Home dialysis is less expensive than in-center dialysis, but it’s still not a low-cost option. Peritoneal home dialysis costs less than home-based hemodialysis, but even peritoneal dialysis can cost more than $50,000 a year. Home Dialysis Central, a nonprofit online educational resource of Medical Information Institute, Inc., breaks down the costs and coverage of home dialysis.

Who pays for home dialysis?

Your health insurance or Medicare will pay for dialysis equipment, supplies, and training. You should be able to get Medicare when you begin dialysis or have a kidney transplant, provided that you’ve worked enough and paid Medicare payroll taxes. If you haven’t met this requirement, you still may qualify under your spouse’s work record. 

If you have an employer group health plan (EGHP), that plan will pay first for the first 30 months that you are eligible for Medicare, and Medicare will pay second. After the first 30 months, they’ll change places and Medicare will pay first. 

Medicare Part B is what covers dialysis. You’ll need to have Medicare Part B by the end of those first 30 months. Part B will pay up to 80% of Medicare’s allowed charge for dialysis after you’ve met your yearly Part B deductible. You’ll need a second plan to pay the remaining 20%. 

Depending on your situation, this second plan may be secured through various channels, some of which include:

• an employer,
• TRICARE, 
• private pay, 
• Medigap, and
• Indian Health Service. 

If you have no health insurance, low income, and few assets, you may be eligible for Medicaid.

Medicare coverage and timing

If you choose in-center dialysis, Medicare will not start to pay until the first day of your fourth month of dialysis. For example, if you start January 1, Medicare will kick in on April 1. In this scenario, you would pay out of pocket for any bills not covered by your plan.

If you start your home dialysis training before then, however, Medicare can be backdated to your first dialysis treatment, saving you tens of thousands of dollars for those first three months.

Any hospital stays, access surgeries, or other healthcare events that occur during the month you start dialysis might be covered by Medicare Part A or Part B, as well.

What covered support services will a clinic provide?

Medicare expects your clinic to provide the following support services:

• in-home visits as needed to monitor your adaptation to home dialysis;
• development of a care plan with you and your dialysis team;
• regular clinic visits and telehealth consults as needed;
• ESRD-related lab tests;
• monitoring of your dialysis equipment and supplies;
• water testing as needed for home HD; and
• updating and maintenance of your medical records.

Is there anything that Medicare doesn’t cover?

While Medicare covers the basics, home hemodialysis (HHD) requires a complex setup that can include some big-ticket items that are not covered.

These items are:

• a back-flow preventer for the incoming water line to the hemodialysis machine;
• waste line connection or installation;
• a special dedicated 20-ampere electrical circuit; and
• a home helper to assist with dialysis sessions.

If your home is not already equipped with the necessary electrical circuit, you would need to pay a licensed electrician to have one installed. You can expect your utility, water, and electricity bills to increase, and you may need to invest in additional shelving or storage aids for supplies.

What about peritoneal dialysis?

Peritoneal dialysis (PD) can be done from anywhere, including at home. There are few out-of-pocket payments, and it involves limited setup. 

PD is not an option for all patients, however, and depends on your:

• kidney function,
• overall health,
• home situation,
• lifestyle, and
• personal preferences.

According to the Mayo Clinic, it also may not be a good option for those who have “extensive surgical scars in your abdomen; a large area of weakened abdominal muscle (hernia); limited ability to care for yourself or a lack of caregiving support; [and/or] inflammatory bowel disease or frequent bouts of diverticulitis.”

*Home Dialysis Central. (2020). Paying for Treatment.