June's Medicare column focuses on help for kidney disease

Medicare covers kidney disease

 

By David Sayen

 

A diagnosis of kidney failure could be a real shock. And it’s becoming more common as the number of Americans with diabetes and high blood pressure grows. But even with this serious diagnosis you can survive and move on. 

 

Medicare can help. The program helps pay for kidney dialysis as well as kidney transplants.

Chronic kidney disease is a serious health problem in the United States. In 2010, more than 20 million Americans aged 20 and older had this disease.

 

And in 2008, nearly 550,000 Americans were getting treated for end-stage renal disease, or ESRD, which is permanent kidney failure.

 

Most people have to be at least 65 years old to get Medicare. But people with ESRD can get Medicare at any age. Even children with ESRD can enroll in Medicare.

 

ESRD is treated by dialysis, a process which cleans your blood when your kidneys don’t work. It gets rid of harmful waste, extra salt, and fluids that build up in your body. It also helps control blood pressure and helps your body keep the right amount of fluids.

 

Dialysis treatments help you feel better and live longer -- but they aren’t a cure for permanent kidney failure.

 

Medicare covers a number of things related to dialysis.

 

If you’re admitted to a hospital for special care, Medicare covers inpatient dialysis treatments under Part A, which is hospital insurance.

 

Medicare Part B covers outpatient dialysis treatments and doctors’ fees for outpatient care.

 

Part B also pays for self-dialysis training, which includes instruction for you and the person helping you with your home dialysis treatments.

 

And Part B covers home dialysis equipment and supplies – like the machine and water treatment system – as well as most drugs for home dialysis.

 

How much would you have to pay for dialysis in a Medicare-certified facility? If you have Original Medicare, you’d pay 20% of the Medicare-approved amount for all covered services.

 

Medicare pays the other 80%.

 

Dialysis and kidney transplants are paid through Original Medicare.

 

In most cases, you can’t join a Medicare Advantage plan if you have end-stage renal disease.

 

Keep in mind that dialysis can be done in your own home or in a Medicare-certified facility.

 

Ask your kidney doctor what facility he or she works with. Or you can look for a facility on Medicare’s “Dialysis Facility Compare” website.

 

It’s located at www.medicare.gov/dialysis.

 

The website has important information such as addresses and phone numbers, how far certain facilities are from you, and what kind of dialysis services the facilities offer.

 

You also can compare facilities by certain quality-of-care information.

 

If you don’t have a computer, you can call us, toll-free, at 1-800-MEDICARE (1-800-633-4227).

 

Medicare Part A also helps pay for hospital inpatient services if you need a kidney transplant.

 

Medicare will help cover the costs of finding the proper kidney for your transplant, and the full cost of care for your kidney donor.

 

For more details on transplants, please consult our pamphlet, “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services” (CMS Product No. 10128).

 

It’s available online or by calling 1-800-MEDICARE.

 

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).