other hand, peritoneal dialysis’ access point is in the peritoneal cavity of your abdomen. The membrane of your peritoneal cavity will act as a filter and remove waste products from your blood which are then returned to your body.
The table below outlines the average cost and number of training sessions required for each type of dialysis.
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Cost of hemodialysis and peritoneal dialysis
|Type of Dialysis||Number of Training Sessions Required||Average Annual Costs without Medicare||Expected Annual Payment with Medicare|
Medicare Enrollment For Dialysis
If you enroll in Medicare while on dialysis, coverage will usually begin on the first day of the 4th month of your dialysis treatment. A secondary private health plan will have to cover the first three months of your treatment. However, coverage can start the first month of your treatment if you meet the following requirements:
- During the first three months of dialysis, you participate in a home dialysis training program.
- Your doctors require that you finish training so you can perform your own self-dialysis.
If you miss the enrollment period for Medicare, you can receive retroactive coverage. Retroactive coverage means that Medicare can pay for your dialysis up to 12 months before the month you apply.
It is important to note that Medicare will not cover surgery needed before dialysis. This includes inserting a catheter or preparing a fistula for blood access. Exceptions to this rule include individuals who need Medicare due to age or disability and kidney failure.
You can also consider enrolling in a Medicare Advantage Plan, which is essentially a combination of Medicare and private insurance coverage. Medicare Advantage Plans for dialysis will combine both Part A and Part B Medicare coverage with additional health benefits. Most Medicare Advantage plans will also cover prescription drugs and can offer additional care, including vision, hearing, and dental. These plans will have higher monthly premiums than Medicare but will, as a result, give you more coverage.
Dialysis Costs without Medicare
Although almost all individuals who require dialysis procedures will be covered under Medicare, if you need emergency dialysis and you are uninsured, dialysis can be costly. Additionally, Medicare coverage is not available if you are not a U.S citizen or permanent resident. Patients with ESRD can only receive dialysis via the emergency department in these situations.
According to DaVita, a company that owns most dialysis centers across the U.S., one dialysis treatment for uninsured patients can cost over $500. Additionally, if receiving dialysis from the emergency department at a hospital, prices can be as high as $10,000 per session.
How to Save Money on Dialysis
Besides Medicare, there are a variety of methods and institutions that can help you save money on your dialysis treatment, including:
- Social Security Administration
- American Kidney Fund
Medicaid is a federal and state health insurance program designed to help low-income individuals and families receive proper health coverage. Medicaid programs differ from state to state; find out your state’s Medicaid program details here. If you find out that you are eligible for Medicaid, you can use your Medicaid coverage and your Medicare coverage to pay for your dialysis treatment.
Social Security Administration
The Social Security Administration is a federal government agency that may be able to provide financial assistance for your dialysis costs. There are two programs that you can apply to for disability benefits.
- Social Security Disability Insurance (SSDI): applying for SSDI can be a rigorous process. However, if you are eligible, you could receive $3,148 per month. It is highly recommended that you get legal representation to successfully receive SSDI.
- Supplemental Security Income (SSI): SSI is a need-based program that is based on your income and your resources. If eligible for this program, you could receive a monthly income payment.
These programs will provide individuals who are unable to work due to disability with financial assistance for dialysis and financial aid in general.
American Kidney Fund
The American Kidney Fund is a national nonprofit organization dedicated to preventing and treating kidney disease. The American Kidney Fund provides need-based financial assistance programs to help patients pay for dialysis-related costs. These costs include prescription medications, housing, transportation, and healthcare premiums. These assistance programs include:
- Health Insurance Premium Program: provides grants for patients with kidney failure that can not afford health insurance premiums.
- Safety Net Grant Program: provides grants for individuals who do not qualify or are not covered by health insurance. This program often covers the costs of transportation, medications, and other doctor-related co-pay fees.
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Dialysis Frequently Asked Questions (FAQs)
The costs associated with dialysis can be difficult to break down. Below are answers to some frequently asked questions to help you better understand dialysis and associated costs.
Does Medicare cover kidney transplants?
Medicare will cover kidney transplant costs as long as the surgery is performed in a Medicare-certified hospital. Similarly to dialysis, Part A and Part B of Medicare will cover different costs associated with the transplant. For instance, Part A will cover laboratory tests, all inpatient services, and the cost of care for your kidney donor. Part B will cover outpatient services such as doctor’s visits and prescription medications related to your surgery.
When do I sign up for Medicare if I already have another insurance plan?
If you are diagnosed with ESRD and already have an insurance plan that is not Medicare, you do not need to enroll in Medicare immediately. Your current health plan, whether it be an employer health plan, a private insurance plan, or retiree coverage, can be your primary health plan for 30 months. This is known as the 30-month coordination period. During these 30 months, you can enroll in Medicare Part A and B at any time, as long as you enroll in both parts at the same time. At the end of the 30-month period, Medicare will become your primary payer.
How do I enroll in Medicare?
Sign up for Medicare by contacting the Social Security Administration (SSA). You can visit your local Social Security Office in person to sign up for medicare. Check to see where your nearest social security office is using this link. You can also contact the SSA via phone by calling 1-800-722-1213.
What are some potential complications of dialysis?
Although dialysis is necessary for almost all individuals with ESRD, there are a number of possible complications to be monitored for:
- Low Blood Pressure is the most common side effect of dialysis, which can manifest as dizziness or nausea
- Infections typically originate at access points such as catheters or fistulas and can manifest as fever and local swelling
- Trouble sleeping
- Electrolyte imbalances
- Fluid Overload
If any of these side effects become serious, it is important to tell your medical team how you are feeling so that the appropriate treatments can be initiated as soon as possible.
What happens if I miss a session of dialysis?
It is very important to stay consistent with your dialysis schedule. Missing dialysis can lead to numerous serious consequences and can also make your following sessions more difficult. If you miss your session you are at much higher risk for electrolyte imbalances which can lead to more serious complications that can affect your heart and your bone health. Additionally, more fluid will have to be removed during your next session, which can lead to more side effects such as dizziness, nausea, and headaches.
Dialysis can be a very costly and overwhelming procedure. In order to ensure that your dialysis treatment goes as smoothly as possible, it is important to understand how to best pay for your treatment and how to get the right help. Enrolling in Medicare is highly recommended if you require dialysis due to ESRD to avoid any extraordinary costs.
There are many ways to prevent chronic diseases such as CKD. If you know that you are at high risk for developing kidney disease, it is fundamental that you go visit your physician regularly. An early diagnosis or getting proper management of risk factors can help reduce the risk of complications related to CKD. For just $45 a month, Mira can help you engage in preventative care by providing affordable doctor visits, laboratory tests, and prescription medications. Learn more about Mira and start saving.