Does Medicare Cover Dialysis? ESRD Coverage, Costs & Eligibility

Who qualifies for Medicare because of kidney failure (ESRD)?

ESRD is one of only three ways a person can qualify for Medicare. The other two are turning 65 and receiving disability benefits for 24 months. ESRD is special because it lets people of ANY age get Medicare—including children and working-age adults—as long as they have permanent kidney failure that requires regular dialysis or a kidney transplant.

Qualifying isn't automatic based on the diagnosis alone. You must also have a work history that connects you to Medicare. You generally need to have worked long enough to be eligible for Social Security or Railroad Retirement benefits, or to have earned enough as a government employee—OR you can qualify as the spouse or dependent child of someone who has. People who already receive Social Security or Railroad Retirement benefits meet this test too.

Because age is not a barrier, Medicare does cover dialysis for children with ESRD when the work-record requirement is met through a parent.

• You (or your spouse, or a parent if you're a dependent child) earned enough work credits under Social Security, the Railroad Retirement Board, or as a government employee.
• A doctor has confirmed permanent kidney failure requiring regular dialysis or a transplant.
• There is no minimum age—people under 65, and children, can qualify.

When does Medicare coverage start after you begin dialysis?

For most people, ESRD Medicare coverage begins on the first day of the fourth month of regular dialysis treatments. This is often called the three-month waiting period. For example, if you start dialysis on July 1, your Medicare coverage would typically begin October 1. Coverage starts this way no matter where you get dialysis—at a facility or at home.

There is an important exception that can move coverage up to the very first month. If you take part in a home-dialysis training program at a Medicare-certified facility during your first three months of dialysis, and you expect to do dialysis yourself at home, Medicare coverage can start as early as the first month you began treatment. If home dialysis is even a possibility for you, ask your care team about training right away—it can save you months of out-of-pocket costs.

To sign up for Medicare because of kidney failure, contact the Social Security Administration (or the Railroad Retirement Board if that applies to you). Your dialysis facility's social worker can also help you start the application.

What dialysis services does Medicare cover?

Medicare covers a full range of dialysis care, mostly under Part B. It generally pays for 3 hemodialysis treatments per week (or the equivalent amount of peritoneal or home dialysis). Both Part A and Part B play a role: Part B covers the ongoing dialysis itself, while Part A covers any inpatient hospital stays related to your kidney care. Most people need both parts to be fully protected.

• In-center (outpatient facility) hemodialysis, covered under Part B.
• Home dialysis—peritoneal dialysis and home hemodialysis—including the equipment, supplies, and certain home support services, under Part B.
• Home-dialysis training for both you and the family member or caregiver who helps with your treatments, under Part B.
• Most injectable drugs given during dialysis, such as anemia (ESA) medications, as part of the Part B dialysis benefit. Some oral-only ESRD drugs may instead be covered under Part D drug plans.
• Kidney disease education—up to 6 sessions—for people with Stage 4 chronic kidney disease, to help you understand your condition and your dialysis and transplant options before you need them.
• Kidney transplants and the related surgery (covered separately under the transplant benefit—see related guides).

How much does dialysis cost with Medicare in 2026?

Medicare does not pay 100%—you share the cost. For dialysis services under Part B, you first meet the annual Part B deductible, which is $283 in 2026. After that, you generally pay 20% coinsurance of the Medicare-approved amount, and Medicare pays the other 80%. This 20% applies to in-center treatments, home dialysis equipment and supplies, training, and dialysis drugs. Because dialysis is ongoing and expensive, that 20% can add up quickly, with no built-in cap under Original Medicare.

To keep the Part B benefit that covers most of your dialysis, you pay the Part B monthly premium, which is $202.90 in 2026 for most people. Part A is premium-free if you or your spouse have at least 40 Social Security work quarters; otherwise it costs $311 per month (30–39 quarters) or $565 per month (under 30 quarters). If you're admitted to the hospital for kidney-related care, the 2026 Part A deductible is $1,736 per benefit period.

Oral kidney or ESRD-related drugs covered under a Part D plan are subject to that plan's costs, but in 2026 Part D includes a $2,100 annual out-of-pocket cap on covered drugs.

• Part B deductible (2026): $283 per year.
• Part B coinsurance: 20% of the Medicare-approved amount for dialysis services.
• Part B premium (2026): $202.90 per month for most people.
• Part A premium: free at 40+ quarters; otherwise $311 or $565 per month.
• Part A deductible (2026): $1,736 per benefit period for inpatient stays.
• Part D out-of-pocket cap (2026): $2,100 per year on covered drugs.

Filling the gap: Medigap, Medicare Advantage, and employer coverage

Because there is no out-of-pocket limit on the 20% coinsurance under Original Medicare, many people with ESRD look for ways to cover that share. A Medigap (Medicare Supplement) policy can help pay the 20% dialysis coinsurance and other Original Medicare gaps. Be aware that Medigap availability and pricing for people under 65 vary by state, so check the rules where you live.

Since 2021, people with ESRD can also enroll in a Medicare Advantage (Part C) plan; before that, most were limited to Original Medicare. Medicare Advantage plans bundle coverage and have their own networks, copays, and an annual out-of-pocket maximum—but benefits and dialysis-network access vary by plan, so compare carefully and confirm your dialysis facility is covered before enrolling.

If you have group health coverage through an employer or union, there is a 30-month coordination period. During the first 30 months of your ESRD Medicare eligibility, your employer or union plan pays first and Medicare pays second—regardless of how large the employer is. After 30 months, Medicare becomes the primary payer. Understanding which plan pays first helps you avoid surprise bills.

After a transplant: when ESRD Medicare ends and how anti-rejection drugs stay covered

If you have Medicare ONLY because of ESRD, the coverage doesn't last forever. It ends 12 months after the month your dialysis treatments stop, or 36 months after the month of a successful kidney transplant. (If you also qualify for Medicare another way—such as turning 65 or by disability—your coverage continues.)

Losing coverage 36 months after a transplant once left some people unable to afford the anti-rejection drugs that keep their new kidney working. To address this, the Part B Immunosuppressive Drug benefit (Part B-ID) lets you keep Part B coverage for immunosuppressive (anti-rejection) drugs ONLY, with no time limit, once your ESRD Medicare would otherwise end. It does not cover any other services—just those drugs.

In 2026, the Part B-ID benefit has a monthly premium of $121.60. The standard $283 Part B deductible applies, and then you pay 20% coinsurance on the covered drugs. If you don't have other drug coverage after a transplant, Part B-ID can be an important safety net.