Does Medicare Cover Dialysis? 

You might not think about your kidneys all that often, but these two matching organs provide a number of very important functions. Kidneys serve as a filtering system that removes waste that can build up in your body. You might know your kidneys as the organs that generate urine, but the kidneys are also responsible for clearing out certain acids and minerals from the body while simultaneously helping to maintain a healthy balance of water and salt.

When the kidneys become dysfunctional, waste materials can build up and lead to serious kidney damage. Additionally, the balance of salt and water in your body can get thrown off track, leading to edema and other harmful and uncomfortable physical problems. In severe cases, waste that is not cleared from the body by impaired kidneys can lead to brain damage and coma.

How is kidney dysfunction treated?

Treatment for kidney impairment depends on the cause. In some cases, medications and dietary changes can lead to an improvement in kidney function. If someone has progressed to chronic kidney disease, dialysis may be needed to help the kidneys. Dialysis is a process that uses artificial filtering to remove waste that damaged kidneys cannot remove. In end-stage kidney disease, a transplant may be needed in order to correct the problem.

Does Medicare cover dialysis?

Original Medicare provides many benefits for dialysis, including home care. The program covers dialysis according to the various parts of the program. These are as follows:

Inpatient dialysis

If you receive dialysis while admitted to a Medicare-participating hospital or skilled nursing facility, your dialysis treatments are covered by Medicare benefits under Part A. All of your treatment in a hospital is covered for 60 days per benefit period. If you require inpatient dialysis beyond that time, Medicare offers an additional 30 days of coverage during which you pay a fee per day that is discounted compared to the full cost of care. After 90 days, you can use lifetime reserve days to continue receiving care at a discounted rate.

Outpatient dialysis

Medicare recipients who receive dialysis at outpatient facilities including doctors’ offices and clinics can have their treatments covered by Medicare Part B, the outpatient benefit. In order to receive this coverage, you must opt into Medicare Part B, pay a monthly premium and meet your deductible threshold. Your dialysis center must also be a Medicare-approved facility.

At-home dialysis

Medicare Part B covers home dialysis treatment if your condition qualifies. If you are able to receive dialysis at home, Medicare benefits will cover durable medical equipment (DME), including a dialysis machine, a water treatment machine, a regular recliner and other supplies needed to complete dialysis.

Original Medicare benefits can also be used to pay for in-home dialysis training for you and a helper. If you require at-home visits from a dialysis facility to assist with the procedure, Medicare coverage may supply benefits. Medicare does not, however, cover the cost of transportation to and from dialysis appointments.

Medication support

If you are prescribed medications to assist with dialysis or to treat your kidney disease or impairment, Original Medicare will provide coverage under Medicare Part D. Drugs that qualify under Medicare Part D can be purchased from a retail pharmacy for use at home. Medications administered during outpatient treatment are covered under Medicare Part B, and medications used during inpatient treatment are covered under Medicare Part A.

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