Dialysis Costs After Medicare: What You'll Actually Pay

What you pay in Original Medicare

Original Medicare covers dialysis under Part B (outpatient) — you pay the Part B deductible once a year, then 20% coinsurance on the Medicare-approved amount for each session and its services (labs, drugs given in the unit, supplies). There is no out-of-pocket maximum in Original Medicare, so the 20% adds up for frequent sessions.

Part A covers hospital stays (including dialysis given as an inpatient) with its own deductible and benefit period structure. Drugs you take at home (e.g., phosphate binders, ESAs given at home) fall under Part D.

Medigap and Medicare Advantage

Medigap (Medicare Supplement) policies cover some or all of the Part B coinsurance — a policy that pays the 20% turns dialysis into mostly a premium and deductible story. Since 2021, Medigap can be bought by ESRD patients (previously barred), making this an important option.

Medicare Advantage (Part C) plans have out-of-pocket maximums and may require network dialysis centers — compare the plan's dialysis network and cost-sharing against Original Medicare plus Medigap.

Reducing what you pay

Confirm your dialysis center participates in Medicare (most do), ask about financial assistance programs (including the American Kidney Fund's health-premium program), and review whether a Medigap policy covers the 20% you'd otherwise pay every month.

For medications: compare Part D plans on your specific drug list (binders, ESAs) — formularies differ and the monthly cost varies meaningfully.

Medications & Kidney Dosing

US Kidney Care & Costs