Is Dialysis Covered By Medicare?

The eligibility requirements for Medicare are different if your eligibility is based on ESRD.

If you don’t enroll right away

If you’re eligible for Medicare based on ESRD but miss your initial enrollment period, you may be eligible for retroactive coverage of up to 12 months, once you’ve enrolled.

If you’re on dialysis

If you enroll in Medicare based on ESRD and you’re currently on dialysis, your Medicare coverage usually begins on the 1st day of your dialysis treatment’s 4th month. Coverage can start the 1st month if:

• During the first 3 months of dialysis, you participate in home dialysis training at a Medicare-certified facility.
• Your doctor indicates that you should finish training so you can do your own dialysis treatments.

If you’re getting a kidney transplant

If you’re admitted to a Medicare-certified hospital for a kidney transplant and the transplant takes place that month or in the next 2 months, Medicare can begin that month.

Medicare coverage can begin 2 months before your transplant if the transplant is delayed more than 2 months after being admitted to the hospital.

If you’re only eligible for Medicare due to permanent kidney failure, your coverage will stop:

• 12 months after the month dialysis treatments are stopped
• 36 months following the month you have a kidney transplant

Medicare coverage will resume if:

• within 12 months after the month, you stop getting dialysis, you start dialysis again or have a kidney transplant
• within 36 months after the month you get a kidney transplant you get another kidney transplant or start dialysis