Kidney care coverage, finally explained.
Understanding your kidney care coverage shouldn't require a medical degree. We translate the complexity so you can focus on your health.
Lead Nephrologist
Dr. Anita Sharma
MD, FASN · 18 yrs experience
90%+
of ESRD patients qualify for Medicare regardless of age
30 mo
your employer plan stays primary before Medicare takes over
$0
out-of-pocket for dialysis with proper supplemental coverage
We accept
Three voices. One clear answer.
Every section of this guide is attributed to the team member who owns that knowledge — because anonymous health information isn't trustworthy health information.
Nephrologist
Dr. Anita Sharma
MD, FASN
“I spend the last five minutes of every appointment on the insurance question — because if patients can't afford their immunosuppressants, everything else I've done doesn't matter.”
Billing Specialist
Marcus Webb
Certified Patient Account Rep
“Prior authorizations for dialysis shouldn't take three weeks. We've built a system that gets approvals in 48 hours — and we'll walk you through every step.”
Patient Navigator
Sofia Reyes
MSW, Patient Advocate
“My job is to make sure you never have to figure out the insurance maze alone. We've helped 400+ CKD patients navigate their first year of coverage.”
What does your plan actually cover?
Every row has a plain-English explanation. Hover the icon for the detail your insurance company won't tell you.
Medicare Traditional (Original)
| Service | Part A (Hospital) | Part B (Outpatient) | Part D (Rx) | Info |
|---|---|---|---|---|
| In-center dialysis (hemodialysis) | Not Covered | Covered | Not Covered | Medicare Part B covers 3 sessions per week at a certified facility. The bundled payment rate is $273.82 per session. You pay 20% after your deductible unless you have Medigap. |
| Home dialysis (peritoneal / home hemo) | Not Covered | Covered | Not Covered | Part B covers home dialysis equipment including your dialysis machine, sterile drapes, gloves, and supplies. Training is covered if done at a Medicare-certified facility. |
| Kidney transplant surgery | Covered | Covered | Not Covered | Part A covers the inpatient hospital stay for your transplant surgery. Part B covers the surgeon's fees and follow-up outpatient visits. |
| Transplant evaluation workup | Not Covered | Covered | Not Covered | Outpatient lab work, imaging, and specialist consultations needed to get listed for a transplant are covered under Part B. Your 20% coinsurance applies. |
| Anti-rejection medications (immunosuppressants) | Not Covered | Covered | Not Covered | Part B covers immunosuppressants after a covered Medicare transplant for as long as you have Part B. This is a critical benefit — losing Part B can mean losing drug coverage. |
| Dialysis-related lab panels (monthly) | Not Covered | Covered | Not Covered | Labs like BUN, creatinine, phosphorus, potassium, and hemoglobin required for dialysis monitoring are bundled into the dialysis payment — no separate bill to you. |
| Telehealth nephrology follow-up | Not Covered | Covered | Not Covered | Medicare covers telehealth visits with your nephrologist. Video visits qualify; audio-only may have restrictions depending on your state. |
| Blood pressure & CKD medications (non-dialysis Rx) | Not Covered | Not Covered | Covered | Part B does NOT cover most oral medications for blood pressure, phosphate binders, or other CKD drugs. You need a Part D plan for these. |
| Dietitian counseling (medical nutrition therapy) | Not Covered | Covered | Not Covered | Part B covers medical nutrition therapy for CKD patients (not on dialysis) and kidney transplant recipients for the first year. Requires a referral from your doctor. |
| Inpatient dialysis during hospital stay | Covered | Not Covered | Not Covered | If you are admitted to a hospital, Part A covers dialysis as part of your inpatient stay. Your Part A deductible ($1,676 in 2025) applies per benefit period. |
Clinical note: After the $257 Part B deductible (2025), Medicare pays 80% of allowed charges. The remaining 20% can be covered by Medigap or Medicaid.
Six terms that change everything.
Insurance companies use jargon to obscure costs. Here's what the six most important terms actually mean for kidney patients.
ESRD
Your kidneys are working at less than 15% of normal function. This diagnosis unlocks Medicare eligibility regardless of your age.
Prior Authorization
Your insurance company's permission slip before they'll pay for a service. Without it, you get the bill. Our team files PAs the same day as your referral.
Coordination Period
If you have employer insurance AND qualify for Medicare due to kidney failure, your employer plan pays first for 30 months. Don't drop your work coverage during this window.
Bundled Payment
Medicare pays dialysis clinics a single flat rate ($273.82) that bundles your dialysis session, related labs, and ESRD drugs together. You get one bill, not six.
Medigap
A private insurance policy that covers the 20% coinsurance Medicare doesn't pay. For dialysis patients, this can save thousands per year. You have 6 months after enrolling in Medicare to sign up.
Formulary
Your plan's approved list of medications. Immunosuppressants not on formulary can cost $300+/month out of pocket. Always verify before your transplant.
Still have questions? Our patient navigator explains these in plain English — for free.
Your printable Coverage Guide.
The last 20% this page doesn't show you — formatted as a PDF you can print and bring to your next appointment. No insurance jargon. No surprises.
- Personalized to your insurance type
- Prior authorization checklist for dialysis & transplant
- Questions to ask your nephrologist on Day 1
- Medication coverage worksheet
- Coordination of benefits timeline
- Emergency contacts: billing navigator & patient advocate
Not ready to download? Talk to our billing navigator first.
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