Medicare Coverage for Dialysis and Kidney Failure (ESRD): A Plain-English Guide

Who qualifies for Medicare because of kidney failure at any age, when coverage starts, what you pay for dialysis, and how Medigap, Medicaid, Medicare Advantage and employer plans fit in.

Updated 2026-09-29. Sources: CMS, Medicare and federal regulations, linked inline.

Kidney failure is the one condition that can make you eligible for Medicare at any age. That matters, because dialysis is expensive and ongoing. Here is how coverage works.

Who qualifies

You can get Medicare based on end-stage renal disease (ESRD) at any age if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these is true:

• You have worked long enough under Social Security, the Railroad Retirement Board or as a government employee, or
• You already get (or qualify for) Social Security or Railroad Retirement benefits, or
• You are the spouse or dependent child of someone who meets the work requirement.

You sign up through Social Security, not automatically. Your dialysis center’s social worker can help you file.

When coverage starts

• In-center dialysis: Medicare usually starts on the first day of the fourth month of dialysis. Many people rely on other coverage, Medicaid or the center’s financial counselors for the first three months.
• Home dialysis training: if you start a home dialysis training program before your third month of dialysis, coverage can start from your first month.
• Kidney transplant: coverage can start the month you are admitted for the transplant, or up to two months earlier if you are admitted for transplant preparation.

What Medicare covers

Part B (medical insurance) covers most dialysis costs:

• Outpatient dialysis treatments in a center, and home dialysis training, equipment and supplies
• Most drugs given during dialysis, and lab tests
• Doctor visits, including your nephrologist

Part A covers inpatient hospital stays, including for a transplant. Part D covers most prescription drugs you take at home; some drugs used in dialysis are paid through the center’s bundled payment instead.

What you pay

With Original Medicare, after the yearly Part B deductible you generally pay 20% of the Medicare-approved amount for dialysis and doctor services. Three treatments a week adds up, so most people need secondary coverage:

• Medicaid, if your income and assets qualify, usually covers the 20% and premiums.
• Medigap (Medicare Supplement) covers the 20%. Federal law guarantees Medigap only for people 65 and older, but many states require insurers to sell it to people under 65 with ESRD too. Check your state’s rules.
• Employer or union coverage (see below).
• Charitable premium assistance programs exist for some patients; ask the center’s social worker.

Medicare Advantage

Since 2021, people with ESRD can join a Medicare Advantage plan. That can limit out-of-pocket costs with a yearly maximum, but plans use networks. Before you join, confirm that your dialysis center and nephrologist are in the plan’s network, and that the plan covers home dialysis if you want it.

If you have employer coverage: the 30-month rule

If you have a group health plan through your job or your spouse’s, it stays your primary coverage for the first 30 months after you become eligible for Medicare because of ESRD. Medicare pays second during that time, then becomes primary. You can delay Part B during this period, but talk to a benefits counselor before you do.

When Medicare coverage ends

ESRD-based Medicare ends 12 months after you stop dialysis, or 36 months after a successful kidney transplant. After a transplant, a separate Part B benefit can continue to cover immunosuppressive drugs if you have no other coverage for them.

Getting help

• Your dialysis center’s social worker helps with enrollment and finding secondary coverage.
• Your state’s SHIP (State Health Insurance Assistance Program) offers free one-on-one Medicare counseling.
• Your regional ESRD Network can help with complaints or finding a center.

Sources: Medicare: Coverage for kidney failure, Medicare & Your Kidney Dialysis and Kidney Transplant Services (CMS publication 10128), Social Security: Medicare for people with ESRD.